Good Evidence: The limits of evidence-based medicine and the sociology of medicine

• Author / Creator

  Hanemaayer, Ariane

• Evidence-based medicine (EBM) is, simply, the conscientious and judicious use of medical research (“evidence”) in clinical practice (Sackett et al. 2000:1). EBM emerged as a solution to various identified uncertainties in clinical practice as a programme for intervention at the level of individual medical judgments. Drawing on textual methods of analysis, my dissertation investigates how uncertainty is dealt with in two specific cases: multiple sclerosis and breast cancer. First, I ask if the principles of evidence-based medicine have the potential to reduce uncertainty by producing practice guidelines for rule-guided, procedural medical judgments. Then, I ask if there are other social relations that influence the production or translation of research and medical knowledge into concrete practices. I argue that the effects produced by the strategies of EBM have the potential to be deresponsibilizing, and that evidence is created within a political economy. I conclude by considering the Grey Zone of clinical practice and the ethic of responsibility, and then highlight the political implications for evidence-based policymaking and the sociology of medicine.

• Subjects / Keywords

  • Medical decision making
  • Social theory
  • Sociology of health
  • Multiple sclerosis
  • Max Weber
  • Sociology of medicine
  • Breast cancer
  • Evidence-based medicine
  • Governmentality
  • Clinical practice
  • Nikolas Rose
  • Bioethics
  • Michel Foucault
  • Sociology
  • Grey zone
  • Medical judgments
  • Evidence-based policy
  • Clinical practice guidelines

• Graduation date

  Fall 2014

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/R3ZH47

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.