Power and Knowledge in Psychiatry and the Troubling Case of Dr Osheroff

2005 ◽  
Vol 13 (4) ◽  
pp. 343-350 ◽  
Author(s):  
Michael Robertson
Keyword(s):  
Scientific Knowledge ◽  
Scientific Method ◽  
Best Practice ◽  
Narrative Form ◽  
Current Debate ◽  
Evidence Based ◽  
Scientific Enterprise ◽  
Treatment Of Depression ◽  
Based Medicine ◽  
Forms Of Knowledge

Objective: To consider the state of knowledge in psychiatry with reference to the ‘Osheroff debate’ about the treatment of depression. Method: A review of the key philosophical issues regarding the nature of knowledge applied to the Osheroff case. Results: There is an apparent dichotomy between knowledge derived from a reductionist scientific method, as manifest in evidence-based medicine, and that of a narrative form of knowledge derived from clinical experience. The Focauldian notion of knowledge/power and knowledge as discourse suggests that scientific knowledge dominates over narrative knowledge in psychiatry. The implication of this applied to the Osheroff case is the potential annihilation of all forms of knowledge other than science. Conclusions: Knowledge in psychiatry is a pluralist, rather than singularly scientific enterprise. In the Osheroff case, the potential for scientific knowledge to abolish other forms of knowledge posed a serious threat of weakening the profession. In the light of the current debate about best practice, there is a need for reconsideration of the implications of Osheroff.

Best practice in primary care pathology: review 11

2007 ◽  
Vol 61 (4) ◽  
pp. 410-418 ◽  
Author(s):  
W S A Smellie ◽  
M P J Vanderpump ◽  
W D Fraser ◽  
R Bowley ◽  
N Shaw
Keyword(s):  
Primary Care ◽  
Best Practice ◽  
Evidence Based ◽  
New Information ◽  
Consensus Statements ◽  
Questions And Answers ◽  
Practice Review ◽  
Based Medicine ◽  
Answer Format ◽  
Pathology Review

This eleventh best practice review examines two series of common primary care questions in laboratory medicine: (i) thyroid testing, and (ii) hypercalcaemia and hypocalcaemia. The review is presented in the same question–answer format as in the previous reviews. These questions and answers deal with common situations in men and non-pregnant women. The recommendations represent a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. In the case of the thyroid series, the recommendations are drawn from the 2006 guidelines published by the Association for Clinical Biochemistry, the British Thyroid Association and the British Thyroid Foundation. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence based. They will be updated periodically to take account of new information.

Best practice in primary care pathology: review 12

2010 ◽  
Vol 63 (4) ◽  
pp. 330-336 ◽  
Author(s):  
W S A Smellie ◽  
C A M McNulty ◽  
P O Collinson ◽  
N Shaw ◽  
R Bowley
Keyword(s):  
Primary Care ◽  
Best Practice ◽  
Evidence Based ◽  
Primary Research ◽  
New Information ◽  
Consensus Statements ◽  
Practice Review ◽  
Based Medicine ◽  
Answer Format ◽  
Pathology Review

This twelfth best practice review examines four series of common primary care questions in laboratory medicine: (i) antiepileptic drug monitoring; (ii) infectious diarrhoea; (iii) methicillin resistant Staphylococcus aureus; and (iv) brain natriuretic peptide. The review is presented in question–answer format, referenced for each question series. The recommendations represent a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by MEDLINE EMBASE searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence-based. They will be updated periodically to take account of new information.

Methodological, Theoretical, Infrastructural, and Design Issues in Conducting Good Outcome Studies

2011 ◽  
Vol 21 (6) ◽  
pp. 644-653 ◽  
Author(s):  
Michael P. Kelly ◽  
Tessa A. Moore
Keyword(s):  
Best Practice ◽  
Outcome Studies ◽  
Controlled Trials ◽  
Evidence Based ◽  
Good Outcome ◽  
Randomized Controlled ◽  
Causal Pathways ◽  
Causal Pathway ◽  
Based Medicine

This article outlines a set of methodological, theoretical, and other issues relating to the conduct of good outcome studies. The article begins by considering the contribution of evidence-based medicine to the methodology of outcome research. The lessons which can be applied in outcome studies in nonmedical settings are described. The article then examines the role of causal pathways between interventions and outcomes and especially the importance of delineating them in advance of undertaking investigations. The development of designs based on randomized controlled trials (RCTs) with fully articulated causal pathways is described. Ways of supplementing RCTs with methods to highlight elements in the causal pathway in outcome studies are indicated. The importance of adhering to best practice in reporting and analysis is also noted.

scholarly journals Awareness and the use of evidence-based medicine resources among physicians

2019 ◽  
Vol 6 (10) ◽  
pp. 4612-4614
Author(s):  
Amjad Alhelo ◽  
Bashar Samara
Keyword(s):  
Evidence Based Medicine ◽  
Best Practice ◽  
Response Rate ◽  
Cross Sectional Study ◽  
Cochrane Library ◽  
Evidence Based ◽  
Cross Sectional ◽  
Evidenced Based ◽  
The Cochrane Library ◽  
Based Medicine

Aim: to evaluate awareness and the use of evidence-based medicine resources among physicians in Jordan.  Method: A cross-sectional study by internet was performed among 517 doctors who were responsive from a total of 717 doctors, a total of 72.1% response rate. Doctors from all specialties were contacted from a Facebook group called doctors café in Jordan. A questionnaire was given to each one of them to measure their awareness and use of Evidence based database.   Result: From 517 physicians 377 they are using evidenced based resources frequently, and 91 using resources but not frequently and 49 not using evidence-based resources. The resource that was mostly used by the doctors was PubMed, followed by other resources such as Up to date, National Guideline Clearinghouse, Medscape, BMJ best practice, e-books and other online journals for published papers. The Cochrane Library was surprisingly not so familiar amongst physicians. Conclusion: There is good awareness about EBM among physicians in Jordan, and that benefits health care in Jordan.

Best practice pharmacologic treatment of schizophrenia: Applying principles of evidence-based medicine

2005 ◽  
Vol 3 (2) ◽  
pp. 53-60 ◽  
Author(s):  
Rajiv Tandon ◽  
Naakesh A. Dewan ◽  
Robert J. Constantine ◽  
Jerry Wells
Keyword(s):  
Evidence Based Medicine ◽  
Best Practice ◽  
Evidence Based ◽  
Pharmacologic Treatment ◽  
Based Medicine

The Limits of Evidence-Based Medicine and Its Application to Mental Health Evidence-Based Practice: Part One

2013 ◽  
Vol 15 (1) ◽  
pp. 18-34 ◽  
Author(s):  
Tomi Gomory
Keyword(s):  
Mental Health ◽  
Clinical Judgment ◽  
Evidence Based Medicine ◽  
Process Model ◽  
Best Practice ◽  
Political Process ◽  
Community Treatment ◽  
Evidence Based ◽  
Systematic Analysis ◽  
Based Medicine

The present article outlines the major limitations of evidence-based medicine (EBM) and through a close review demonstrates that the three component EBM process model is a pseudoscientific tool. Its “objective” component is the collection, systematic analysis, and listing of “effective” treatments applying a research hierarchy from most rigorous (systematic reviews of randomized controlled trials [RCTs]) to least rigorous (expert opinion). Its two subjective components are the clinical judgment of helping professionals about which “evidence-based” treatment to select and the specific and unique relevant personal preferences of the potential recipients regarding treatment. This procedural mishmash provides no more rigor in choosing “best practice” than has been provided by good clinical practitioners in the past because both turn out to be subjective and authority based. The article also discusses EBM’s further methodological dilution in the National Institute of Mental Health (NIMH) endorsed Evidence-Based Mental Health Practice (EBP) movement. In EBP, the allegedly rigorous EBM protocol is altered. Instead of systematic expert protocol-driven EBM reviews of RCTs, NIMH sanctioned expert consensus panels decide “evidence-based practices.” This further problematizes the development of best practices in mental health by converting it to a political process. The article concludes with some observations on these issues. In a second article (part two) forthcoming, assertive community treatment (ACT) is examined as an example of an EBP that fails as a scientifically effective treatment despite its EBP certification and general popularity among practitioners.

scholarly journals How Scientism Infiltrated Medicine and Distorted Clinical Practice: Scientism May Be Hazardous to Your Health

2020 ◽  
Vol 3 (2) ◽  
pp. p117
Author(s):  
Charles J Kowalski ◽  
David Fessell ◽  
Adam J Mrdjenovich ◽  
Richard W Redman
Keyword(s):  
Clinical Practice ◽  
Evidence Based Medicine ◽  
Scientific Method ◽  
Human Learning ◽  
Empirical Science ◽  
Evidence Based ◽  
Universal Applicability ◽  
Based Medicine

Scientism can be defined as a passionate belief in the universal applicability of the scientific method and approach, and the view that empirical science constitutes the most authoritative worldview or most valuable part of human learning, to the exclusion of other viewpoints. At this level of generality, it is not difficult to show that scientism poses some distinct dangers, putting a damper as it does on the validity and usefulness of other kinds of knowledge and/or ways of learning. But this has not dissuaded some from thinking that scientism might still be of value in medicine. The popularity of evidence based medicine (EMB) attests to the fact that many so believe. We argue, to the contrary, that clinical practice relies on other kinds of knowledge, and that this is attainable only if we admit consideration of other kinds of learning. We conclude that scientism may be dangerous to your health.

Disease specificity and evidence-based medicine: a historical perspective

2020 ◽  
Vol 8 (3) ◽  
pp. 308
Author(s):  
Timo Bolt ◽  
F G Huisman
Keyword(s):  
Evidence Based Medicine ◽  
Historical Perspective ◽  
Clinical Epidemiology ◽  
Unintended Consequences ◽  
Current Debate ◽  
Evidence Based ◽  
Negative Consequences ◽  
Based Medicine ◽  
Ontological Concept

This paper seeks to inform the current debate on an alleged ‘crisis’ and the ‘unintended negative consequences’ of evidence-based medicine (EBM) from a historical perspective. EBM can be placed against the background of a long term process of medical quantification and objectification. This long term process was accompanied by a ‘specificity revolution’, which made the ontological concept of diseases as specific entities the central ordering and regulatory principle in healthcare (as well as in clinical epidemiology and EBM). To a certain extent, the debate about EBM’s alleged crisis can be understood as resulting from this specificity revolution. When the ontological concept of disease is applied too rigidly, this will contribute to ‘negative unintended consequences’ of EBM such as ‘poor mapping of multimorbidity’ and medical practice ‘that is management-driven rather than patient-centered’.

scholarly journals Demystifying the Medical Literature

2016 ◽  
Vol 6 (4) ◽  
pp. 556-567
Author(s):  
Christopher Greeley
Keyword(s):  
Scientific Knowledge ◽  
Evidence Based Medicine ◽  
Diagnostic Tests ◽  
Medical Literature ◽  
Current Medical ◽  
Evidence Based ◽  
The Past ◽  
Based Medicine ◽  
Critical Literature ◽  
Historic Background

The published literature is not just the ongoing record of current medical and scientific knowledge; it is a record of the past and can give an eye toward future knowledge. Reading the published literature can give a view of the evolution of knowledge on a particular question, the growth of a discipline, the identification of new diseases, and the refinement of diagnostic tests. The reality is that most busy physicians read only the abstract of an article. The purpose of this article is to place published medical literature into a context and to provide some considerations for critically evaluating articles. This paper will provide historic background of evidence-based medicine and medical publications. Specific strategies for critical literature appraisal are highlights and pitfalls to avoid are outlined.

Elaboration and Formalization of Current Scientific Knowledge of Risks and Preventive Measures Illustrated by Colorectal Cancer

2001 ◽  
Vol 40 (04) ◽  
pp. 323-330
Author(s):  
J. Gouvernet ◽  
J. Dufour ◽  
P. Degoulet ◽  
R. Laugier ◽  
F. Quilichini ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Scientific Knowledge ◽  
Evidence Based Medicine ◽  
Scientific Information ◽  
Personalized Recommendation ◽  
Evidence Based ◽  
Levels Of Evidence ◽  
Cyclical Process ◽  
The Moment ◽  
Based Medicine

Summary Objectives: Present the method used to elaborate and formalize current scientific knowledge to provide physicians with tools available on the Internet, that enable them to evaluate individual patient risk, give personalized preventive recommendations or early screening measures. Methods: The approach suggested in this article is in line with medical procedures based on levels of evidence (Evidence-based Medicine). A cyclical process for developing recommendations allows us to quickly incorporate current scientific information. At each phase, the analysis is reevaluated by experts in the field collaborating on the project. The information is formalized through the use of levels of evidence and grades of recommendations. GLIF model is used to implement recommendations for clinical practice guidelines. Results: The most current scientific evidence incorporated in a cyclical process includes several steps: critical analysis according to the Evidence-based Medicine method; identification of predictive factors; setting-up of risk levels; identification of prevention measures; elaboration of personalized recommendation. The information technology implementation of the clinical practice guideline enables physicians to quickly obtain personalized information for their patients. Cases of colorectal prevention illustrate our approach. Conclusions: Integration of current scientific knowledge is an important process. The delay between the moment new information arrives and the moment the practitioner applies it, is thus reduced.

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