Cochrane Lecture 1997. What evidence do we need for evidence based medicine?

Area of Science:

• Integrates social sciences with medical practice.
• Critiques the reductionist approach in current medical science.

Background:

• Evidence-based medicine (EBM) aims for rational practice but often uses a narrow definition of science.
• Current EBM models overlook patient complexity and social determinants of health.
• The transactional model of care in EBM can lead to disease reification and process-focused outcomes.

Discussion:

• Proposes a paradigm shift towards viewing patients as co-producers of health.
• Advocates for shared decision-making utilizing comprehensive evidence.
• Emphasizes a socialized definition of science in healthcare.

Key Insights:

• Current EBM practices are reductionist and fail to address complex health issues.
• A patient-centered, cooperative model can enhance health gain.
• Economic and political interests pose significant barriers to EBM reform.

Outlook:

• A major socio-cultural shift is needed for healthcare professionals.
• Changes in public attitudes and professional-manager relations support this shift.
• Recognizing the choice between transactional and cooperative models is crucial for progress.