Speciale: Evidensbaseret medicin og praksis mellem filosofi, samfund og politik
”Der er tale om et speciale af særdeles høj faglig kvalitet. Specialet vidner om et betydeligt analytisk og forskningsmæssigt talent og en evne til at forbinde filosofiske og samfundsteoretiske perspektiver i interdisciplinært forskningsarbejde.”
(Citat fra fællesbedømmelsen).
In this paper I argue that evidence-based medicine (EBM) is a challenge to the traditional hippocratic practice, where the doctor treats every patient as an uniqe case, towards a more general practice where the doctor treats the patient based on a hypothetical average patient, calculated on the grounds of randomised controlled trails (RCT) or metaanalysis of a selected population.
In the second part my analysis shows that the development in the Cochrane-Collarboration has moved away from Archie Cochranes values and thoughts on equality and common velfare, to a more political and economic powered enterprise based on a natural science model of objectivity and clarity that ignores the Canadian philosopher Charles Taylor's hermeneutic notion on the human as a ”self-enterpreting animal”. And in treatments besides being a reductive explanatory model for behaiviour as outcome, neglects humanistic aspects and their significance for practice, such as care and empathy.
With Max Weber I show similarities between the calling of the Protestantic ethic and practicers of EBM as a ”sacred” organisation and method to almost every medical problems, that in a standardized version gives an economic vision of a treatment of the same quality to all patients, as a formal right. With the potential risk of becoming a tool for bureaucratic control and documentation for external interest. Through DJØFicering and a growing review culture that nurses politicians, health economics, and scientists egocentric interests in a complete economic rationalized health care practice, and thereby an economic responsible and profitable business, while it bureaucratizes patients and doctors in a dehumanizing health care practice. It exemplifies Archie Cochrane's horror scenario. With a theory of ”shared goods,” Taylor shows a second and more solidary way, that abolishes an atomistic conception of health care as only individual rights and demands.
Through Habermas I show that EBM is vulnarable to the economic interests of funds with a risk of reification, where the doctor sees the patient as a consumer of health and medical products. It is also shown that juridification in some cases makes practice formal. With Geörg Lukács the structure of reification is analysed. The psycological effects af such a reifiction is shown with P.F. Strawsons thesis on reactive feelings in Freedom and Resentment. Recapitulative I claim to have shown that there is a tendency to objectify man in the development of EBM, human understanding(s) and behaviour.