Beware Those Offering “Gold Standards”: Evidence-Based Medicine and the Potential for Institutional Change in Clinical-Medical Provision

Abstract:

Evidence-based medicine (EBM) has meteorically emerged to dominate contemporary medical methods and practicess. Its proponents argue that it offers a “new paradigm ” for medicine through the prospects of generating “gold standards” of care and democratizing provision by generating more reliable evidence and information. As such, EBM has the theoretical and ontological potentials to act as a catalyst of institutional change. Institutional economics has been sluggish in investigating whether such claims are warranted. This paper, by presenting a theoretical and abstract conceptual analysis, contests that there are sufficient grounds for considering that EBM is capable of promoting the dominance of a particular epistemological orientation in the framing of medical procedures through its invocation of instrumentalism, de-contextualization and reductionism in evidential sources. Thus, far from being the value-neutral, objective scientific evidential “gold standard” and democratic pathways its advocates claim, EBM presents the promise of a more utilitarian foundation for health care.

Keywords::

• Evidence based medicine
• clinical-medical care
• institutional change
• randomized controlled trials