Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #105211

Seiji Yamada, MD, MPH, Hawaii/Pacific Basin AHEC, John A Burns School of Medicine, University of Hawaii, 1960 East-West Road, Biomed T105, Honolulu, HI 96822, 808-358-3505, seiji@hawaii.edu

“Evidence-Based Medicine” (EBM) is examined for any light that might be shed on Evidence-Based Public Health (EBPH). The gold standard of knowledge in EBM is the meta-analysis of double-blind, randomized controlled trials. This reflects a positivistic view that implies that through observation, we are able to attain true knowledge. The concern with observable facts alone begs the question of whether the appropriate observational instruments are being utilized. Moreover, reflection on ultimate causes is excluded. EBM is driven by the philosophical stance of instrumental rationality, the mode of thinking in which the goal is to find the most efficient means to achieve the particular ends chosen by those who have power. Medicine is reduced to being a task-oriented endeavor: to determine the correct diagnosis and treatment. There is no room, in such technocratic thinking for value-oriented action.

To some extent, following EBM, in EBPH, the gold standard is the randomized controlled trial. However, the inherent difficulties of blinding and randomization of populations make evidence in public health inherently different from that in medicine.

In parallel with EBM, as a social phenomenon, EBPH is a vehicle for academically based public health specialists to promote their agendas. Knowledge of the public health literature is privileged over knowledge of history, the community, or social forces. This contrasts with historically informed approaches such as social medicine, which critically examines social forces and institutions for their role in the causation of disease.

Learning Objectives: At the conclusion of the presentation, the learner will be able to

• List the fundamental assumptions underlying evidence-based medicine
• Contrast these with the fundamental assumptions underlying evidence-based public health.
• Outline the uses to which “evidence” is put in the social context of public health practice

Keywords: Evidence Based Practice, Theory

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation