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

Abstract #118741

Nadav Davidovitch, MD, Health Systems Management, Faculty for Health Sciences, Ben Gurion University, P.O. Box 653, Beer Sheva, 84105, Israel, 972-50-465479, mikinadv@post.tau.ac.il and Dani Filc, MD, PhD, Politics and Government, Faculty of Humanities and Social Sciences, Ben Gurion University, P.O. Box 653, Beer Sheva, 84105, Israel.

The emergence of evidence-based-medicine (EBM) as the gold-standard practice in biomedicine and public health practices represents a significant epistemological turn in modern medicine. The present paper analyzes the historical and sociological roots of this turn. The paper's claim is that EBM became the dominant discourse as the result of various forces: 1) The 'scientification' of the clinical encounter, emblemized by the adoption of the double-blind randomized clinical trial and then brought to a higher level of abstraction by the development of meta-analysis techniques. 2) The crisis felt by the medical profession as a result of attacks that have come from various sources, including the civil rights discourse, the rise of bio-ethics, legal suits, the "rise" of alternative medicine, that emphasized the need to preserve the profession's monopoly. 3) The transition into a neo-liberal organization of medical practice and welfare services which has put economical pressure on medical providers to contain costs and has introduced the language and practices of the business sector into the medical field. Managed competition have required a medical practice with privileged data and measurable facts as its foundation. This paper will illuminate the ethical and social consequences of this transformation, both within the medical profession (the polarization between a medical elite which strengthened its professional status, and a rank and file which experienced a process of 'de-professionalization') and in its relationship to the welfare state (the link between the medical elite, the new medical paradigm and the commodification of health care and public health).

Learning Objectives:

• Describe the historical roots of EBM.
• Analyze the social forces underlying evidence-based medicine.
• Identify the ethical and social consequences of EBM in the context of public health practice.

Keywords: History, Social Justice

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.