Thomas S. Kuhn's classic book is now available with a new index.

It is important and urgent to question therelationship between evidence-based medicineand power shifts in health care systems.Although definitions of EBM are phrased as ascientific approach to medicine, EBM is anormative concept: it aims to improve medicineand health care. Both proponents and opponentsuse a normative concept. More particularly,they provide particular views on positions,responsibilities, possibilities, norms andrelationships between professionals, patientgroups, governments and other parties in healthcare and society. From this perspective, wewant to analyse the role of EBM in modernwestern societies. By using (...) citizenshiptheory, we will argue that the role of EBM isnot fixed but depends on the relation betweenstate and society. We will first analyse thefundamental change in western societies duringthe past decades, from modern to post-modernsocieties. Then, we will elaborate a fourfoldmodel of possible relationships between stateand society, and discuss the issue of how EBM mayfit in, by giving some examples of the practiceof EBM in different European countries. On thisbasis, we conclude to consider EBM as a publicforum where proponents and opponents of EBMdiscuss diverse and possibly conflicting waysof changing medicine, health care, and healthpolicy. This requires the incorporation of theperspective of citizens and their socialnetworks, professionals with practical andtacit knowledge, and diverse public views onwhat is regarded as `a good life'. Inasmuch asEBM is expected to be practically relevant, itought to be tied to rather than separated fromthe normative world of emancipated patients anddiverse health care practices. Proponents andopponents of EBM should be prepared to defendthe normative claims and power effects that areinherently tied to any presentation ofevidence. (shrink)

Evidence-based medicine is seen not only as an important means to improve the quality of medical care, but also as an instrument to control costs. In view of the scarcity of health care resources, decisions on the allocation of care will have to be made more explicitly and should be made more transparent.

The interaction between evidence-based medicineand doctors' duty of care to patients iscomplex. One the one hand, there is surely anobligation to take account of the bestavailable evidence when offering health care topatients. On the other hand, it is equallyimportant to be aware of important shortcomingsin the processes and practices ofevidence-based medicine. There are tensionsbetween the population focus of evidence-basedmedicine and the duties that doctors have toindividual patients. Implementingevidence-based medicine may have unpredictableconsequences upon the overall quality of healthcare. Patients may have (...) a range of reasons forpreferring one form of treatment over another,not all of which are captured by currentformulations of evidence. This paper examinesthese issues, using relevant examples fromevidence-based medicine. (shrink)

In recent decades a number of criminal convictions have been reversed on appeal, partially on the basis of problems associated with the use of scientific evidence adduced by the prosecution during the trial. These miscarriage of justice cases have received considerable attention from news media, legal commentators, criminologists and in formal public inquiries. Most responses to these cases have been critical of the scientific evidence originally relied upon at trial. Few commentators have been critical of, or even reflective about, the (...) scientific evidence used to acquit. Generally, their analyses have utilized idealized images of science and scientists. In contrast, by importing the concept of methodological symmetry from science studies, this paper aims to identify and explore the conceptual disparity (or asymmetry) between the assessment of scientific evidence used to convict and the scientific evidence used to acquit. In order to illustrate some of the limits to conventional approaches to miscarriages of justice as well as examine the judicial use of scientific evidence this will be undertaken in relation to the successful appeal of the Birmingham Six. (shrink)

In this paper we set out to examine thearguments for and against the claim thatEvidence-Based Medicine (EBM) will improve thequality of care. In particular, we examine thefollowing issues.

The institutionalization of History and Philosophy of Science as a distinct field of scholarly endeavour began comparatively earl- though not always under that name - in the Australasian region. An initial lecturing appointment was made at the University of Melbourne immediately after the Second World War, in 1946, and other appoint ments followed as the subject underwent an expansion during the 1950s and 1960s similar to that which took place in other parts of the world. Today there are major Departments (...) at the University of Melbourne, the University of New South Wales and the University of Wollongong, and smaller groups active in many other parts of Australia and in New Zealand. "Australasian Studies in History and Philosophy of Science" aims to provide a distinctive publication outlet for Australian and New Zealand scholars working in the general area of history, philosophy and social studies of science. Each volume comprises a group of essays on a connected theme, edited by an Australian or a New Zealander with special expertise in that particular area. Papers address general issues, however, rather than local ones; parochial topics are avoided. Further more, though in each volume a majority of the contributors is from Australia or New Zealand, contributions from elsewhere are by no means ruled out. Quite the reverse, in fact - they are actively encour aged wherever appropriate to the balance of the volume in question. (shrink)

`Fluid, readable and accessible ... I found the overall quality of the book to be excellent. It provides an overview of major (and preceding) developments in the field of science studies. It examines landmark works, authors, concepts and approaches ... I will certainly use this book as one of the course texts' Eileen Crist, Associate Professor, Science & Technology in Society, Virginia Tech Science is at the heart of contemporary society and is therefore central to the social sciences. Yet science (...) studies has often encountered resistance from social scientists. This book attempts to remedy this by giving the most extensive, thorough and best argued account of the field and explaining to social scientists why science matters to them. This is a landmark book that demystifies science studies and successfully bridges the divide between social theory and the sociology of science. Illustrated with relevant, illuminating examples, it provides the ideal guide to science studies and social theory. (shrink)

Medicine, like law, is a pragmatic, probabilistic activity. Both require that decisions be made on the basis of available evidence, within a limited time. In contrast to law, medicine, particularly evidence-based medicine as it is currently practiced, aspires to a scientific standard of proof, one that is more certain than the standards of proof courts apply in civil and criminal proceedings. But medicine, as Dr. William Osler put it, is an "art of probabilities," or at best, a "science of uncertainty." (...) One can better practice medicine by using other evidentiary standards in addition to the "scientific." To employ only the scientific standard of proof is inappropriate, if not impossible; furthermore, as this review will show, its application in medicine is fraught with bias. Evidence is information. It supports or undermines a proposition, whether a hypothesis in science, a diagnosis in medicine, or a fact or point in question in a legal investigation. In medicine, physicians marshal evidence to make decisions on how to best prevent, diagnose, and treat disease, and improve health. In law, courts decide the facts and render justice. Judges and juries assess evidence to establish liability, to settle custody and medical issues, and to determine a defendant's guilt or innocence. (shrink)