evidence-based medicine

is important to interrogate critically because it is the basis for treatment, insurance, and public health decisions, and clinical guidelines that are an increasingly salient dimension of patients' and physicians' everyday lives.

As the basis for treatment, insurance, and public health decisions, clinical guidelines are an increasingly salient dimension of patients' and physicians' everyday lives. p.2

is important to interrogate critically because, for patients with contested illnesses, it is of critical importance which evidence gets to count toward the substantiation and formal recognition of their suffering.

Because Lyme's controversy hinges on differences over how to clinically manage Lyme disease and, more critically, whether chronic Lyme disease has an objective evidentiary basis, clinical guidelines are urgently relevant to Lyme patients and physicians. For all patients with contested illnesses, which evidence gets to count toward the substantiation and formal recognition of their suffering is paramount. p.2

is a mode of understanding whose rise excluded certain ailments from the trappings of medical legibility, insurance coding, and clinical research.

Although the history of physical ailments perceived to lack a biological basis is long (S. Johnson 2008, 13), it was only with the rise of evidence-based medicine that these ailments became formally recognized as medically unexplainable and, as a result, were excluded from the trappings of medical legibility, including an insurance code, eligibility to be the object of clinical studies, and corresponding pharmaceutical treatments and clinical guidelines. Through formal categorization, patients with contested illnesses (chronic Lyme patients foremost among them) have become bound together in a more cohesive and more visible "biosociality" of "delegitimized" suffering that has allowed them to mobilize against their medical marginalization, mobilizations no more clearly demonstrated than in the Lyme patient community's protest against the idea. p.3

is responsible for a hardened boundary between explainable and unexplainable illnesses, but it also offers patients a set playing field on which to make claims to medical truth.

evidence-based medicine has hardened the boundary between explainable and unexplainable illnesses, it has also unexpectedly offered patients a path to perceived biological legitimacy by providing a platform on which individuals inside and outside the medical arena can make claims to medical truth. I p.3

is a notion that intended to streamline medical opinion, but has instead produced a proliferation of opinions and a set, authoritative playing field on which patients as well as practitioners can make their opinions heard.

the opportunity for patients as well as practitioners to draw on the authority of evidence-based medicine to validate their experiences and make their opinions heard. Intended to streamline medical opinion, evidence-based medicine has instead produced a proliferation of opinions and, more critically, has created the opportunity for patients as well as practitioners to draw on the authority of evidence-based medicine to validate their experiences and make their opinions heard. p.4

is a formalization of the importance of objective (symptoms) over subjective evidence (signs) in the diagnosis of disease.

present with more symptoms (subjective markers of disease) than they do signs (objective markers of disease). For example, because evidence-based medicine has formalized the importance of objective over subjective evidence in the diagnosis of disease, illnesses that present with more symptoms (subjective markers of disease) than they do signs (objective markers of disease) bring out epistemic differences within biomedical practice over the extent to which symptoms can be used to substantiate and explain the biological reality of illness. And because of these epistemic differences, patients with contested illnesses straddle the divide between the experience of living a disease and the experience of being perceived to have a medically unexplainable illness. p.7 . . . Over the course of this book, I also suggest that evidence-based medicine's role in amplifying disagreement over the biological reality of contested illnesses is the product of a foundational feature of bio-medicine: the relative importance of the sign versus the symptom in the diagnosis and treatment of ill health. p.7-8

is responsible for a normative delineation between the "right" and "wrong" ways of being sick.

Indeed, within the now immanent institutional framework of evidence-based medicine, the distinction between medically explainable and medically unexplainable conditions can be more fully understood as a normative delineation between the "right" and "wrong" ways of being sick.18 p.9

evidence based medicine, n.All

evidence based medicine