The Proliferation of Evidence-based Medicine : Ideas, Translations and Advocates

Sammanfattning: In the last few decades, the idea of evidence-based medicine (EBM) has proliferated throughout the world. EBM is, in its essence, an idea that is based on the assumption that doctors need to integrate evidence from clinical research into their patient care. This study contributes to Scandinavian institutionalism by exploring how EBM has proliferated in processes of translation and why EBM has proliferated in this way. The study is based on documents, interviews and participant observations. It investigates the translations of EBM in biomedical journals 1992-2002, guiding us in particular through discussions on EBM in three general medical journals that transformed the content and shape of the idea but also contributed to the circulation of it. Also, the study examines three advocates of EBM; Evidence-Based Medicine Working Group, the Cochrane Collaboration and Swedish Council on Technology Assessment in Healthcare (SBU). In this way, it highlights dynamics in idea proliferation.The study shows how EBM was translated into a broad and ambiguous idea as it travelled across time and space. EBM developed from criticisms advanced by medical educators at a Canadian university hospital to an idea for medical practice developed by doctors as well as by those in the medical environment. The translations of EBM into a broad and ambiguous idea meant that the idea moved beyond the pressure to examine evidence from clinical research – it combined the examination of evidence from clinical research with clinical expertise and patient views. The study demonstrates that the translation processes involved interplay and contestations among the individuals and organisations engaged in EBM.These results suggest that EBM proliferated in translation processes that were created and set in motion through contestations that incorporated the limitations found in EBM. Much of what seemed, at first sight, to be limitations to and criticisms levelled against EBM should thus ultimately be reinterpreted as many steps pushing for the translations of the idea. The advocates studied translated EBM in accordance with their own interests and work, in this way developing important although disparate roles. It appears from the results of the study that EBM was translated differently depending on the context in which the translation took place (the context of the translation) and the context of the advocates. EBM was translated into a broad and ambiguous idea by being mixed with various traditions and fields of knowledge and other ideas and models, and developed for existing local practices in organisations and work fields.