Tuesday, July 3, 2012

[EQ] Evidence-based medicine conceptual cul-de-sacs and some off-road alternative routes

Why do we always end up here?
Evidence-based medicine’s conceptual cul-de-sacs and some off-road alternative routes

Trisha Greenhalgh, Healthcare Innovation and Policy Unit, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, United Kingdom

J PRIM HEALTH CARE - 2012; 4(2):92–97 http://bit.ly/O01QYX

‘’…………Let me explain what I mean by ‘conceptual cul-de-sacs’. Thomas Kuhn proposed that science progresses in paradigms—a paradigm being a set of assumptions and beliefs shared by a group of sci­entists about what the important questions are and how they should be tackled.
4 Most scientists, most of the time, work within an existing paradigm and build rather doggedly on what has gone before. This is what Kuhn called ‘systematic puzzle-solving’, Wittgenstein called ‘the railway tracks of science’5 and Einstein called ‘99% perspiration’.

Occasionally, someone (often a youngster new to the discipline or perhaps someone in a second career) questions the prevailing assumptions and methodological rules—Einstein’s ‘1% inspiration’. A fight ensues, with the newcomer typically re­jected by the old school as ignorant or not rigorous, and a breakaway group forms. The most famous ex­ample of this is Einstein himself, who challenged the assumptions and methods of Newtonian phys­ics and started playing to new rules, allowing new questions to be addressed in a whole new way.

Paradigms are not bad things. They don’t just constrain our thinking, they enable us to think.6 Science could not progress without them. We learn the rules, apply them, argue about them, modify them. Indeed, Susan Leigh Star defined a discipline as ‘a commitment to engage in disagreements’.7 If you’re a geneticist and a historian challenges your work, you won’t get very far. But with a fellow geneticist, you can have a good argument and make progress.

The pre-paradigmatic research of off-road breakaway groups is typically slow, messy and charac­terised by wrong turnings and periodic pile-ups.4 But eventually some tracks are laid and a clear direction of travel is pointed out. Yesterday’s radicals become today’s sticklers for procedure. Disagreement, and therefore progress, becomes possible. A new paradigm is born……….”


Why National eHealth Programs Need Dead Philosophers:

Wittgensteinian Reflections on Policymakers' Reluctance to Learn from History

Trisha Greenhalgh, Jill Russell, Richard E. Ashcroft, and Wayne Parsons Queen Mary University of London

The Milbank Quarterly - Volume 89, Number 4, December 2011


Evaluating eHealth:
how to make evaluation more methodologically robust
Lilford RJ, Foster J, Pringle M:. PLoS Med 2009, 6: e1000186.

Why do evaluations of eHealth programs fail?
An alternative set of guiding principles.
Greenhalgh Trisha, Russell J. PLoS Med 2010, 7: e1000360


Realist review
 – a new method of systematic review designed for complex policy interventions

Ray Pawson, Trisha Greenhalgh1, Gill Harvey2, Kieran Walshe2
Department of Sociology and Social Policy, University of Leeds, Leeds; 1University College London, London; 2Manchester Business School,
University of Manchester, Manchester, UK
Journal of Health Services Research & Policy


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