EBM and Epistemological Imperialism: Narrowing the divide between evidence and illness

Evidence Based Medicine (EBM) is an approach to clinical practice that relies on the use of systematically reviewed published clinical research of high quality. Whilst there is some speculation as to whether a true consensus definition of EBM exists (Loughlin (2008)(1)), a commonly cited explanation “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients’ (Sackett et al (1996)(2)). Most approaches to “EBM” incorporate the use of an evidence hierarchy that presupposes that some forms of evidence are better than others (Guyatt and Rennie (2002)(3)), that meta-analyses and randomised controlled trials (RCTs) will guide a better level of care than expert or local knowledge. Although EBM is pervasive throughout all health literature a number of ethical (Gupta (2009)(4)), epistemological (Loughlin (2008)(1)), and clinical practice critiques (Tobin (2008)(5)) have emerged. Criticisms of EBM on ethical grounds have previously been summarised by Kerridge (2010)(6) and include ; “that the implicit and explicit requirement for RCTs may lead to unnecessary research being done where sufficient evidence already exists;... that methods privileged by EBM, most notably the RCT, are methodologically unable to answer questions related to individual patients;.... that evidence hierarchies are inadequate and misleading;.... that the dataset that EBM draws from is systematically bias[ed],.... that the translation of evidence into practice through clinical practice guidelines and decision aids is both ethically and epistemologically problematic...[and] that evidence is not value-neutral and cannot be easily translated into practice.

Medical Imaging and the "Borderline Gaze of Touch and Hearing" : The Politics of Knowledge beyond "Sense Atomism"

I would like to thank the editors of this Special Section, Bettina Papenburg, Liv Hausken, Sigrid Schmitz and Natasha Myers, and the two anonymous reviewers for their careful reading of my work and helpful suggestions on how to clarify its arguments. I would also like to thank the participants of the Authors’ Workshop at 7th New Materialism Annual Conference “Performing Situated Knowledges: Space, Time, Vulnerability”, Warsaw, Poland, 21-23 September 2016, and the participants at “New Materialisms and Politics” Workshop at the University of Aberdeen, UK, 21-22 September 2017, for their comments and reactions to the earlier drafts of this article.Peer reviewedPublisher PD

Towards an epistemology of medical imaging

Tese de doutoramento (co-tutela), História e Filosofia das Ciências (Filosofia), Faculdade de Ciências da Universidade de Lisboa, Università degli Studi di Milano, 201

Data infrastructures and digital labour : the case of teleradiology

In this thesis, I investigate the effects of digitalisation in teleradiology, the practice of outsourcing radiology diagnosis, through an analysis of the role of infrastructures that enable the transfer, storage, and processing of digital medical data. Consisting of standards, code, protocols and hardware, these infrastructures contribute to the making of complex supply chains that intervene into existing labour processes and produce interdependent relations among radiologists, patients, data engineers, and auxiliary workers. My analysis focuses on three key infrastructures that facilitate teleradiology: Picture Archiving and Communication Systems (PACS), the Digital Imaging and Communication in Medicine (DICOM) standard, and the Health Level 7 (HL7) standard. PACS is a system of four interconnected components: imaging hardware, a secure network, viewing stations for reading images, and data storage facilities. All of these components use DICOM, which specifies data formats and network protocols for the transfer of data within PACS. HL7 is a standard that defines data structures for the purposes of transfer between medical information systems. My research draws on fieldwork in teleradiology companies in Sydney, Australia, and Bangalore, India, which specialise in international outsourcing of medical imaging diagnostics and provide services for hospitals in Europe, USA, and Singapore, among others. I argue that PACS, DICOM, and HL7 establish a technopolitical context that erodes boundaries between social institutions of labour management and material infrastructures of data control. This intertwining of bureaucratic and infrastructural modes of regulation gives rise to a variety of strategies deployed by companies for maximising productivity, as well as counter-strategies of workers in leveraging mobility and qualifications to their advantage

An anthropologist’s voice in a veterinarian’s noise: gearing up for new cultural realities

Over the past three decades, the veterinary profession has faced a cultural shift towards postspeciesism that requires a reassessment of the foundations of the existing distinctions between human and non-human animals proclaimed by the speciesism paradigm, which represents institutionalized discrimination against species and recognizes only the subjectivity of humans. Based on ethnographic observations in anthropological fieldwork and using speciesism/postspeciesism distinction, we aimed to explain the main causes of small animal practitioners’ work-related stress and apply humanistic knowledge to recommend ways to alleviate the negative effects of the work environment. The explanatory model of disease, illness, and sickness, the example of the concept of family, and the circumstances of the feminization of the veterinary profession are discussed to illustrate the divergence between speciesist naturalistic veterinary knowledge and the postspeciesist cultural framework and its consequences. By failing to accommodate the changing values towards animals and by failing to challenge the anthropocentric hierarchy of values, the speciesist rationale of the veterinary profession contributes to many of the problems faced by practicing veterinarians. The incorporation of a modern moral-philosophical mindset towards animals may not even be possible because veterinary science is subject to a paradigm that is irreversibly tied to institutional discrimination against species and defies reflection on veterinary science itself. However, the veterinary profession has a privileged position in establishing an alternative ontological thinking and an alternative conception of “animal life.” Anthropological knowledge was applied to anticipate further intervention of social and cultural sciences in the problems of small animal practitioners. Rather than further diversifying and increasing expectations towards veterinarians by expecting them to acquire additional skills, we propose another practitioner who can support, mediate, and enhance veterinary performance – the cultural anthropologist. With their deep knowledge of cultural differences and social dynamics, they can collaborate with veterinarians to act as a liaison between cultures, paradigms, and species

Unleashing the power of reflection, action and collaboration in health care improvement

Treating people in a safe environment, including protecting them from avoidable harm, and improving the quality of both care and leadership are the top priorities for the NHS since the tragedies and high profile cases of recent years (Berwick, 2013; Francis, 2013; Keogh, 2013). My research describes the value of an action-based approach to research and learning in North West London (NWL) NHS organisations, in response to the challenges and recommendations of the Berwick review (2013). This proposed that the NHS should become a system in which leaders create and support capability for continual learning and improvement. The research is in the form of a first-person inquiry (into my life as the researcher – Reason & Torbet, 2001) and a second-person inquiry (with others, into issues of mutual concern – Reason & Bradbury, 2008) including learning and sharing with others beyond NWL. This thesis illustrates my experience – as a practitioner inquirer with lived personal experience of being a patient receiving critical care and in active collaboration with other co-inquirers (NWL practitioners and patient representatives) – of working in the complex system that is the NHS: a collective, human, living organism that is non-linear, unpredictable, dynamic and networked over multiple organizational boundaries. My doctoral research has made a contribution to academic literature and professional practice by evidencing what it takes to operate through relational leadership in the NHS. I offer my view from the inside, capturing the emotional rollercoaster of anxiety, excitement, struggle, messiness and warmth involved and describing the dynamics we experienced. It includes exploration of the less obvious thread that connects race, voice and power to leadership practices, which was a critical part of my personal leadership experience. My doctoral research demonstrates that nurturing effective use of the voice and power of practitioners and patients not only improves patient safety at an individual level, but also promotes the safety of the wider healthcare system. It does this through enhancing a self-reflective approach in leadership practices and thereby fostering sustainable cultural change