The Evidence-Based Approach to Medicine and the Commodification of Health Care Services
According to one definition, evidence based medicine "involves the delivery of optimal individual patient care through the integration of current best evidence on pathophysiological knowledge, cost effectiveness, and patient preferences." In essence, evidence based medicine is rooted in the following central conceptions: clinical decisions should be grounded on the best available scientific evidence; identifying the best evidence means using epidemiological and biostatistical ways of thinking; and this evidence should guide medical practice. Evidence-based medicine emerged in the context of reforms of health care services worldwide that shared the growing commodification of health care. Using Foucault's idea of governmentality as a "rationality of government", this paper argues that evidence-based medicine is not only an approach which optimizes the quality of care patients receive but, with its emphasis on cost-effectiveness and its positivistic approach to rationality and science, it functions as one of the intellectual strategies that allow for the acceptance among health care providers of the logic of commodification processes. The paper begins by discussing evidence-based medicine epistemological assumptions and the ways it influences clinical practice. In its second section it analyzes the main characteristics of neo-liberal health care reforms and finally it shows in which ways the evidence-based approach functions as part of a neo-liberal governmentality.
Keywords: Medicine, Health Care
Dr. Dani Filc
Senior Lecturer, Department of Politics and Government, Ben Gurion University
Dr. Nadav Davidovitch
Senior Lecturer, Divion of Public Health, Ben Gurion University