The Laboratory: The Making of Evidence in Health Care
In the past three decades, debates about health care organisation have often focused around the role of ‘evidence’ and demonstrations of eff ectiveness in the articulation of policy and the determination of practice. Since the 1990s, discussions about ‘evidence-based medicine’ (EBM) and ‘evidencebased policy’ have occupied much of the attention of social actors and groups concerned with health care. Evidence is suggested to address issues of quality of health care and of its variations. For critics, evidence is seen as a simpliﬁ cation of the kinds of decision-making processes deployed by health care practitioners in diagnosing and treating individual patients. It is also seen to skew policy towards well-documented and funded health care problems to the detriment of less visible, singular conditions (Will and Moreira, 2010). As discussed in the introduction, such considerations about the role of evidence have put the production, evaluation and use of knowledge at the centre of contemporary health care. Such transformation is recognised by all the approaches to health care reform discussed in Chapter 1, and indeed motivated much of the formulation of the model proposed in Chapter 2.