ABSTRACT
Evidence-based care has bedded down as a mainstream para digm in health care over the last five years. Within the UK, the National Institute for Clinical Excellence (NICE) con tinues to issue national guidelines on a plethora of areas of health care, pre dic ated on a robust methodology of appraising and integrating the best avail able evid ence. Guidelines for practice have become commonplace and norm ative in maternity provider settings. In fact, they have become even more author itat ive because providers’ safety and quality agendas are underpinned by such guidelines. How clinical guidelines feed into levels of indemnity insurance cover for the Clinical Negligence Scheme for Trusts (CNST) which operates in England and Wales is a good example. Yet, concerns remain about the pol itics of evid ence: how it is distilled at a national level (Milewa and Barry 2005), how it is enacted at a local level (Nettleton et al. 2008) and how indi vidual practitioners in ter pret and apply it (Kulier et al. 2008). Rogers (2004) prob lematises evidence-based medicine in relation to women’s health, arguing that gender bias affects both the choice of research topics (a focus on tech no logy and pathology) and the methods chosen to research, ana lyse and synthesise them (ran domised controlled trials (RCTs) and stat ist ical ana lysis over lived ex peri ence), as well as guideline de velopment (under-representation of women and consumers). Earlier, Pope (2003) had traced the evid ence para digm’s epidemiological roots, characterising it as a social movement whose spread in Western health care has been remark able since the mid-1990s. Large sections of the health professions, health care managers and finally gov ern ments themselves have em braced it with an almost evan gel ical fervour. Rather simplistic slogans have trumpeted its common-sense appeal. ‘Doing the right thing, in the right way at the right time to the right patient’ was one nursing rendition of its intent (RCN 1998). Others have simply stated that it is about doing what works, what is effective.
