The Histories and Cultures of Evidence Utilisation: The Cases of Medical Oncology and Haematology
As outlined in our introduction to this book, the idea of EBM or EBP, for biomedical clinicians, is to apply the best evidence to the clinical condition they are presented with. However, while EBM may seem to be mere commonsense, in actuality, and particularly in the context of specialties like medical oncology and haematology, it presents a plethora of ideological, epistemological and practical issues. We argue here that for oncology clinicians operating at a grassroots level there is often a disconnection between EBM (and processes of standardisation) and the actual character of contemporary oncological work (De Vries and Lemmens 2006). Furthermore, the very value judgements and subjectivities that often go unrecognised in an EBM framework are actually critically important skills in oncology and haematology practice (Tredaniel et al. 2005). In oncology such disjunctions are accentuated with the constant development of new interventions (Ioannidis, Schmid and Lau 2000) combined with the omnipresent need to ‘try new things’ with potentially terminal patients where standard treatments do not work.