Medicine
Medicine is a very important domain for LIS, in which many front technologies are being developed and explored. In the Journal Citation report 2005 has Journal of the American Medical Information Association the second highest impact factor among journals in the category "Information Science and Library Science". Among the front technologies are the development of a medical metathesaurus, Unified Medical Language System,
The is a connection between organizing medical knowledge and medical epistemology (theory of knowledge). If we consider evidence based medicine (EBM) as one theory of medical knowledge), is the connection expressed in this quote:
Cohen et al. (2004):
"Medical informatics and EBM are closely associated" (p.35).
"EBM is an increasingly popular usage model for information within medical informatics" (p. 35).
"like any usage model, [EBM] places substantial
requirements and limitations on any information system designed to support it.
Therefore, it is essential that medical informaticians are familiar with the
principles, major issues, criticisms, and limitations associated with the theory
and practice of EBM in order to achieve their goal of effectively using and
managing health care information." (p. 35)
Two related concepts should be introduced together with EBM: the concept of meta analysis (of scientific literature) and the Cochrane databases. Those three concepts seem very related from an epistemological point of view.
"The beginnings of EBM as a named movement (or ‘‘new paradigm’’ as some have called it) began in the early 1990s in Canada, the United Kingdom, and slightly later, in the United States" (p. 36).
| However, it has always been the purpose of medical research to serve medical practice. If EBM is considered a new approach, was medicine not based on evidence until EBM started? If EBM is one among other approaches or views, how do other approaches meet this new challenge? |
"Current criticisms and limitations of EBM can be grouped into five main themes:
EBM is based on empiricism, misunderstands or misrepresents the philosophy of science, and is a poor philosophic basis for medicine [Charlton & Miles, 1998; Harari, 2001]
The EBM definition of evidence is narrow and excludes information important to clinicians [17,18].
EBM is not evidence-based, that is, it does not meet its own empirical tests for efficacy [1,19,20].
The usefulness of applying EBM to individual patients is limited [12,18,21].
EBM threatens the autonomy of the doctor/patient relationship [5,8,18,22]." (p. 37)
"Originally, supporters of EBM declared it ‘‘a new paradigm, in which evidence from health care research is the best basis for decisions for individual patients and health systems [1].’’ Thomas Kuhn describes a paradigm as ‘‘a conceptual box into which scientists try to fit nature [23].’’ Applied to medicine, this amounts to declaring that EBM was a new way of thinking about medical knowledge and healthcare, replacing what came before with a new, better view of the world of patient care." (p. 37)
"EBM was initially ‘‘pitted against’’ [1] traditional medical teaching where the ‘‘understanding of basic pathophysiologic mechanisms of disease coupled with clinical experience’’ is of primary importance" (p. 37).
"The primary criticism is rooted in the idea that
EBM is an approach founded on evidence provided by experimental studies designed
to minimize bias, rather than on physiologic theory [16]. The belief that
scientific observations can be made independent of the biases of the observer is
one of the aspects of the philosophy of science known as empiricism; the
empirical view holds that medical observations can be made independent of
pathophysiological theory. In contrast, one of the basic principles of
qualitative research assumes that all observers are biased and therefore
requires that the viewpoint
and biases of the observer be made explicit [24].
EBM as a paradigm ‘‘suffers’’
from empiricism in that ‘‘evidence’’ is deemed both more reliable and more
important to clinical decision making than other kinds of knowledge, thus
relegating to lesser importance the theory and the understanding of physiology
and disease processes. Interestingly, EBM was originally declared to be
‘‘rational, objective
and altruistic [8]’’, when in fact it has been understood by philosophers and
scientists since the late 19th century that making theory-free, objective
observation is impossible [16].
Since observations cannot be made by a naive, completely objective observer, the biases, and therefore the world-view, of the observer must be identified and taken into account. That world-view defines and limits what questions can be asked, as well as which information is deemed important and which is deemed noise." (Pp. 37-38).
"criticisms center on three main points: (1) RCTs and
meta-analysis have not been
shown to be more reliable than other research methods, (2) the questions that
EBM can answer are limited, and (3) EBM has failed to provide a means to
integrate other, non-statistical, forms of medical information, such as
professional experience and patient specific factors." (p. 38)
Literature:
Bovbjerg Schultz, S. & Sønderstrup-Andersen, E. (2006). Paradigmatisk medicin. En undersøgelse af epistemologiske tilgange og ontologiske positioner i det medicinske fagdomæne. Speciale ved Danmarks Biblioteksskole, Kandidatuddannelsen i biblioteks- og informationsvidenskab.
Charlton, B. G. & Miles, A. (1998). The rise and fall of EBM, QJM [Quarterly Journal of Medicine], An International Journal of Medicine, 91(5), 371—374.
Cohen, A. M., Starvi, P. Z., & Hersh, W. R. (2004). A categorization and analysis of the criticisms of Evidence-Based Medicine. International Journal of Medical Informatics, 73, 35-43. Manuscript available at:
http://medir.ohsu.edu/~hersh/ijmi-04-ebm.pdf
Greenhalgh, T. & Hurwitz, B. (1998). Narrative Based Medicine: Dialogue and discourse in clinical practice. London: Bmj Publishing Group.
Harari, E. (2001). Whose evidence? Lessons from the philosophy of science and the epistemology of medicine, Australian and New Zealand Journal of Psychiatry 35(6), 724—730.
Haynes, , R. B.; Wilczynski, N.; McKibbon, K. A.; Walker, C. J. & Sinclair, J. C. (1994). Developing optimal search strategies for detecting clinically sound studies in MEDLINE. Journal of the American Medical Informatics Association, 1(6), 447-458.
Heine, M. H. & Tague, J. M. (1991). An investigation of the optimization of search logic for the MEDLINE database. Journal of the American Society for Information Science, 42(4), 267-278.
Lussky, J. P. (2004). Bibliometric patterns in an historical medical index: using the newly digitized Index Catalogue of the Library of the Surgeon General's Office, United States Army. Thesis, Drexel University. Available (full text): http://dspace.library.drexel.edu/retrieve/3815/Lussky_Joan.pdf
Murero, M. & Ronald Rice, R. (Eds.). (2006). The Internet and Health Care: Theory, Research, and Practice. Lawrence Erlbaum.
Smith, T. C. & Cleary, J. G. (2003). Automatically linking MEDLINE abstracts to the Gene Ontology. Proceedings of the ISMB 2003 BioLINK Text Data Mining SIG, Brisbane, Australia. June. http://www.reeltwo.com/news/Text_Mining_SIG_abstract.pdf
Unified Medical Language System (UMLS). Current semantic types: http://www.nlm.nih.gov/research/umls/META3_current_semantic_types.html
WHO (1990). ICD-10: International Statistical Classification of Diseases and Related Health Problems. World Health Organization.
Wikipedia. The free encyclopedia. (2006). Medical classification. http://en.wikipedia.org/wiki/Medical_classification
See also: Evidence based practice and LIS (Core Concepts in LIS); Medical Subject Headings; Medicine (Epistemological lifeboat); Metathesauri; Unified Medical Language System
See also: International Classification of Diseases
Birger Hjørland
Last edited: 16-04-2007