FROM PRACTICE TO RESEARCH - THE CASE FOR CRITICISM IN AN AGE OF EVIDENCE

The growth in research and in health care costs has made it important for clinicians to use and critically appraise published evidence for t heir medical decisions. The evidence-based medicine movement is an exa mple of the present effort to teach clinicians to evaluate research ev idence by methodologic standards. Though this effort can only improve the clinical decisions of practitioners, it suggests that when assessi ng evidence there are no reasons to critically evaluate the standards of research and evidence themselves. A precedent for assessing standar ds of research and evidence exists in the broad tradition known as ''c riticism''. Using contextual, cultural and other forms of analysis, wr iters have used criticism to;show that the meaning and validity of sci entific evidence is influenced as much by the sociocultural characteri stics of readers and users as it is by the meticulous use of research methods. Scholars outside of medicine have suggested, for example, tha t data become evidence only in the context of specific beliefs and dis agreements and that there are interesting pragmatic reasons why we see some forms of evidence and not others in the medical literature. Soci al critical studies of research and evidence would reveal the many inf luences similar to these that are relevant to clinical medicine. The e ffort would be practically useful to physicians, who with a broader un derstanding of research could critically appraise published evidence f rom both scientific and sociocultural perspectives. It would also help correct an imbalance in contemporary medicine in which clinicians are being trained to maintain high standards of critical consciousness in methodological domains but not in the broader historical and sociocul tural domains which subsume them. (C) 1998 Elsevier Science Ltd. All r ights reserved.