The greatness and the immorality of standards since EBM: The need for quantitativists and qualitativists to work together
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Evidence-based medicine (EBM) holds that the standard should be scientific evidence. But what evidence? The putting forward of the case for medicine based on standards has favored quantitative methods. Qualitative methods have been ignored and marginalized. Should scientific evidence be based solely on randomized controlled trials (RCTs) that evaluate an average patient? Scientific medicine based on numbers has ignored qualitative medicine that is based on words. And the poor quality of the quantitative literature could jeopardize EBM. In the early 2010s, researchers showed that what had been published was poorly reproducible. For the editor-in-chief of the Lancet, half of the publications would be incorrect. Certain currents have drawn attention to the biases of these “standards,” citing a crisis in EBM. Qualitative studies help us to understand how promising clinical interventions have never “worked” in real life, and how professionals and patients use diagnostic and therapeutic strategies. These studies explore the complex relationships between systems and people in a socio-political context that regulates health. The methods of humanities and social sciences researchers are robust if they are carried out by professionals in these disciplines. The return of the qualitativists does not mean a move away from standards, contrary to what the quantitativists think.
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