At 12:05 PM 11/1/01 +0000, you wrote:
>Hello,
> Democracy is undoubtably relevant to ebm but surely
>certain versions of ebm can operate without democracy? I think it needs to be
>debated what it is about democracy that enables better science, and how
>our own
>democracies act as barriers/facilitators of good research and practice.
Perhaps the issue is not altogether democracy but ethics,
specifically the values, beliefs and practices that guide how we behave
towards one another. Epidemiology, or EBP if you prefer, is a tool that we
apply to assist us to make decisions about the allocation of resources
(money, practitioners' time etc.) Depending on the group's values, this
tool can be used to help us get the best care for the most people (e.g. if
our best evidence demonstrates that labour-intensive screening practices
don't really lead to extra years of life for patients, we can recommend
that the resources be moved to practices that have a larger pay off). On
the other hand, we also know that there is potential for this tool to give
decision-makers ammunition to limit access to valuable care, particularly
in situations where there is little evidence of benefit simply because no
controlled studies have been carried out or the care itself is so complex
and/or future oriented that our tools and research resources aren't always
up to the task of assessing this care.
Democracy is yet another tool that helps us make good decisions
about what we should offer one another. Democracy makes it infinitely
easier to debate the merits of different ways of allocating resources, but
it does not ensure ethical decisions.
So why am I taking up your valuable time to sputter this
out? Personally, I feel it is important to remember that we use our tool
of EBP in a societal context that, as humans, we have a duty to
understand. Because EBP can be used for or against our fellow beings. And
I think we are at a special time in history when people all over the world
could say, we will not fight over tools (such as EBP, different political
systems and cultures and religions), but we will unite to ensure that we
treat each other as human beings. And this might mean, for us, in the US,
UK, Canada etc. speaking out against a campaign of displacing and killing
Afghan people.
Feeling compelled to post this but promising I will not speak on
this issue again - Mary
Mary Egan, PhD, OT(C)
Ontario Ministry of Health and Long-Term Care Career Scientist
School of Rehabilitation Sciences
School of Nursing
Faculty of Health Science
University of Ottawa
451 Smyth Road
Ottawa, Ontario K1H 8M5
(613) 562-5800 ext 8043
(613) 562-5428 (fax)
[log in to unmask]
http://www.health.uottawa.ca/megan/
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