Equality, Efficiency, and Effectiveness: Going Beyond RCTs in A. L. Cochrane’s Vision of Healthcare

0499642 - SOÚ 2019 RIV GB eng J - Journal Article
Trnka, Susanna - Stöckelová, Tereza
Equality, Efficiency, and Effectiveness: Going Beyond RCTs in A. L. Cochrane’s Vision of Healthcare.
Sociology of Health & Illness. Roč. 41, č. 2 (2019), s. 234-248. ISSN 0141-9889. E-ISSN 1467-9566
R&D Projects: GA ČR GA15-16452S
Institutional support: RVO:68378025
Keywords : Czech Republic * complementary and alternative medicine * evidence-based medicine
OECD category: Sociology
Impact factor: 2.317, year: 2019
https://onlinelibrary.wiley.com/doi/abs/10.1111/1467-9566.12817

A. Cochrane’s Effectiveness and Efficiency frequently appears as a key reference in debates over, and a justification for, contemporary evidence-based medicine. Cochrane’s concern in this text with the equality of care as the ultimate rationale for why effectiveness and efficiency of cure are needed has, however, largely disappeared from debate. In this article, we reconsider Cochrane’s approach through the use of case studies of plural forms of medicine in the Czech Republic, namely traditional Chinese medicine, homeopathy and spa care. In addition to bringing equality back into the picture, we also identify four expansions to Cochrane’s original vision arising from the difficulties of separating cure from care, the overlap between prevention and cure, the complex actions of some multi-faceted therapies, and recent reconceptualizations of the placebo effect. In conclusion, we suggest that instead of the widely used strictly vertical 'evidence pyramid', a descriptor of the horizontal and additive ordering of evidence might be more appropriate. We also argue that in healthcare systems characterized by a multiplicity of approaches, if we want to truly benefit from this heterogeneity, we must take seriously each medical tradition’s approaches to prevention, cure, care, as well as efficiency, efficacy, and equality.
Permanent Link: http://hdl.handle.net/11104/0292988