The warp of evidence-based medicine: Lessons from dutch maternity care

Most critiques of evidence-based medicine (EBM) focus on the scientific shortcomings of the technique. Social scientists are more likely to criticize EBM for its ideological biases, a criticism that makes sociological sense but is difficult to substantiate. Using evidence from the scientific debate over maternity care in the Netherlands-where nearly one-third of births take place at home-the author shows that research evidence is the product of a researcher's assumptions about the practice in question. In the case of maternity care in the Netherlands, ideological differences about the most appropriate way to give birth-based in the researcher's clinical experience give rise to irresolvable disagreements about what constitutes evidence and how that evidence is to be interpreted. "Evidence" cannot settle scientific disputes in any simple way. Rather, it becomes a rhetorical justification for whatever particular groups were going to do anyway. Scientific evidence rests on clinical practice, which in turn is rooted in structural arrangements and cultural ideas.