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 their medical decisions. The evidence-based medicine movement is an example of the present effort to teach clinicians to evaluate research evidence by methodologic standards. Though this effort can only improve the clinical decisions of practitioners, it suggests that when assessing evidence there are no reasons to critically evaluate the standards of research and evidence themselves. A precedent for assessing standards of research and evidence exists in the broad tradition known as "criticism". Using contextual, cultural and other forms of analysis, writers have used criticism to show that the meaning and validity of scientific evidence is influenced as much by the sociocultural characteristics of readers and users as it is by the meticulous use of research methods. Scholars outside of medicine have suggested, for example, that data become evidence only in the context of specific beliefs and disagreements and that there are interesting pragmatic reasons why we see some forms of evidence and not others in the medical literature. Social critical studies of research and evidence would reveal the many influences similar to these that are relevant to clinical medicine. The effort would be practically useful to physicians, who with a broader understanding of research could critically appraise published evidence from 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 sociocultural domains which subsume them.