Reconstructing data: Evidence-Based Medicine and Evidence-Based Public Health in context

The emergence of Evidence-Based Medicine (EBM) as the gold-standard practice in biomedicine and public health practices represents a significant epistemological turn in modern medicine. The development of Evidence-Based Public Health (EBPH) followed the emergence of Evidence-Based Medicine, as an attempt to ground health policies and interventions on «sound facts». The present paper analyzes the historical and sociological roots of this turn. We evaluate the ethical and social consequences of this transformation, both within the medical profession (the polarization between a medical elite which strengthened its professional status, and a rank and file which (*) Center for the History and Ethics of Public Health, Mailman School of Public Health, Columbia University and Department of Health Systems Management. Division of Public Health. Faculty of Health Sciences. Ben Gurion University of the Negev. PO Box 653, Israel. E-mail: [email protected] (**) Department of Politics & Government. Faculty of Humanities and Social Sciences, Ben Gurion University of the Negev. PO Box 653, Israel. NADAV DAVIDOVITCH and DANI FILC 288 DYNAMIS. Acta Hisp. Med. Sci. Hist. Illus. 2006, 26, 287-306. experienced a process of «de-professionalization») and in its relationship to the welfare state (the link between the medical elite, EBM, EBPH and the commodification of health care and public health). Palabras clave: medicina basada en la evidencia, salud pública basada en la evidencia, historia de la salud pública, sociología de la salud, profesión médica.