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Beacon: The Index of Evidence

The Centre’s Beacon Projects aspire to exemplify the ways in which the Centre aims to create and sustain cultures and environments of health through transdisciplinary engaged research.

How is evidence constituted and mobilised in health decision-making in a ‘post-truth’ world?

Professor Mike Michael (Affiliate Member)
Professor Laura Salisbury
Professor Steve Hinchliffe
Dr Lara Choksey

This project uncovers and explores the constitution and mobilisation of medical evidence in health decision-making in the twentieth century, while undertaking an analysis of the contemporary use of medical facts in a so-called ‘post-truth’ world.

The project will track the emergence of evidence-based medicine and the use of Randomised Controlled Trials as the gold standard, alongside the challenges to this model from qualitative and more narrative-based approaches. This account will be situated within a longer history of medicine; it will also be read alongside a twentieth-century history of ideas that pays attention to the linguistic turn, the turn to narrative, and the emergence of what Jean-Francois Lyotard named an ‘incredulity towards metanarratives’ that gained traction in the humanities and social sciences at precisely the moment that evidence-based medicine was becoming discursively and institutionally powerful. By placing the use of quantitative and qualitative evidence in health decision-making within a broader intellectual history, including the two cultures debate of the 1960s, the theory wars of the 1980s, the movement from matters of fact to matters of concern, and the more recent emergence of so-called ‘post-truth’ in public discourse, this project will enable an analysis of which aspects of evidence, as it is currently constituted, need to be defended, and which aspects can valuably be complicated and transformed to enable the emergence of ‘healthy publics’.

Access to digital media and big data analytics have ensured that variously constituted (and constituting) publics are exposed to and mobilise increasing amounts of information. But information cannot be transformed into credible evidence, or into facts that are legible as such, without modes of interpretation that use affective investments, narratives, generic conventions and particular patterns to render data into a meaningful shape. Changes in the ways in which people access information have transformed narratives and genres of evidence, however, destabilising the consistency of discourses of fact and fiction and the distinction between the quantitative and the qualitative in ways that sometimes enable richer understandings of the complexity of actions and relations, but sometimes weaponise uncertainty. Current conditions thus render particularly explicit the ways in which the cognitive and affective experiences folded into health decision-making necessarily rely on complex patterns rather than particular points of evidence. This project will survey shifts in the affects, investments and genres that are essential to the constitution and mobilisation of facts and evidence in health decision-making at the macro level in order to determine trends in the relationship between Western biomedicine and discourses concerned with truth and efficacy. It will also use carefully developed case studies to track the complex and multiple connections that are assembled in and between publics and the medical evidence they both use and by which they are used. This aspect of the research will seek to engage publics to help determine the research questions and sites, and to take account of the patterns of affects and investments that go into a particular set of health decision-making practices.

The final part of the project will engage with publics to co-create knowledge about how medical evidence, understood as a complex assemblage and as working through particular genres and patterns that collapse the boundaries between qualitative and quantitative, might be represented, disseminated and used. Researchers and publics will use the Centre to work with artists on innovative ways to present the multiple and sticky elements that come together to form evidence in ways that might facilitate the emergence of healthy publics.


The Index of Evidence

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