What historiography can tell us about evidence-based medicine and policy: A response to Pawson’s ‘The Realist Foundations of Evidence-based Medicine’

Abstract

In the battle between experimental study designs and realist approaches, Ray Pawson has fired the next shot. This time evidence based medicine is in his aim. He argues that evidence based medicine is becoming more appreciative of specific circumstances of interventions and hence medical research may be approximating realist evaluation’s approach. He illustrates his argument with the history of cancer where the disease increasingly looks like it is playing ‘cat and mouse’ with researchers. In the paper I try to disentangle the epistemological and methodological dimensions of Pawson’s claim. I argue that, what may look similar on a narrative level, may not be consequential for the different types of epistemologies that sustain medical and policy impact research.