University of Pennsylvania, Department of History and Sociology of Science and School of Medicine, USA.
University of California San Francisco, Department of Family & Community Medicine, USA.
Soc Sci Med. 2013 Dec;99:176-86. doi: 10.1016/j.socscimed.2013.04.009. Epub 2013 Apr 17.
The apolitical legitimacy of "evidence-based medicine" offers a practical means for ethnography and critical social-science-and-humanities-of-health theory to transfer survival resources to structurally vulnerable populations and to engage policy and services audiences with urgent political problems imposed on the urban poor in the United States that harm health: most notably, homelessness, hyperincarceration, social service cut-backs and the War on Drugs. We present four examples of collaborations between ethnography and clinical research projects that demonstrate the potentials and limits of promoting institutional reform, political debate and action through distinct strategies of cross-methodological dialog with epidemiological and clinical services research. Ethnographic methods alone, however, are simply a technocratic add-on. They must be informed by critical theory to contribute effectively and transformatively to applied health initiatives. Ironically, technocratic, neoliberal logics of cost-effectiveness can sometimes render radical service and policy reform initiatives institutionally credible, fundable and capable of generating wider political support, even though the rhetoric of economic efficacy is a double-edged sword. To extend the impact of ethnography and interdisciplinary theories of political-economic, cultural and disciplinary power relations into applied clinical and public health research, anthropologists - and their fellow travelers - have to be able to strategically, but respectfully learn to see through the positivist logics of clinical services research as well as epidemiological epistemology in order to help clinicians achieve - and extend - their applied priorities. In retrospect, these four very differently-structured collaborations suggest the potential for "good-enough" humble scientific and political strategies to work for, and with, structurally vulnerable populations in a punitive neoliberal era of rising social inequality, cutbacks of survival services, and hyperincarceration of the poor.
“循证医学”的非政治性合法性为民族志学和批判性社会科学及健康人文理论提供了一种切实可行的手段，使这些理论能够将生存资源转移到结构上处于弱势的人群，并使政策和服务受众关注强加给美国城市贫困人口的紧迫政治问题，这些问题损害了健康：最突出的是无家可归、过度监禁、社会服务削减和禁毒战争。我们提出了四个民族志学和临床研究项目合作的例子，展示了通过与流行病学和临床服务研究进行跨方法对话的不同策略，促进制度改革、政治辩论和行动的潜力和局限性。然而，仅靠民族志学方法只是一种技术官僚的附加手段。它们必须得到批判理论的指导，才能有效地、变革性地为应用健康计划做出贡献。具有讽刺意味的是，成本效益的技术官僚、新自由主义逻辑有时可以使激进的服务和政策改革计划在制度上具有可信度、可资助性，并能够产生更广泛的政治支持，尽管经济功效的言辞是一把双刃剑。为了将政治经济、文化和学科权力关系的民族志学和跨学科理论的影响扩展到应用临床和公共卫生研究中，人类学家——以及他们的同行——必须能够战略性地，但尊重地了解临床服务研究的实证主义逻辑以及流行病学认识论，以便帮助临床医生实现——并扩展——他们的应用重点。回想起来，这四个结构非常不同的合作项目表明，在一个社会不平等加剧、生存服务削减和穷人过度监禁的惩罚性新自由主义时代，“足够好”的谦逊科学和政治策略有可能为结构上处于弱势的人群服务，并与他们合作。
