Prof. Robert A. Aronowitz (University of Pennsylvania): Lost in translations: clinical judgement and the highly intervened-in body

In economically advanced societies over the past half century, the amount, intensity, and power of medical interventions have created many historically unprecedented challenges for clinical and consumer judgment.  People and their bodies are more different from one another, making the translation of aggregate evidence of efficacy and safety to individual decisions even more difficult than in the past.  Increasingly, the effects of disease and intervention are hard to distinguish.  Health and illness are more likely to be mediated by prior or concurrent interventions than disease.  There is also a dearth of reliable prognostic knowledge about highly intervened-in diseases & bodies.  These and other developments have led to an increased reliance on therapeutic rationalism, greater clinical and patient/consumer improvisation, and other underappreciated changes in decision-making, providing care, and experiencing illness despite the ascendancy of ¡°evidence-based¡± medicine, and other efforts at data collection and evaluation.