Enacting evidence-based medicine in fertility care: Tensions between commercialisation and knowledge standardisation.

Manuela Perrotta,Alina Geampana

doi:10.1111/1467-9566.13381

Manuela Perrotta, Alina Geampana

Open Access

https://doi.org/10.1111/1467-9566.13381

Copy DOI

Abstract

In this article we explore the recent enactment of evidence-based medicine (EBM) in the field of fertility care. We aim to contribute to the medical sociology literature through an analysis of how evidence is produced, interpreted and institutionalised in a relatively new medical field such as in vitro fertilisation (IVF), characterised by high uncertainty due to limited knowledge and high levels of commercialisation. Drawing on extensive ethnographic research conducted in England, this article explores the challenges IVF professionals encounter in producing credible data on the effectiveness of additional treatments, offering novel insights on the tensions between commercialisation and standardisation in the enactment of EBM. Extant medical sociology and Science and Technology Studies literature has shown the hidden professional work required to enact randomised control trials in practice. Our analysis shows that this hidden work is not enough when there is a broader lack of standardisation in both clinical and research practices, as producing 'good quality' evidence requires high levels of standardisation of knowledge production.

Highlights

The rise of evidence-based medicine (EBM) in the last four decades has made it imperative to use ‘the best available evidence’ in making decisions about the care of individual patients (Sackett et al, 1996)
Drawing on the medical sociology literature, in this article we explore the recent enactment of EBM in fertility care and in vitro fertilisation (IVF)
As fertility care developed in the late 1970s and 1980s, at a time when EBM was not yet accepted as dominant practice, all IVF treatments currently considered standard were initially introduced without the support of clinical trials

Summary

Introduction

The rise of evidence-based medicine (EBM) in the last four decades has made it imperative to use ‘the best available evidence’ in making decisions about the care of individual patients (Sackett et al, 1996). Drawing on the medical sociology literature, in this article we explore the recent enactment of EBM in fertility care and IVF (in vitro fertilisation). The medical literature offers two main opposing explanations for the scarcity of evidence: some scholars suggest that this is mainly due to the commercialisation of the sector, as private clinics have an interest in continuing to sell expensive unproven treatments (Harper et al, 2017; Wilkinson et al, 2019a), while other scholars believe that, due to the specificity of fertility care, IVF treatments are not suitable to be assessed through EBM criteria (Cohen & Alikani, 2013; Dhont, 2013; Macklon et al, 2019)

Objectives

Methods

Discussion

Conclusion