From data to evidence
Résumé
The randomised controlled trial (RCT) is considered the scientific foundation of medical practice in evidence based medicine. Therefore, the evidence it brings should put an end to controversies. But this was not the case if we look at the demonstration of the protective role of male circumcision (MC) against HIV/AIDS infection. Although based on a series of epidemiological investigations, culminating in RCTs, the benefits of MC are a controversial subject in the medical and scientific community. The RCTs are considered too reductionist; they allow for control during the investigation but are divorced from real-life conditions. In fact, evidence appears as a social,construction, relying on,more than objective factors, sometimes prejudices and misconceptions. Articles published on MC in scientific journals over nearly two decades and the reactions they elicited, both inside and outside the,medical community are analysed. Data produced within RCTs have been criticised, notably for the gap between efficacy and effectiveness, experimentation and experience. Even though it is reduced, uncertainty is not dispelled by RCTs. In any case, this does not influence the scaling up of MC, which depends on both scientific evidence and the personal beliefs of the actors --researchers, decision makers, and the public.
Origine : Fichiers produits par l'(les) auteur(s)
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