Wednesday, February 16, 2011

The value of truth...

The marriage of Comparative Effectiveness Research (CER) with the Culture-Centered Approach (CCA) seems to be one that was destined to happen...the synergies between these approaches to the uses of clinical information are incredible. This brings me to the core point about CCA, the one about Structure, and one that puts it in opposition to postmodern approaches to critical theory that often get reduced to the feel-good elements of identity politics in multiculturalism. In foregrounding the localized voices of the margins, the approach continually seeks to engage with entry points for making truth claims in relationship to social structures. That hunger is a truth in the most salient rendition of it is something that is continually brought to the forefront in multiple CCA studies.

If CCA is positioned in the quest for truth that is grounded in material evidence, the value of CER to CCA precisely lies in the quest for clinical evidence base for medical decision-making that is grounded in an empirical evidence base. The value of this evidence base precisely lies in the information capacity it seeks to build in the local communities at the margins. That information is ultimately powerful as a resource for patients who are often marginalized has been again and again articulated by community members. What is most amazing is the invaluable demonstration of ways in which individual community members search for this information base in their interactions with their physicians. The experiences of marginalization are often narrated precisely at these moments of physician-patient interactions, where information becomes the marker of structural violence. Community members talk about being marginalized precisely because they don't have access to information.

Therefore, for CCA to work well, where local communities feel empowered to make clinical decisions on the basis of the latest evidence base, the challenge is to (a) actually seek out the most credible evidence base for medical decision-making (if there is one thing that the CER process brings to surface, it is this: How often it is that medical decisions are made in the absence of adequate evidence-base for decision-making), and (b) find ways to center this evidence base as a resource for local communities (resist the grand narrative that local communities at the margins don't have the necessary skillsets to engage with information).

I want to wrap up this posting by foregrounding how important it is to continually come back to this quest for truth claims in CCA work because it is ultimately in these truth claims that we co-create opportunities for structural transformations.

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