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Thinking about early 20th c medical practitioners and their fascination with standardisation and how absolutely vital this was to medicine's success as an institution has produced some thoughts.
in early 20th c, widespread belief was that medical standardisation was not only about ensuring conformity, it was also considered vital to innovation. Without a standard, there was no basis from which to deviate, thereby to innovate. standards were idealised as process, not end.
The early 20th c notion that standards were arbitrarily set so that deviations from these standards will absolutely occur and then, where successful, be adopted as standard themselves and so on shows the sway of industrial notions of progress in medicine.
Whether following industry was good or bad, it dictated that success would come through values like conformity and stability and then innovation--this would lead, it was thought, to exactly the kind of medical progress - of standard to standard to standard - that we now embrace.
we see the good side of these notions here and there. e.g., for all of the inability of medicine to 'cure' COVID-19, practitioners have usefully 'innovated' from related standards of care to create supportive practices specific to COVID-19. And they have done so quickly.
But when thinking about it in these terms, we also are forced to recognise the downside of our current fascination with what the 'evidence' says, since standards and evidence are somewhat in tension with each other, even as they are also - recently - intimately connected.
Unlike standards, evidence has been constructed as very much about the determination of what is best. Yet, evidence is also intractable, inscrutable, interpretable. TO use it to decide what to make standard is by definition an unrewarding and paradoxical process.
Evidence - this purported gold standard of practice - acts structurally in this equation to induce chaos, to defy standard setting. it is easily adopted as a way of challenging or curtailing unbridled authority, which, god knows, is often really necessary.
but the lesson from the vantage point of the early 20th c - is that evidence should not be the determiner of standards, its use comes further down the line, to test the standard and dispatch with it, if need be. If brought in too early, only chaos ensues.
And in a health crisis, where health is constructed as this weird standard from which we all have recently deviated, what we seem to need as a cure is a restoration of health order: a conformation of practices and ideas, the opposite of the chaos of evidence.
Our obsession with evidence, after all quite a recent one, deserves greater scrutiny. it shouldn't be a given that this is the best or only way to operate. Perhaps the standard of using evidence to determine things is a standard we might usefully deviate from? So far, we haven't.
That would involve a major sea change in our thinking and mores...And I'd also be happy to suggest that standard-setting as a mode of medical practice was itself an arbitrary decision - set as standard - in the early 20th c--not best or only, but expedient. So there's that.
