Image shown: Sheelagh Broderick

Sheelagh Broderick

Evidence-based medicine is the use of current best research in making decisions about the care of individual patients. With the delivery of arts projects within healthcare settings, there is a debate at large as to whether it is appropriate to apply an evidence-based approach to arts interventions. Sheelagh Broderick, artist and PhD researcher, presents her views.

‘The notion of evidence-based art is as absurd as an impressionist school of science’ (1)

Evidence is a concept that can fall into many categories; judicial evidence to establish a burden of proof, experimental evidence to verify or falsify hypotheses and statistical evidence to establish patterns.(2) It exists in relation to questions originating from a particular context and which are as a consequence already guided by inference.

In the domain of healthcare, the specific context is largely one of cure or care. Therefore it is unsurprising that the questions originating within this specific domain concern cure or care and in the case of arts practices are often formulated to consider ‘the healing power of the arts’. As a consequence of the dominance of evidence-based approaches to medicine (EBM) and in tandem with a misunderstanding of the differences between arts therapies, arts recreation services and contemporary arts practices, the question of evidence has become a pressing one in relation to arts practices in healthcare settings.

The deployment of EBM in relation to arts practices in healthcare settings is challenged in this essay from two different points of view. Firstly I refer briefly to both internal and external critics of EBM and secondly, I point to an internal logical incoherence when such approaches are applied to arts practices.

The purpose of Evidence Based Medicine (EBM) is to identify safe, replicable and cost-effective interventions that can provide positive clinical outcomes to a target population. Policy makers and practitioners often see EBM as a ‘gift horse’ in the way that it combines science and managerial practices.(3) EBM purports to offer a transparent evaluative process. It offers the promise of objective measures to distinguish between effective interventions on the basis of resource allocation. It is easily deployed by decision makers who act on the basis of its ‘independent’ advice. It has become the dominant mode of validating knowledge in healthcare, providing a ranking schema for deciding which studies warrant greater recognition by deploying a hierarchy of evidence. Systematic reviews and randomised control trials rank highest while expert opinion is ranked lowest.

But EBM has also been seen as a ‘Trojan horse’ as it obscures the subjective elements that inescapably enter all forms of human inquiry.(4) The seemingly self-evident common sense of EBM occurs because it is assumed that contaminating factors such as social context have been statistically removed. The pervasive view that evidence-based practices stand or fall in the light of ‘evidence’ is based on outdated understanding of evidence as ‘facts’, through the scientific elimination of culture, contexts, and the subjects of knowledge production. Even advocates for EBM have expressed concern that a critical appraisal of studies can reveal a lack of rigour and tendency to bias.(5) This blind belief in a method ‘permits the use of evidence as a political instrument where ‘power interests can be obscured by seemingly neutral technical resolve’.(6)

Taking a satirical view, De Vries and Lemmens record their frustration with EBM in their article, ‘Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomized controlled trials.’ With tongues firmly planted in cheeks, the authors review the medical evidence on the value of parachute use and conclude: (a) no RCTs of parachute use have been done, and (b) the basis for parachute use is ‘purely observational’, and could potentially be explained by a ‘healthy cohort’ effect. They conclude; ‘individuals who insist that all interventions need to be validated by a randomized clinical trial need to come down to earth with a bump’.(7)

Notwithstanding these critiques, the question whether arts interventions should be subjected to clinical trials depends largely on what kind of arts intervention is at stake. The clinical evaluation of arts therapies is logically consistent as they are conceived of as clinical interventions, but clinical evaluation of contemporary arts practices is to misunderstand them. Expectations of positive clinical outcomes, places an unreasonable burden on artists who are not clinically trained and imposes an unreasonable doubt on contemporary arts practices.(8) These arts practices are concerned with issues such as power and knowledge, spectatorship and participation, institutional and public spaces, technology and embodiment, through diverse artforms including digital media, sculpture, performance and painting.  They are not intended as clinical interventions and present clinical researchers with substantive and ethical impediments in research design.

Substantive issues relate to the necessity for trials to be replicable and to be constructed so that findings can be generalised to a given population. Arts practices are not replicable. An artist working with a specific cohort of people will not come up with the same outcomes or outputs when working with other groups. Similarly two artists working with the same group will not generate the same outcomes or outputs. Nor will an installation in one setting amount to the same thing when transported to another. Neither do arts practices give rise to generalisable outcomes. Sample sizes are too small to make generalisable claims that will stand up to subsequent scrutiny. In order to generate a statistically reliable outcome, a large sample is required as research findings are less likely to be true when the studies conducted in a field are smaller. Finally ethical issues arise in relation to the imposition of a clinical frame on an arts practice that is not concerned with clinical outcomes.

The artist is concerned with an aesthetic that stands apart from clinical practices. When artists infiltrate healthcare spaces, their practices enter what Gadamer has coined ‘the grey zone’ – ‘those areas which are not fully amenable to techniques of methodological verification’.(9) Blum has also noted this indeterminacy when he writes of the zone of ambiguity that haunts modern medicine with unspoken assumptions, understandings and equivocations that cannot be completely mastered and made explicit.(10) The field of art itself operates in this ‘grey zone’ of indeterminacy refusing to offer a definitive answer to the question ‘What is art?’, although Aranda et al concede that art at its best does not provide answers and solutions; it creates problems, troubling accepted narratives.(11)

That is not to say that such arts practices should pass without ethical oversight or critical reflection. The website is an important step in creating such a critical platform. It must be populated by examples of practice that can document prevalence, and also act as a locus for an interdisciplinary critical discourse that includes discussion of validation practices.

‘We like to pretend that our experiments define the truth for us. But that’s often not the case. Just because an idea is true doesn’t mean it can be proved. And just because an idea can be proved doesn’t mean it’s true. When the experiments are done, we still have to choose what to believe.’ (12)

(1) M. Baum, “Evidence-based art?,” Journal of the Royal Society of Medicine 94, no. 6 (2001): 306.

(2) Thomas J.Csoradas, “Evidence of and for what?,” Anthropological Theory 4, no. 4 (December 1, 2004): 474.

(3) Helen Lambert, Elisa J. Gordon, and Elizabeth A. Bogdan-Lovis, “Introduction: Gift horse or Trojan horse? Social science perspectives on evidence-based health care,” Social Science & Medicine 62, no. 11 (June 2006): 2613-2620.

(4) Maya J. Goldenberg, “On evidence and evidence-based medicine: Lessons from the philosophy of science,” Social Science & Medicine 62, no. 11 (June 2006): 2621-2632.

(5) K. L. Florczak, “Rigor: Lost in the Quest for Evidence-Based Practice,” Nursing Science Quarterly 24, no. 3 (July 2011): 202-205; John P. A. Ioannidis, “Why Most Published Research Findings Are False,” PLoS Med 2, no. 8 (2005): e124.

(6) Goldenberg, “On evidence and evidence-based medicine,” 2622.

(7) Smith & Pell, 2003, p. 1460 cited in Raymond De Vries and Trudo Lemmens, “The social and cultural shaping of medical evidence: Case studies from pharmaceutical research and obstetric science,” Social Science & Medicine 62, no. 11 (June 2006): 2694-2706.

(8) Sheelagh Broderick, “Arts practices in unreasonable doubt? Reflections on understandings of arts practices in healthcare contexts,” Arts & Health: An International Journal for Research, Policy and Practice (June 2011): 1-15.

(9) HansGeorg Gadamer, The Enigma of Health: The Art of Healing in a Scientific Age (Polity Press, 1996), 106.

(10) Alan Blum, The Grey Zone in Health and Illness (Intellect, 2010).

(11) “Editorial – ‘Artistic Thinking’,” e-flux, no. 26 (2011),

(12) Jonah Lehrer, “The Truth Wears Off: Is there something wrong with the scientific method?,” The New Yorker, December 13, 2010,

Sheelagh Broderick

Sheelagh Broderick is a PhD Artist researcher with the Graduate Schools of Creative Arts and Media. Her research concerns arts practices in healthcare settings.


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