Evidence-based medicine and private clinics in Russia: Unlikely co-production of good care and profit-making.

Abstract

Critical social science research demonstrates that evidence-based medicine (EBM) emerged through its proponents' deliberate efforts to defend EBM's knowledge production methods as credible and independent of commercial interests. In the present study, we expand this discussion by showing how EBM is co-produced with profit-making within the context of private clinics in Russia. Drawing on the ethnography of three private clinics in Russia, we explore how they strategically articulate EBM ideals to demarcate the boundaries between good and bad medical practices. We identified four forms of boundary work that private clinics perform to define their epistemic culture as different from those applying poor quality evidence, providing harmful prescriptions, over-relying on clinical experience, and practicing a top-down approach in patient relations. We discuss how, in the Russian healthcare context, EBM, instead of becoming the opposite of commerce, has become interwoven with and even dependent on private healthcare.