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2 The history of evidence-based medicine: philanthropy and the drive to improve diagnostic methods in Ireland, 1915–1935
  1. John Wallace
  1. University of Oxford, Oxford, UK


Background The Rockefeller Foundation is an American philanthropic organisation that wished to improve diagnostic methods internationally. This wealthy, formidable agent for change focused on producing university-educated, science-orientated medical doctors. Laboratory-orientated diagnostic research was at its core based on an interaction between hospital, university, and laboratory. The overall aim of this study was to increase understanding of the Foundation’s attempts to introduce a more critical, scientific approach to diagnosis at the medical school in Trinity College Dublin between 1915 and 1935.

Research Methods This investigation involved a literature review and a case study. Employing a social-history methodology, the primary printed sources utilized, between 1915 and 1935, included.

  • journals such as The British Medical Journal, the New England Journal of Medicine, The American Journal of Nursing, and The Lancet.

  • newspapers such as the New York Times, The Illustrated London News, The Irish Times, and The Washington Post, among others.

  • electronic databases were also used, including the Lind Library, The Cochrane Library, Medline, and Embase.

Findings Trinity College Dublin did not embrace proposals to introduce a more scientific approach to medical diagnosis. There was a suspicion of laboratories. Individualism was valued over standardisation. There was a tension between bedside and laboratory medicine. Dublin, like Edinburgh, turned out practically-trained, all-round medical men suited to needs of the British navy and colonies. The Foundation had also wanted co-operation between the two Dublin universities with different religious affiliations. The Foundation wished hospitals to be under academic rather than religious control. There was a concern in Dublin about the Foundation’s motivation and also a reluctance to accept external financial assistance. By 1933, the offer of funding was withdrawn.

Conclusion and Recommendations Political, cultural, and structural factors can play a decisive role in how science is perceived. In Dublin, the Rockefeller Foundation encountered significant barriers to its attempts to apply a technical, laboratory-based model to medical diagnosis. The financial support offered by the Foundation was effectively declined due to entrenched social, cultural, and religious factors. Ingrained attitudes meant that the Rockefeller Foundation was defeated in its plans. Science is not neutral and money could not wipe out old antagonisms. Ultimately, in the field of diagnostic methodology, Dublin failed to accommodate itself to a wealthy, formidable agent of scientific philanthropy.

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