ESHS/HSS Annual Meeting

Defying the logic of the randomised controlled trial: Evidential disparity of treatment strategies for congenital toxoplasmosis in a (proto-)EBM-world, 1960s–1990s

• In Event: The Politics, Epistemology and Ethics of Medical Evidence, ca. 1960–ca. 2000

English Abstract

Debates of parasitologists, obstetricians, and public health experts on introducing or rejecting prenatal screening for toxoplasmosis have revolved around one central topic: the safety and thus acceptability of prenatal drug treatment to prevent a maternal-fetal transmission of Toxoplasma gondii, and thus congenital toxoplasmosis. Only if acceptable treatment was available would screening for case-finding be justified and worth the burden for the screened population and the costs for the public.
A comparative analysis of arguments (1960s–1990s) about case-management from countries that adopted screening and drug treatment in the 1970s (Austria, GDR, France) and those who did not (USA, UK) exposes significantly differing evidential judgements of the evolving clinical knowledge from continental Europe on effectiveness and safety that was never able to keep pace with the ever-increasing demands of proto-evidence-based-medicine (EBM) in the anglophone world. Moreover, opposing stances on “therapeutic abortion” as an acceptable intervention became apparent, with experts in the USA promoting it without even seeking solid laboratory evidence for an infection, Austrian experts condemning abortion, and French and GDR experts taking intermediate positions. This divergence indicates a judgment of medical evidence based less on explicit standards than on its compatibility with established practices, moral and ethical norms, and economic interests.
By taking the respective national contexts into account, I will analyse epistemic and medical developments regarding toxoplasmosis treatment during pregnancy alongside the evolution of proto-/explicit EBM demands, and discuss deficiencies of solely applying associated standards to every disease even if ethics and the natural history of the condition prevent meaningful output—partially by exaggerating the randomised controlled trial and associated evidence-based knowledge as the only valid form of medical evidence.

Author

• Hanna Lucia Worliczek, University of Vienna, Faculty center for transdisciplinary historical-cultural studies