By Tony McHugh
Drawing on reviews of floor topography, photograph modifying, and diagnostic and surgical event, Faces inside and out the hospital addresses the thought of ’truth’ in what are thought of to be ’right’ and ’wrong’ faces, no matter if in medical beauty approaches or in particular sociocultural contexts outdoor the hospital. With realization to the style during which the human face - and sometimes the person herself or himself therefore - is bodily outlined, conceptually judged, numerically measured and clinically analysed, this booklet finds that on nearer inspection, supposedly goal and evidential ’truths’ are actually subjective and prescriptive. Adopting a Foucauldian research of the ways that ’normalising applied sciences’ and ’techniques’ finally shield and extend upon an expanding array of ’abnormal’ facial configurations, Faces inside and out the medical institution exhibits that once deciding upon ’right’ and ’wrong’ faces, what occurs contained in the health facility is inextricably associated with what occurs outdoor the health facility - and vice versa. As such, it will likely be of curiosity to students and scholars of social, cultural and political conception, modern philosophy and the social clinical examine of technological know-how, future health and know-how.
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If the clinician’s subjective judgements are now juxtaposed with so-called ‘best available external evidence’ (the strength of which is contingent upon the aforementioned ‘hierarchy of evidence’), fundamental problems become apparent with the EBM approach. Ironically, as highlighted by Cohen and Hersh, ‘EBM is [itself] not evidencebased, because it does not meet its own empirical tests for efficacy’ (2004: 197). In fact, Cohen and Hersh go on to point out that for a system that claims to improve patient care by basing clinical decision-making on statistical 8 The ‘hierarchy of evidence’ consists of (in descending order): results of systematic reviews of well-designed studies, the pinnacle of which is the ‘double blind’ randomised controlled trial; results of one or more well-designed studies; results of large case series; expert opinion; and, personal experience (Harrison 1998: 20; Pandya 2008: 42).
Droplets of sweat emerge from the face. The skin’s sebaceous glands produce a mixture of lipid and cell debris (James et al. 2006: 1–13). Tears flow from lacrimal ducts, mucus from the nose, saliva and vomit are expelled from the mouth, and blood emerges whenever the face’s skin is sufficiently disrupted. With the passing of the years alterations in both the facial skeleton and the soft tissues result in a rotation of the facial structures downward and inward. Gravity and atrophy contribute to soft tissue changes (Kaufman et al.
Put another way, ‘the [EBM] model is therefore probabilistic (that is, one where the cause-effect relationships are inherently uncertain) and empiricist (that is, one where knowledge can only justifiably be derived from past experience)’ (Harrison 1998: 26). In fact, the results of this type of research have a tendency to randomise away clinically important individual characteristics. Randomised control trials inform us about possible ‘truths’ or correlations between experimental treatments and quantified results, whereas in the practice of individualised patient care we learn another set of ‘truths’ about the reciprocal nature of our actions (or non-actions) and their consequences.