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  4. Morten Sager

Morten Sager

Senior Lecturer

Linguistics and Theory of 91Ě˝»¨ unit
Telephone
+46 31-786 47 22
Mail
morten.sager@theorysc.gu.se
Visiting address
Renströmsgatan 6
41255 Göteborg
Room number
C536
Postal address
Box 200
40530 Göteborg

About Morten Sager

In my I use actor-network theory (ANT) to try out different ways of understanding how multiple actors, in the USA, related to stem cell research.

Currently, I lead a Forte-funded project on how knowledge supports can be drafted and used in social care services.

Previously I have been involved in a study about the newly implemented system for health insurance in Sweden. In the research project, we are interested in studying how universal standards such as the sick-listing recommendations confront and structure the practical use of the recommendations in physicians everyday clinical experience. The research project consists of two sections, where the first section focuses on the background to the recommendations and on the grounds based on which the recommendations have been developed, and the second section focuses on how physicians perceive the recommendations and their role in the clinical operations and as a basis for dialogue between various actors in the sick-listing process. The project is a collaboration between researchers from the Department of Public Health and Community Medicine and researchers from the Department of Philosophy, Linguistics and Theory of 91Ě˝»¨. The research project is running during 2010-2012.

I have also been involved in a research project about evidence-based medicine (EBM) together with Ingemar Bohlin (The Department of Sociology at 91Ě˝»¨ ): “A Double Movement: Production and Application of Knowledge within Evidence-Based Medicine”. The project dealt with how EBM was configured and established during (and before) the 1980s and 90s, and how this concept is now being implemented in Swedish health care. A major output of the project is the edited volume Evidensens mĂĄnga ansikten [The Many Faces of Evidence] published in the spring of 2011 on Arkiv förlag with Bohlin and myself as editors.

In the project we identified and analyzed the underlying assumptions about objectivity and reliability of the evidence-based methodology. Actor-network theory (ANT) was the main theoretical resource. Bohlin looked at the path from individual studies (such as Randomized Clinical Studies, RCTs) to the general summaries of reliable evidence. One important contribution by Bohlin, published in Evidensens många ansikten, was the uncovering of a multiplicity in the very origin of the evidence-based movement. At least four historical developments have anticipated and contributed to the movement: the outcomes movement, clinical epidemiology, meta-analysis, and the RCT. These developments cause insoluble tensions that remain in today’s performance of evidence-based medicine. In my research on the implementation of new guidelines these tensions (re-)appear between different actors on various levels.

My part of the project dealt with the movement from the general back to the individual (i.e. the clinical practice) with a special focus on cardiac health care in Sweden. The movement was followed across several levels, from the Swedish Council on Health Technology Assessment (SBU) and the Swedish National Board of Health and Welfare (Socialstyrelsen), via regional health politicians, health care managements and directors, to practicing doctors. Effects intended from higher levels of decision-making are often absent on the lower (not least the lowest) levels. Formulated in ANT-terms, it has been difficult to translate the actors’ interests sufficiently in order to arrive at the coordination of decisions and practices desired by the National Board; black boxes are not always (but sometimes) successfully created. As well the authorities’ actions as lower-level attitudes toward the initiatives build on specific assumptions about the nature of clinical competence and the presumed bases for clinical interventions. Different assumptions can be traced back to the historical developments explored by Bohlin. More specifically, I describe how administrators and the guidelines of the National Board of Health and Welfare rely on relevance typical of the outcomes movement while clinical cardiologists and SBU emphasize the rigour of evidence following from meta-analysis and RCTs. These conflicting views result in disagreements on the pace of implementation of two new device treatments in preventive heart care.