Journal of medical ethics
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Journal of medical ethics · Apr 2004
ReviewEvidence based medicine guidelines: a solution to rationing or politics disguised as science?
"Evidence based medicine" (EBM) is often seen as a scientific tool for quality improvement, even though its application requires the combination of scientific facts with value judgments and the costing of different treatments. How this is done depends on whether we approach the problem from the perspective of individual patients, doctors, or public health administrators. Evidence based medicine exerts a fundamental influence on certain key aspects of medical professionalism. ⋯ This challenges traditional professionalism in much the same way as managed care has done in the US. Here we chart some of these major philosophical issues and show why simple solutions cannot be found. The profession needs to pay more attention to different uses of EBM in order to preserve the good aspects of professionalism.
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Traditionally, surgical practice has been experiential and based on the contemporary understanding of basic mechanisms of disease. It was both a science and an art and depended to far too great an extent on the individualism and self belief of its main exponents. "Evidence based medicine" (EBM) emerged in the 1980s and a new gospel of "Rules of Evidence" was introduced. ⋯ There are valid and spurious reasons for this that are discussed. The situation is improving but inevitable tensions remain between the surgeon committed to the individual patient here and now, and the clinical researcher whose focus is the benefit of future patients in the larger community.
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Journal of medical ethics · Apr 2004
ReviewEvidence-based medicine and ethics: a practical approach.
The clinical decision is supposed to be based on evidence. In fact, what counts as evidence is far from being established. ⋯ Evidence in medicine very often has fuzzy boundaries, and dichotomising fuzziness and uncertainty can have serious consequences. Physicians and patients should accept the irreducible fuzziness of many of the concepts they use when dealing with health and disease.
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Journal of medical ethics · Apr 2004
ReviewEthical problems arising in evidence based complementary and alternative medicine.
Complementary and alternative medicine has become an important section of healthcare. Its high level of acceptance among the general population represents a challenge to healthcare professionals of all disciplines and raises a host of ethical issues. This article is an attempt to explore some of the more obvious or practical ethical aspects of complementary and alternative medicine.
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Journal of medical ethics · Apr 2004
CommentThe standard of care debate: against the myth of an "international consensus opinion".
It is argued by Lie et al in the current issue of the Journal of Medical Ethics that an international consensus opinion has formed on the issue of standards of care in clinical trials undertaken in developing countries. This opinion, so they argue, rejects the Declaration of Helsinki's traditional view on this matter. ⋯ Although the latter conclusion is supported by this author, it will be demonstrated in this paper that there is not such a thing as an international consensus opinion, and that the authorities used by Lie et al as evidence in support of their claim should not be relied upon as authorities or final arbiters in this debate. Furthermore, it will be shown that arguments advanced substantively to show that lower standards of care are ethically acceptable in the developing world, conflate scientific with economic reasons, and ultimately fail to bolster the case they are designed to support.