Countering medical nihilism by reconnecting facts and values

Upshur, Ross; Goldenberg, Maya J.

doi:10.1016/j.shpsa.2020.08.005

Cited by 6 publications

(5 citation statements)

References 29 publications

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“…By embracing and acknowledging values and exploring them seriously, we anticipate (as others before us) that EBM will achieve a more mature, and socially useful status. 39…”

Section: Discussionmentioning

confidence: 99%

“…Our argument supports and adds to a growing body of literature contesting the possibility (or even desirability) of EBM's prescriptive goal to inform clinical decisions by solely curating evidence. This literature-powered by voices such as Upshur, 5,38,39 Goldenberg, 8,40 and Kelly 41 -is itself building on a now well-established feminist and post-positivist literature in the philosophy of science. In light of this robust philosophical literature, EBM and its proponents adapted their philosophical view to recognize the role of clinicians' expertise and patients' values in clinical decision-making.…”

Section: Implications For Ebm (And Ebm-users)mentioning

confidence: 99%

“…This difference in prioritization can best be explained in terms of inductive risk. 39,42 Inductive risk refers to the risk for error that occurs when we infer broader conclusions from limited data, which is omnipresent in medicine and most evident in the case of developing clinical guidelines from EBM evidence. The decision-maker must balance the opposing wrongs of false positives and false negatives.…”

Section: Is Probably the Most Comprehensive Criticmentioning

confidence: 99%

“…While EBM was developed to rescue clinical medicine from physicians' fallibility and value-ladenness, it fails to recognize-or at least convincingly acknowledge-that the relationship of physicians with evidence is itself fallible and value-laden. 39 EBM effectively maintains a dichotomy between the 'objective value-free' evidence and the 'subjective values' of patients and society. 4 While they acknowledge the ubiquity and need for values, advocates of EBM merely encompass them in patients' values and preferences.…”

Section: Implication 2: An Optimal Theory Of Evidencebased Decision-m...mentioning

confidence: 99%

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Use of evidence in acute stroke decision‐making: Implications for evidence‐based medicine

Langlois-Thérien

Dewar

Upshur

et al. 2021

Evaluation Clinical Practice

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Rationale, aims and objectives Evidence‐Based Medicine proposes a prescriptive model of physician decision‐making in which ‘best evidence’ is used to guide best practice. And yet, proponents of EBM acknowledge that EBM fails to offer a systematic theory of physician decision‐making. Methods In this paper, we explore how physicians from the neurology and emergency medicine communities have responded to an evolving body of evidence surrounding the acute treatment of patients with ischemic stroke. Through analysis of this case study, we argue that EBM's vision of evidence‐based medical decision‐making fails to appreciate a process that we have termed epistemic evaluation. Results and Conclusions Physicians are required to interpret and apply any knowledge—even what EBM would term ‘best evidence’—in light of their own knowledge, background and experience. This is consequential for EBM as understanding what physicians do and why they do it would appear to be essential to achieving optimal practice in accordance with best evidence.

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“…By embracing and acknowledging values and exploring them seriously, we anticipate (as others before us) that EBM will achieve a more mature, and socially useful status. 39…”

Section: Discussionmentioning

confidence: 99%

Section: Implications For Ebm (And Ebm-users)mentioning

confidence: 99%

Section: Is Probably the Most Comprehensive Criticmentioning

confidence: 99%

Section: Implication 2: An Optimal Theory Of Evidencebased Decision-m...mentioning

confidence: 99%

See 2 more Smart Citations

Use of evidence in acute stroke decision‐making: Implications for evidence‐based medicine

Langlois-Thérien

Dewar

Upshur

et al. 2021

Evaluation Clinical Practice

View full text Add to dashboard Cite

show abstract

“…It is worth noting that evidence-generating activities and the evidence (or facts) they generate are fallible and value laden 17 18. Choices about research questions and methodologies are usually determined by a narrow group of individuals (often excluding the voices of individuals with experience in substance use and other key stakeholders) leading to an evidence base that is incomplete and biased 18…”

Section: The Role Of Evidencementioning

confidence: 99%

Prescribing safe supply: ethical considerations for clinicians

et al. 2022

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The COVID-19 pandemic has exacerbated the drug poisoning epidemic in a number of ways: individuals use alone more often, there is decreased access to harm reduction services and there has been an increase in the toxicity of the unregulated drug supply. In response to the crisis, clinicians, policy makers and people who use drugs have been seeking ways to prevent the worst harms of unregulated opioid use. One prominent idea is safe supply. One form of safe supply enlists clinicians to prescribe opioids so that people have access to drugs of known composition and strength. In this paper, we assess the ethical case for clinicians providing this service. As we describe, there is much that is unknown about safe supply. However, given the seriousness of the overdose death epidemic and the current limited evidence for safe supply’s efficacy, we argue that it is ethically permissible for clinicians to begin prescribing opioids for some select patients.

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Emerging, Evolving Self-Regulation by the Scientific Community

Redman

2023

Reconstructing Research Integrity

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Countering medical nihilism by reconnecting facts and values

Cited by 6 publications

References 29 publications

Use of evidence in acute stroke decision‐making: Implications for evidence‐based medicine

Use of evidence in acute stroke decision‐making: Implications for evidence‐based medicine

Prescribing safe supply: ethical considerations for clinicians

Emerging, Evolving Self-Regulation by the Scientific Community

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