Personal paper: Ethics and evidence based medicine

A comparison of two approaches used to gather evidence to support clinical decision making: An editorial

“…Popularization of the EBP approach has led to debate (Herbert, Sherrington, Maher, and Mosely, 2001;Powers, 2003) and criticism (Kerridge, Lowe, and Henry, 1998;Sinclair, 2004;Tanenbaum, 1999;Tonelli, 1998;Tygiel, 2001) by several authors. While it is beyond the scope of this editorial to reiterate all of the issues in their entirety, some will be highlighted to contrast two discordant methods of gathering and using evidence.…”

“…Several authors have taken issue with this assumption and criticized the EBP approach because information derived from the literature may not be easily translated to the clinical context. Apart from issues debated in the literature such as generalizability of research finding across environments or across patients (Herbert, Sherrington, Maher, and Mosely, 2001;Tanenbaum, 1999;Tonelli, 1998), applying a priori rules across situations (Sinclair, 2004), or whether EBP is ethically sound (Biller-Andorno, Lenk, and Lietitis, 2004;Kerridge, Lowe, and Henry, 1998;Kirschner, 2001) the type of knowledge derived from written information is different compared to clinical knowledge. Basically, professional skills cannot be obtained entirely from printed material in general or from scientific knowledge specifically (Sinclair, 2004;Tanenbaum, 1999;Tonelli, 1998;Tygiel, 2001).…”

Développer de meilleures pratiques

“…Enfin, l'allocation des ressources sur la base de données probantes implique la possibilité de jugements de valeur, comme celui que le manque de données probantes signifie un manque de valeur. Enfin, le risque existe que : « Those charged with making these decisions are seeking simplistic solutions to inherently complex problems… the danger is that through evidence based medicine we will supply them » (Kerridge et al, 1998).…”

The precarious future of the discourse of person-centered medicine

“…They lead also to critiques and the critiques lead to dialectic that often modifies the original discourse. In the case of EBM, counter-discourses (see, for example, [12][13][14][15][16][17][18][19][20][21][22][23]), have meant that the early privileging of numerical data [24][25][26] has had to be softened so that experience and informed professional opinion can be included in the hierarchy of levels of evidence [27][28][29]. EBM has survived in part because it has been prepared to compromise, to allow back into its fold the kinds of evidence that it initially criticized and rejected.…”