Download Ethics and Evidence-Based Medicine: Fallibility and by Kenneth W. Goodman PDF

By Kenneth W. Goodman

The expansion of evidence-based drugs has happened opposed to a backdrop of future health care reform, controlled care, price containment, and caliber development. Clinicians were steered to undertake the trials of technological know-how whereas closing precise to their 'clinical judgment'. This incisive publication studies the background and conceptual origins of evidence-based perform and discusses key moral concerns that come up in medical perform, public well-being, and health and wellbeing coverage. it truly is crucial interpreting for all physicians, and practitioners in epidemiology and public well-being.

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Ignorance leads to error. Error can lead to medical harm. Preventable harms can be morally blameworthy. But where does evidence-based medicine fit on this continuum? What about the evidence- and outcomes-based practice guidelines? Do we know that use of, or adherence to, guidelines reduces particular errors – or is that we have reason to believe it will improve outcomes, a general measure? This distinction, between error reduction and outcome optimization, captures 19 20 Foundations and history one of the great tensions in the debate over evidence-based practice.

Phillips et al. 10 So the lowest level of evidence is “expert opinion without critical appraisal . ” and the highest level is shared by systematic reviews of randomized controlled trials, individual randomized controlled trials (with narrow confidence intervals), or “all-or-none” observational data in which either all patients die before a treatment is available but, later, some survive when the treatment becomes available, or some died before the treatment’s availability but none die on the treatment.

The distinction between individual and collective ignorance – a simple affair – is mainly that if no-one has evidence to support a particular belief, then it is not blameworthy if you are among them. But if most people have evidence for a belief, and you are not among them, then you are, or should be, in trouble. Failing to stay abreast of progress in one’s field becomes a moral failing. Indeed, as we earlier noticed, the duty to stay up to date was identified in antiquity. 12 This is especially true of training; it would be absurd if otherwise.

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