Evidence-Based Medicine:
Arguments
Primary Contributors:
Editors: Beckett Sterner
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Evidence-Based Medicine:
Introduction
Introduction
Evidence-based medicine is now a highly influential as well as controversial approach to determining which practices doctors should adopt in the clinical care they provide. This page collects and reconstructs types of arguments for and against the approach.
Mechanistic Reasoning Is Unreliable
Mechanistic Reasoning Is Unreliable
RCTs have in the past elucidated certain treatments previously grounded in mechanistic principles to be generally ineffective or even outright harmful.
Example: A certain class of antiarrhythmic drugs, for instance, “became widely used based on what was (believed to be) understood about the causes of sudden death after heart attack (‘mechanistic reasoning’)” (Howick 2011). Clinical trials later revealed, however, that patients prescribed these drugs actually had a greater mortality than those given a placebo (Packer 1985).
It's Difficult to Apply Randomized Trial Results to A New Patient
It's Difficult to Apply Randomized Trial Results to A New Patient
RCTs are done on populations, but whether the results apply to individuals outside that study group is a difficult problem (Deaton and Cartwright 2018).
RCTs sometimes mandate strict inclusion criteria for participants and have neglected to incorporate women and minorities into research
References
References
Deaton, A., & Cartwright, N. (2018). “Understanding and misunderstanding randomized controlled trials.” Social Science & Medicine. 210, 2-21.
Howick, J. H. (2011). The Philosophy of Evidence-Based Medicine. John Wiley & Sons, Inc.
Packer, M. (1985). “Sudden unexpected death in patients with congestive heart failure: a second frontier.” Circulation. 72(4), 681-685.
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