Ethical Issues in Evidence-Based Medicine

“Evidence-based medicine” (EBM), a term coined in the early 1990s, has become a key component of medical education and clinical practice internationally. January’s authors consider how physicians should best use EBM in medical decision making—balancing statistical evidence from systematic research with their own knowledge and experience and the unique characteristics and values of the individual patient. Contributors also consider aspects of EBM that relate to medical education, including the incorporation of ethics into the teaching of EBM—topics relevant to mentors and trainees alike.

Volume 15, Number 1: 1-97 Full Issue PDF
  • From the Editor
    Jan 2013

    Evidence-Based Medicine: A Science of Uncertainty and an Art of Probability

    Matthew Rysavy
    That is how William Osler portrayed the medicine he practiced at the turn of the last century, but he might as well have been describing the current era of “evidence-based” medicine.
    Virtual Mentor. 2013;15(1):4-8. doi: 10.1001/virtualmentor.2013.15.1.fred1-1301.
  • Case and Commentary
    Jan 2013

    Communicating Evidence in Shared Decision Making

    Paul J. Christine, MPH and Lauris C. Kaldjian, MD, PhD
    Shared decision making requires that physicians acknowledge their responsibility to the patient, their responsibility to be true to their own clinical judgment about the patient's best interest, their accountability to society, and the uncertainty of the evidence.
    Virtual Mentor. 2013;15(1):9-17. doi: 10.1001/virtualmentor.2013.15.1.ecas1-1301.
  • Case and Commentary
    Jan 2013

    Authority, Health Advocacy Organizations, and Scientific Evidence

    Jodi Halpern, MD, PhD and Richard L. Kravitz, MD, MSPH
    Just as people frequently support political parties without endorsing their entire platforms, perhaps physicians can support a health care advocacy organization without agreeing with its screening guidelines.
    Virtual Mentor. 2013;15(1):18-22. doi: 10.1001/virtualmentor.2013.15.1.ecas2-1301.
  • Medical Education
    Jan 2013

    Teaching Critical Appraisal of Medical Evidence

    Martha Carvour, MD, PhD
    Three practical methods for actively teaching critical appraisal skills in an evidence-based medicine curriculum.
    Virtual Mentor. 2013;15(1):23-27. doi: 10.1001/virtualmentor.2013.15.1.medu1-1301.
  • In the Literature
    Jan 2013

    When Research Evidence is Misleading

    Chetan Huded, MD, Jill Rosno, MD, and Vinay Prasad, MD
    Our system of medical education and postgraduate medical training rewards the accumulation of publications (abstracts, posters, presentations, and papers) rather than the pursuit of truths. The consequences of all this bad science are not felt by researchers, whose careers may be propelled by these erroneous results, but by the patients who are subject to medical practices the validity of which is uncertain.
    Virtual Mentor. 2013;15(1):29-33. doi: 10.1001/virtualmentor.2013.15.1.jdsc1-1301.
  • Health Law
    Jan 2013

    Medicine, the Law, and Conceptions of Evidence

    Valarie Blake, JD, MA
    Using evidence-based medical guidelines in courts will require confronting legal professionals' lack of training in assessing scientific evidence, the limitations of available evidence, and fundamental distinctions between the meaning of evidence in medicine and law.
    Virtual Mentor. 2013;15(1):46-50. doi: 10.1001/virtualmentor.2013.15.1.hlaw1-1301.
  • State of the Art and Science
    Jan 2013

    Effective Ways to Communicate Risk and Benefit

    Evan A. Wilhelms and Valerie F. Reyna, PhD
    When engaging in shared decision making, the authors recommend using gist representations, including visual representations, of risk information, framing the data in a way that accords with the balance of risks and benefits the patient is likely to encounter, and remembering that experts are subject to the same cognitive biases as patients.
    Virtual Mentor. 2013;15(1):34-41. doi: 10.1001/virtualmentor.2013.15.1.stas1-1301.
  • State of the Art and Science
    Jan 2013

    N-of-1 Trials: Individualized Medication Effectiveness Tests

    Sunita Vohra, MD, MSc and Salima Punja, BSc
    N-of-1 trials bring the rigor of research to an individual patient's clinical benefit.
    Virtual Mentor. 2013;15(1):42-45. doi: 10.1001/virtualmentor.2013.15.1.stas2-1301.
  • Policy Forum
    Jan 2013

    Evidence-Based Guidelines and Quality Measures in the Care of Older Adults

    Erika Ramsdale, MD and William Dale, MD, PhD
    This process of developing EBM-based guidelines and applying them to clinical care highlights the tension between generating unbiased knowledge based on statistical aggregation and the application of this information to individual patients.
    Virtual Mentor. 2013;15(1):51-55. doi: 10.1001/virtualmentor.2013.15.1.pfor1-1301.
  • Policy Forum
    Jan 2013

    Public Deliberation in Decisions about Health Research

    Joanna E. Siegel, ScD, Jessica Waddell Heeringa, MPH, and Kristin L. Carman, PhD
    As efforts to include patients in the design and execution of research studies continue to expand, public deliberation offers a means for the general public to become involved with the broader social context that determines the impact of research, from the identification of research priorities to the use of research results to shape health care policy and practice.
    Virtual Mentor. 2013;15(1):56-64. doi: 10.1001/virtualmentor.2013.15.1.pfor2-1301.
  • Medicine and Society
    Jan 2013

    Paradigms, Coherence, and the Fog of Evidence

    Dien Ho, PhD
    There is no appeal to evidence that does not rely on an accepted paradigm. The relationship between evidence and theory may hinge more on psychology than on logic or the pursuit of objective truth.
    Virtual Mentor. 2013;15(1):65-70. doi: 10.1001/virtualmentor.2013.15.1.msoc1-1301.
  • History of Medicine
    Jan 2013

    Evidence-Based Medicine: A Short History of a Modern Medical Movement

    Ariel L. Zimerman, MD, PhD
    The history of McMaster University's problem-based learning curriculum and critical appraisal methods, which Gordon Guyatt and David Sackett would later advocate as evidence-based medicine.
    Virtual Mentor. 2013;15(1):71-76. doi: 10.1001/virtualmentor.2013.15.1.mhst1-1301.
  • Personal Narrative
    Jan 2013

    The Median Isn’t the Message

    Stephen Jay Gould, PhD
    Reprint of Stephen Jay Gould's essay “The Median Isn't the Message.”
    Virtual Mentor. 2013;15(1):77-81. doi: 10.1001/virtualmentor.2013.15.1.mnar1-1301.
  • Personal Narrative
    Jan 2013

    The Message Isn’t as Mean as We May Think

    Thomas W. LeBlanc, MD, MA
    Prognostication means informing patients what the outcome of their illnesses and treatments are expected to be, based on the best available evidence. Prognosticating in a way that helps patients in decision making about treatment is difficult for physicians to do.
    Virtual Mentor. 2013;15(1):82-85. doi: 10.1001/virtualmentor.2013.15.1.mnar2-1301.
  • Viewpoint
    Jan 2013

    A Call to Integrate Ethics and Evidence-Based Medicine

    Ross E.G. Upshur, MD, MSc
    There is much to be gained by integrating ethics and EBM, focusing on the implications of uncertainty for clinical practice and exploring the effect a clinician’s values have on acquisition and application of evidence.
    Virtual Mentor. 2013;15(1):86-89. doi: 10.1001/virtualmentor.2013.15.1.oped1-1301.