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.
Thomas W. LeBlanc, MD, MA and Amy P. Abernethy, MD, PhD
One strategy to promote adherence is the use of “care pathways,” effectively roadmaps that seek to standardize cancer treatment on the basis of some agreed-upon set of guidelines within a particular center or group of patients.
There are few situations in which the standard of care is so clear-cut as to preclude physician judgment. Assessing the degree of need (not just the standard of care) when asking a patient to spend money requires judgment.
When deciding whether to offer deep brain stimulation earlier than usual for Parkinson disease, it is important to consider not only the patient’s autonomy but also the validity of the evidence and concepts of harm that are being used to form practice policies.
This month, AMA Journal of Ethics editor-in-chief Audiey Kao, MD, PhD, interviewed Wendy Levinson, MD, about the efforts of the Choosing Wisely initiative to foster cultural change in medicine cross-nationally by stimulating dialogue about overuse of tests and treatments
Because many complementary and alternative medicine therapies for autism are based on misguided notions of its cause and lack support from scientifically sound studies, physicians should steer parents away from these practices and toward safe, effective, and evidence-based interventions.
AMA J Ethics. 2015;17(4):375-380. doi:
10.1001/journalofethics.2015.17.4.sect2-1504
There is evidence that some complementary and alternative treatments improve physiological abnormalities in autism and thus hold promise for improving symptoms.
AMA J Ethics. 2015;17(4):369-374. doi:
10.1001/journalofethics.2015.17.4.sect1-1504.
Diethylstilbestrol (DES) was widely used in the 1940s to 1960s to prevent pregnancy loss but was later found to be associated with adverse health effects in exposed offspring, underscoring the need for careful evaluation of new therapies.
AMA J Ethics. 2015;17(9):865-870. doi:
10.1001/journalofethics.2015.17.9.mhst1-1509.