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A philosophical argument against evidence-based policy.

Rani Lill Anjum1, Stephen D Mumford1,2

  • 1School of Economics and Business, Norwegian University of Life Sciences, Ås, Norway.

Journal of Evaluation in Clinical Practice
|June 11, 2016
PubMed
Summary
This summary is machine-generated.

Evidence-based medicine guidelines, based on randomized controlled trials, may not suit all patients. Clinicians may need to deviate from rules when individual patient benefit is greater, challenging uniform intervention policies.

Keywords:
clinical guidelinesevidence-based medicinehealth policy

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Area of Science:

  • Medical Ethics
  • Health Policy
  • Clinical Decision-Making

Background:

  • Evidence-based medicine (EBM) integrates rigorous research (randomized controlled trials) with policy recommendations for uniform interventions.
  • The policy component of EBM often employs rule utilitarianism to guide clinical practice.
  • Randomized controlled trials acknowledge individual variation, a key factor in treatment efficacy.

Purpose of the Study:

  • To examine the philosophical underpinnings of evidence-based medicine's policy component.
  • To assess the validity of rule utilitarianism in clinical decision-making within EBM.
  • To explore the tension between EBM guidelines and individual patient needs.

Main Methods:

  • Philosophical analysis of rule utilitarianism and its application to EBM.
  • Examination of Smart's objection to rule utilitarianism in the context of healthcare.
  • Case-based reasoning considering individual patient variation and treatment benefit.

Main Results:

  • Rule utilitarianism, as applied in EBM policy, faces collapse when individual benefit contradicts the rule.
  • A utility maximizer should prioritize greater individual benefit over adherence to a general rule.
  • Ignoring a guideline is justifiable when a clinician knows a patient will not benefit from the recommended intervention.

Conclusions:

  • EBM's policy component, if based on rule utilitarianism, may lead to suboptimal patient care.
  • Clinicians' intuition to deviate from guidelines when beneficial for the patient is philosophically supported.
  • Reconciling EBM guidelines with clinical judgment requires acknowledging the limitations of uniform policy recommendations.