Ethics and evidence-based medicine

In reply: Much of the literature about evidence-based medicine (EBM) has focused on the science of generating evidence, or the technical process of critically appraising and interpreting evidence for individual patients. In our article1 we opted to discuss EBM as a social activity with inherent potential for multiple manifestations. To describe EBM as a social activity is to emphasise how its definition, interpretation and application, and the ethical implications of those factors, are dependent on societal values and priorities — be they explicit or implicit.

Debate about what EBM means, or should mean, in the context of Australian policy and practice does not degrade or negate the clearly ethical practice of consulting the best available research when making clinical or policy decisions. We challenge the view of Parker et al that by identifying and discussing how the concepts or language associated with EBM could be misused or misappropriated we will somehow reduce the motivation of health professionals to find and apply the best treatments. Indeed, our proposition is quite the opposite.

Few of today's readers of the MJA will be unfamiliar with the benefits of systematic reviews of the best available research in their clinical area, and few are likely to be dissuaded of that view by our article.

Our exploration of the relationship between ethics and EBM does not "misinterpret" EBM, but, rather, purposefully describes scenarios or social consequences about which there may be ethical concerns. If we can articulate clearly what we do not want EBM to mean, and describe the processes and consequences that we would consider unethical, it can only strengthen the development of an ethical and acceptable notion of what we do want from evidence-based policy and practice.