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What patients know: evidence-based medicine and its discontents in the U.S.

Sandra Tanenbaum

Abstract


Almost 20 years ago, the New England Journal of Medicine published this author’s article entitled, “What Physicians Know” [1]. In it, I raised epistemological challenges to evidence-based medicine (EBM), noting the limitations of probabilistic knowledge for patient care. Since that time, EBM has put down strong roots in medicine and health policy but research policy, at least in the U.S., has begun to acknowledge the shortcomings of EBM’s hierarchy of knowing and now inches toward a more pluralistic view of medical knowledge. In 2010, the Affordable Care Act (ACA) created the Patient-Centered Outcomes Research Institute (PCORI), a public-private entity charged with defining, facilitating and funding patient-centered comparative effectiveness research (CER). Not only does PCORI expressly recognize the limits of RCTs and the strengths of other statistical study designs, but it legitimizes individual patient and practitioner knowledge as a component of medical decision-making. PCORI's Methodology Committee presented its draft report to the Board on May 10, 2012, and a month earlier, the Institute had announced the funding of 50 pilot research projects.  Upon review, both the report and the proposed projects can be said to more often, but not always, challenge the tenets of traditional EBM and value what patients know.

Keywords


Comparative effectiveness research, epistemology, evidence-based medicine, health policy, hierarchy of evidence, medical decision-making, PCORI, patient perspectives

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References


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DOI: http://dx.doi.org/10.5750/ejpch.v2i2.703

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