Thursday, May 13, 1999
Library, Department of Epidemiology
Harvard School of Public Health
 

Albert J. Jovell; MD, DrPH, PhD
Executive Director
Fundacio Biblioteca Josep Laporte
University Autonoma of Barcelona

Associate Professor
University Autonoma of Barcelona

Associate Researcher
Catalan Agency for Health Technology Assessment

Evidence-based medicine (EBM) has been proposed as a new paradigm for the
practice of medicine and public health. Proponents of  EBM  sustain that
decision making should be grounded in the results of  randomized
controlled trials and systematic reviews of  evidence. In this sense,
their concept of systematic reviews of the evidence is quite similar to
what has been known for many years as meta-analysis or quantitative
overviews. EBM has raised a lot of interest in governments around the
world, managed care organizations and pharmaceutical companies. Concepts
such as evidence-based policymaking, disease management, and clinical
practice guidelines are having  abig impact in research funding and in the
coverage of health services. Criticisms to the EBM approach sustain that
EBM is like "old wine poured in new bottles" . Also, they qualify EBM as
incomplete and unrealistic for efective decision-making. The level of
criticisms include ethical concerns associated with professional autonomy
and patient's right to choice.

        The aim of this presentation is to present a broader approach to
EBM using specific cases studies in different fields of medicine and
public health. The cases should allow us to present  some of the strengths
and limitations of EBM alonside its ethical boundaries for
decision-making.