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The Other War on Drugs: The Pharmaceutical Industry, Evidence-Based Medicine, and Clinical Practice

Published online by Cambridge University Press:  27 April 2009

Howard I. Kushner
Howard I. Kushner
Affiliation:
Rollins School of Public Health Emory University
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Extract

Over the past decade, evidence-based medicine (EBM) has become the standard for medical practice.1 Evidence-based practices have been established in general medicine and specialized fields; new evidence-based journals have been launched.2 Although its roots can be found in mid-nineteenth-century medical philosophy, contemporary EBM was largely developed by the clinical epidemiology program at McMaster University in 1992.3 According to the McMaster manifesto published in JAMA, EBM “deemphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision-making, and stresses the examination of evidence from clinical research.”4 The most frequently cited definition of EBM is reliance on the “conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients,” based on an integration of “individual clinical expertise with the best available external clinical evidence from systematic research.”5 However, as Stefan Timmermans and Aaron Mauck recently observed, EBM “is loosely used and can refer to anything from conducting a statistical meta-analysis of accumulated research to promoting randomized clinical trials, to supporting uniform reporting styles for research, to a personal orientation toward critical self-evaluation.”6

Type
Articles
Information
Journal of Policy History , Volume 19 , Issue 1: Special Issue: New Perspectives on Public Health Policy , January 2007 , pp. 49 - 70
Copyright
Copyright © The Pennsylvania State University, University Park, PA. 2007

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References

Notes

1. Upshur, Ross E. G., “Looking for Rules in a World of Exceptions: Reflections on Evidence-Based Practice,” Perspectives in Biology and Medicine 48 (2005): 477–489.CrossRefGoogle Scholar

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4. Ibid., 2420.

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8. EBMWG, “Evidence-Based Medicine,” 2421–22.

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12. Ibid., xv–xviii. See also Angell, Marcia, “Your Dangerous Drugstore,” New York Review of Books 53(10) (2006): 38–40.Google Scholar

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15. Ibid., xii–xiii.

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24. Abramson, Overdosed America, 68.

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29. Moynihan and Cassels, Selling Sickness, 1–3.

30. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, “Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)” [special communication], JAMA 285 (16 05 2001): 2486–2497, quotations p. 2486.CrossRefGoogle Scholar

31. Moynihan and Cassels, Selling Sickness, 1–3.

32. Ibid., 4.

33. Angel, The Truth About the Drug Companies, 85–86 (italics in original).

34. Moynihan and Cassels, Selling Sickness, 11.

35. Ibid., 12–13 (italics in original).

36. Ibid., 14.

37. Abramson, Overdosed America, 166.

38. Moynihan and Cassels, Selling Sickness, 12.

39. Avorn, Powerful Medicines, 293.

40. Ibid.

41. Angell, The Truth About the Drug Companies, 135.

42. Abramson, Overdosed America, 185.

43. Avorn, Powerful Medicines, 411.

44. Belluck, Pam, “Massachusetts Sets Health Plan for Nearly All,” New York Times, 5 04 2006, A1Google Scholar; Fahrenthold, David A., “Mass. Bill Requires Health Coverage State Set to Use Auto Insurance as a Model,” Washington Post, 5 04 2006, A01.Google Scholar

45. Abramson, Overdosed America, 204–5.

46. Angell, The Truth About the Drug Companies, 240.

47. Moynihan and Cassels, Selling Sickness, 197.

48. Avorn, Powerful Medicines, 410.

49. Eddy, “Evidence-Based Medicine: A Unified Approach,” 16; Timmermans and Mauck, “The Promise and Pitfalls of Evidence-Based Medicine,” 21.

50. Timmermans, “From Autonomy to Accountability,” 494.

51. Ibid.

52. Rothstein, William G., Public Health and the Risk Factor: The History of an Uneven Medical Revolution (Rochester, N.Y., 2003), 366.Google Scholar

53. For a fuller discussion of this history, see Rothstein, Public Health and the Risk Factor; Halperin, Sidney A., Lesser Harms: The Morality of Risk in Medical Research (Chicago, 2005)Google Scholar; and Marks, Harry, The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900–1990 (New York, 1997).Google Scholar