Integrating Values into Evidence-Based Medicine (INVITE)

 

Lead: Leah McClimans, Associate Professor, University of South Carolina, ASSISTID Marie Curie Fellow, University College Cork

Co-Leads: Katherine Furman, Lecturer, University College Cork, Associate at: Centre for Philosophy of Science and Social Science (LSE), Essex Autonomy Project and Knowledge for Use (Durham University) 

Stuart Nicholls, Senior Clinical Research Associate, Ottawa Hospital Research Institute

Background and Aims

Although the original conception of evidence-based medicine (EBM) includes the conscious integration of patient values with the best clinical evidence, the ways values integrate into EBM extend well beyond patient values in the application of EBM. Values play roles in multiple points along the EBM path. From the prioritization of RCTs in the construction of high quality evidence, to decisions about what, e.g. guidelines to develop, to the evaluation of evidence as beneficial or effective, to how we apply evidence in patient populations, values are inherent in EBM. While the philosophical and bioethics literature has made significant contributions in identifying and analyzing these different roles, there is relatively little guidance about how to recognize and integrate consciously, values into the practice of EBM. Values are often neglected in EBM. Their neglect tends to efface them from practice, allowing practitioners to operate with a set of biases about what counts as evidence, e.g. methodologically sound evidence can be purified of judgement, evidence is value-free, facts and values are distinct and evidence is a fact. These biases have real world consequences.

Objectives

Our main objective is to create a platform for discussing practical steps to recognize and integrate consciously, values into the practice of EBM. A second objective is to pilot of some the ideas that arise from our discussion.

To achieve these objectives INVITE will

  • Co-author a scoping paper that uses a series of case studies to 1) assess the various roles values can play and 2) provide practical suggestions for their conscious recognition and/or integration
  • Apply for additional funds (e.g. Wellcome Trust Small Grant Funding, Canadian Institutes of Health Research Meeting Grant) to support a series of meetings with philosophers, bioethicists, clinical epidemiologists and health services researchers to discuss the conscious recognition and integration of values into practice
  • Actively seek collaboration with ongoing initiatives and undertake empirical research. Such work may include critical analysis of discordant evidence syntheses or guidelines, as well as primary data collection regarding barriers and facilitators to the recognition and conscious integration of values in EBM education and practice.

To learn more about the philosophical and bioethical work that has been done to date, you may want to read:

Maya Goldenberg, 2006. “On evidence and evidence-based medicine”, Social Science and Medicine, 62: 2621-32

Ross Upshur, 2013. “A call to integrate ethics and evidence” Virtual Mentor, 15: 86-9; Upshur et al. 2001. “Meaning and measurement: an inclusive model of evidence in health care” Journal of Evaluation in Clinical Practice, 7: 91-6.

Mike Kelly et al. 2015. “The Importance of values in evidence-based medicine”, BMC Medical Ethics, 16: 69.

Nicholls et al. 2016. “The need for ethics as well as evidence in evidence-based medicine”, Journal of Clinical Epidemiology, 77: 7-10.

McClimans, Leah (2010) “Elective Twin Reductions: Evidence and Ethics”, Bioethics, 24: 295-303.

McClimans, Leah (2017) “Place of Birth: Ethics and Evidence”, Topoi, 36: 531-38.

Valles, Sean A. (2018) Philosophy of Population Health Philosophy, (Abington, Oxen: Routledge)

Inaugural Event

INVITE’s inaugural Advanced Studies Seminar on was held on 30th April 2018 at St Catherine’s College Oxford University. This event brought together philosophers, bioethicists and public health researchers who have acted as thought leaders in the area of values in EBM.

For further details, please see

Meeting Agenda

Meeting Presentations 

List of Participants 

List of Members

Please see Here

To Join

Please contact Leah McClimans (mccliman@mailbox.sc.edu) for more information and/or to join our network listserv. All are welcome!