Ethical aspects of evidence based medicine (EBM)

Abstract

The ethical reasons for being conversant with EBM can be divided into clinical and economic aspects, each of which has ethical aspects which will be discussed. These arguments are well known, and relatively non-controversial. But there are also strong ethical arguments for not practicing EBM all the time, and this paradox will also be discussed.

All medical procedures have both specific and non-specific effects: dummy medicines can relieve severe post-operative pain, and dummy operations can relieve both cardiac pain and epilepsy. In mental health, these effects are well known, albeit difficult to quantify. Our most potent weapon in doing so is the randomised controlled trial (RCT), and ethical aspects of such trials will be touched upon.

We are left with problems of mental disorders where the supposed beneficial effects of an active drug – we will give the example of anti-depressants – is entirely non-specific. What are the ethical aspects of prescribing potentially toxic drugs for conditions where they have no specific effect? This is a major problem in both specialist mental health care and above all, in general medical care – where the bulk of antidepressants and sedatives are prescribed. There are major ethical problems here, which will be discussed.