Part 2: A Reader Responds to "Ethics and Evidence-Based Medicine: Is There a Conflict?"

Michael Rie, MD, FACP


December 13, 2007

To the Editor,

I enjoyed reading Dr. Loewy's article[1] on the abuses of EBM [evidence-based medicine].

As we all understand, EBM has produced some great success in many areas of clinical medicine. I share Dr. Loewy's cautions and doubts, and have been working on this problem in a more concrete way to bring to public attention the abuses of the quality improvement revolution at the level of medical ethics in the law and policy of finitude in financial healthcare resources. When cost containment impinges on the ethical integrity of healthcare professionals, the rule of law requires the courts to step in to protect that integrity. That day may already be upon the healthcare sector of this nation.[1]

The crossover of research ethics into quality improvement activities is the third generation of the Nuremberg Code of Ethics in American medicine recently introduced into American common case law. We recently covered the evolution of the code in a paper published earlier this year in Critical Care Medicine.[2] The mentioned AHRQ [Agency for Healthcare Research and Quality] report from the Hastings Center Task Force[3] was published, and there was a commentary about it from an editorial from NIH [National Institutes of Health] in the May issue of Annals of Internal Medicine.[4] This is a developing theme for medicine and the law, and should be covered in Medscape as the issues make there way into Congress and the courts.

Yours truly,

Michael Rie, MD, FACP
University of Kentucky College of Medicine
Lexington, Kentucky

Editor's Note:
This letter was shown to the author, who chose not to respond.




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