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Science and proven experience : a Swedish variety of evidence based medicine and a way to better risk analysis?

Persson, Johannes LU ; Vareman, Niklas LU ; Wallin, Annika LU ; Wahlberg, Lena LU and Sahlin, Nils-Eric LU (2017) In Journal of Risk Research
Abstract (Swedish)
A key question for evidence-based medicine (EBM) is how best to model the
way in which EBM should ‘[integrate] individual clinical expertise and the best
external evidence’. We argue that the formulations and models available in
the literature today are modest variations on a common theme and face very
similar problems when it comes to risk analysis, which is here understood
as a decision procedure comprising a factual assessment of risk, the risk
assessment, and the decision what to do based on this assessment, the risk
management. Both the early and updated models of evidence-based clinical
decisions presented in the writings of Haynes, Devereaux and Guyatt assume
that EBM consists of, among other... (More)
A key question for evidence-based medicine (EBM) is how best to model the
way in which EBM should ‘[integrate] individual clinical expertise and the best
external evidence’. We argue that the formulations and models available in
the literature today are modest variations on a common theme and face very
similar problems when it comes to risk analysis, which is here understood
as a decision procedure comprising a factual assessment of risk, the risk
assessment, and the decision what to do based on this assessment, the risk
management. Both the early and updated models of evidence-based clinical
decisions presented in the writings of Haynes, Devereaux and Guyatt assume
that EBM consists of, among other things, evidence from clinical research
together with information about patients’ values and clinical expertise. On
this A-view, EBM describes all that goes on in a specific justifiable medical
decision. There is, however, an alternative interpretation of EBM, the B-view,
in which EBM describes just one component of the decision situation (a
component usually based on evidence from clinical research) and in which,
together with other types of evidence, EBM leads to a justifiable clincial
decision but does not describe the decision itself. This B-view is inspired
by a 100-years older version of EBM, a Swedish standard requiring medical
decision-making, professional risk-taking and practice to be in accordance
with ‘science and proven experience’ (VBE). In the paper, we outline how the
Swedish concept leads to an improved understanding of the way in which
scientific evidence and clinical experience can and cannot be integrated in
light of EBM. How scientific evidence and clinical experience is integrated
influences both the way we do risk assessment and risk management. In
addition, the paper sketches the as yet unexplored historical background
to VBE and EBM. (Less)
Abstract
A key question for evidence-based medicine (EBM) is how best to model the way in which EBM should‘[integrate] individual clinical expertise and the best external evidence’. We argue that the formulations and models available in the literature today are modest variations on a common theme and face very similar problems when it comes to risk analysis, which is here understood as a decision procedure comprising a factual assessment of risk, the risk assessment, and the decision what to do based on this assessment, the risk management. Both the early and updated models of evidence-based clinical decisions presented in the writings of Haynes, Devereaux and Guyatt assume that EBM consists of, among other things, evidence from clinical research... (More)
A key question for evidence-based medicine (EBM) is how best to model the way in which EBM should‘[integrate] individual clinical expertise and the best external evidence’. We argue that the formulations and models available in the literature today are modest variations on a common theme and face very similar problems when it comes to risk analysis, which is here understood as a decision procedure comprising a factual assessment of risk, the risk assessment, and the decision what to do based on this assessment, the risk management. Both the early and updated models of evidence-based clinical decisions presented in the writings of Haynes, Devereaux and Guyatt assume that EBM consists of, among other things, evidence from clinical research together with information about patients’ values and clinical expertise. On this A-view, EBM describes all that goes on in a specific justifiable medical decision. There is, however, an alternative interpretation of EBM, the B-view, in which EBM describes just one component of the decision situation (a component usually based on evidence from clinical research) and in which, together with other types of evidence, EBM leads to a justifiable clincial decision but does not describe the decision itself. This B-view is inspired by a 100-years older version of EBM, a Swedish standard requiring medical decision-making, professional risk-taking and practice to be in accordance with‘science and proven experience’(VBE). In the paper, we outline how the Swedish concept leads to an improved understanding of the way in which scientific evidence and clinical experience can and cannot be integrated in light of EBM. How scientific evidence and clinical experience is integrated influences both the way we do risk assessment and risk management. In addition, the paper sketches the as yet unexplored historical background to VBE and EBM. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
evidence based medicine, Philosophy of science, vetenskap och beprövad erfarenhet, Science and proven experience, science and proven experience, vidence-based medicine, risk analysis, risk management, philosophy of risk
in
Journal of Risk Research
pages
11 pages
publisher
Routledge
ISSN
1366-9877
DOI
10.1080/13669877.2017.1409251
language
English
LU publication?
yes
id
79c1cd2a-3c54-413e-ad0b-a985b2c52823
date added to LUP
2017-12-04 20:49:46
date last changed
2017-12-06 16:09:03
@article{79c1cd2a-3c54-413e-ad0b-a985b2c52823,
  abstract     = {A key question for evidence-based medicine (EBM) is how best to model the way in which EBM should‘[integrate] individual clinical expertise and the best external evidence’. We argue that the formulations and models available in the literature today are modest variations on a common theme and face very similar problems when it comes to risk analysis, which is here understood as a decision procedure comprising a factual assessment of risk, the risk assessment, and the decision what to do based on this assessment, the risk management. Both the early and updated models of evidence-based clinical decisions presented in the writings of Haynes, Devereaux and Guyatt assume that EBM consists of, among other things, evidence from clinical research together with information about patients’ values and clinical expertise. On this A-view, EBM describes all that goes on in a specific justifiable medical decision. There is, however, an alternative interpretation of EBM, the B-view, in which EBM describes just one component of the decision situation (a component usually based on evidence from clinical research) and in which, together with other types of evidence, EBM leads to a justifiable clincial decision but does not describe the decision itself. This B-view is inspired by a 100-years older version of EBM, a Swedish standard requiring medical decision-making, professional risk-taking and practice to be in accordance with‘science and proven experience’(VBE). In the paper, we outline how the Swedish concept leads to an improved understanding of the way in which scientific evidence and clinical experience can and cannot be integrated in light of EBM. How scientific evidence and clinical experience is integrated influences both the way we do risk assessment and risk management. In addition, the paper sketches the as yet unexplored historical background to VBE and EBM.},
  author       = {Persson, Johannes and Vareman, Niklas and Wallin, Annika and Wahlberg, Lena and Sahlin, Nils-Eric},
  issn         = {1366-9877},
  keyword      = {evidence based medicine,Philosophy of science,vetenskap och beprövad erfarenhet,Science and proven experience,science and proven experience,vidence-based medicine,risk analysis,risk management,philosophy of risk},
  language     = {eng},
  month        = {12},
  pages        = {11},
  publisher    = {Routledge},
  series       = {Journal of Risk Research},
  title        = {Science and proven experience : a Swedish variety of evidence based medicine and a way to better risk analysis?},
  url          = {http://dx.doi.org/10.1080/13669877.2017.1409251},
  year         = {2017},
}