Daños y valores en MBE.
Harms and values in EBM.
Evidence-based medicine (EBM), like all science, is based on values (Kelly et al, 2015). Values act as psychological heuristics automatic thinking—and are not just the ‘reflective’ side of our psychology. Values are about of how we feel on an issue emotionally, thus are not concerned exclusively with matters of fact in a ‘scientifically’ neutral environment, and cannot be completely understood by the means of logic. Values, and in particular a patient's values, are important at the point of care decision. Other aspects of EBM may be also value-based, for example, the decision as to which question to ask. A cross-sectional study reporting on epidemiological characteristics of SRs estimated that the majority of SRs (73%) published in November 2004 in the English language and cited in Medline focused on therapeutic interventions with a predominance of studies, nearly half, reporting on health effects of pharmacological interventions (Moher et al, 2007). However, drugs are far from being the only interventions used in medicine. Other intervention, like surgical procedures, may be introduced without evidence of their benefits and harms. The focus questions of SRs, at least when the movement began, were those of efficiency and cost-effectiveness. Values in both cases stem from the utilitarian philosophical tradition as to which course of actions is chosen if they maximize benefits for the greatest number. However, this is not necessarily congruent with patient's interests and values.
http://onlinelibrary.wiley.com/doi/10.1111/odi.12500/full