Evidence-based Medicine and Mechanistic Evidence: The Case of the Failed Rollout of Efavirenz in Zimbabwe

Author:

Park Andrew1,Steel Daniel2,Maine Elicia3

Affiliation:

1. University of Victoria, Victoria , British Columbia , Canada

2. University of British Columbia , Vancouver, British Columbia , Canada

3. Simon Fraser University , Burnaby, British Columbia , Canada

Abstract

Abstract Evidence-based medicine (EBM) has long deemphasized mechanistic reasoning and pathophysiological rationale in assessing the effectiveness of interventions. The EBM+ movement has challenged this stance, arguing that evidence of mechanisms and comparative studies should both be seen as necessary and complementary. Advocates of EBM+ provide a combination of theoretical arguments and examples of mechanistic reasoning in medical research. However, EBM+ proponents have not provided recent examples of how downplaying mechanistic reasoning resulted in worse medical results than would have occurred otherwise. Such examples are necessary to make the case that EBM+ responds to a problem in clinical practice that urgently demands a solution. In light of this, we examine the failed rollout of efavirenz as a first-line HIV treatment in Zimbabwe as evidence of the importance of mechanistic reasoning in improving clinical practice and public health policy decisions. We suggest that this case is analogous to examples commonly given to support EBM.

Publisher

Oxford University Press (OUP)

Subject

Philosophy,General Medicine,Issues, ethics and legal aspects

Reference47 articles.

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5. Efavirenz and the CNS: What we already know and questions that need to be answered;Apostolova;Journal of Antimicrobial Chemotherapy,2015

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