Assessing the evidence in a “post-truth” world
“Post-truth”—2016’s word of the year, according to Oxford Dictionaries—refers to a circumstance in which appeals to emotion and personal belief are more influential than facts in shaping public opinion. This concept has application in medicine because clinicians often interpret evidence in light of their beliefs about the legitimacy and authority of the source and the nature of that evidence. Yet disagreement on how to assess legitimacy can sow uncertainty, distrust and confusion among health professionals. This month’s edition of the AMA Journal of Ethics® explores this and related ethical issues, including professional self-regulation, procedural fairness and therapeutic decision-making in imperfect environments.
Take a moment to consider this situation: A man whose wife has recently died appears depressed during a primary care appointment. How should his physician respond?
- Refer him to a psychiatrist likely to prescribe SSRIs
- Refer him to a psychiatrist likely to monitor his symptoms before prescribing medication
- Monitor his progress herself
- Solicit his input about next steps
“The case of Dr. Oz: Ethics, evidence and does professional self-regulation work?” Dr. Mehmet Oz, MD, is widely known as a successful media personality, registering the title “America’s Doctor,” but to some he is also a physician visibly out of step with his profession. A recent, unsuccessful attempt to censure Dr. Oz raises the question of whether the medical profession can effectively self-regulate. Explore whether physicians and other health professionals have sufficient knowledge of the less visible Dr. “Ozes” quietly operating under medicine’s presumptive endorsement.
“How should therapeutic decisions about expensive drugs be made in imperfect environments?” Clinicians inevitably make therapeutic decisions under less-than-ideal conditions involving incomplete evidence. Under these circumstances, stakeholders can and should contribute to optimizing the development, approval, funding and prescription of therapies, particularly expensive and marginally beneficial therapies. Investigate decisions that physicians might pursue to facilitate fair and cost-effective patient care.
“What is the relevance of procedural fairness to making determinations about medical evidence?” Dilemmas in medical ethics and health policy generally involve two questions: which benefits an intervention will have and how to distribute those benefits. Consider the potential of fair procedures to help address factual and value questions in medicine, using the debate over antidepressant efficacy as a test case.
“Reasonableness, credibility and clinical disagreement.” Disagreements in medicine may result from different, but reasonable, interpretations of the available evidence or unreasonable refusals to consider legitimate evidence. Find out how assessments of the relevance and implications of evidence are typically affected by factors beyond the evidence itself, such as beliefs about the credibility of the speaker or the source of the evidence.
In the journal’s February podcast, James Mohr, PhD, distinguished professor of history in the College of Arts & Sciences at the University of Oregon, discusses how the medical profession has been regulated, and how it has regulated itself, over the course of American history.
Submit manuscripts and artwork
The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. Submit a manuscript for publication or look at the most recent call for papers. The journal also invites original photographs, graphics, cartoons, drawings and paintings that explore the ethical dimensions of health or health care.
A look ahead
Upcoming issues of the AMA Journal of Ethics will focus on language and hierarchy, moral psychology and "difficult" patient-clinician dyads, mental health and oncology, moral distress and quality of life in dementia. Sign up to receive email alerts when new issues are published.