The epistemology and ethics of chronic disease research: Further lessons from ecmo

Theoretical Medicine and Bioethics 31 (2):107-122 (2010)
Robert Truog describes the controversial randomized controlled trials (RCTs) of extracorporeal membrane oxygenation (ECMO) therapy in newborns. Because early results with ECMO indicated that it might be a great advance, saving many lives, Truog argues that ECMO should not have been tested using RCTs, but that a long-term, large-scale observational study of actual clinical practice should have been conducted instead. Central to Truog’s argument, however, is the idea that ECMO is an unusual case. Thus, it is an open question whether Truog’s conclusions can be extended to other areas of medical research. In this paper, I look at epistemological and ethical issues arising in the care of patients with chronic diseases, using ECMO as a starting point. Both the similarities and the dissimilarities of these two cases highlight important issues in biomedical research and support a conclusion similar to Truog’s. Observational studies of clinical practice provide the best evidence to inform the treatment of patients with chronic disease.
Keywords Randomized controlled trials  Research ethics  ECMO  Chronic disease  Research methods
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DOI 10.1007/s11017-010-9139-8
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References found in this work BETA
Are Rcts the Gold Standard?Nancy Cartwright - 2007 - Biosocieties 1:11-20.
What Evidence in Evidence-Based Medicine?John Worrall - 2002 - Proceedings of the Philosophy of Science Association 2002 (3):S316-S330.
The Randomized Controlled Trial: Gold Standard or Merely Standard?J. Grossman & F. Mackenzie - 2005 - Perspectives in Biology and Medicine 48 (4):516-34.
Evidence and Ethics in Medicine.John Worrall - 2008 - Perspectives in Biology and Medicine 51 (3):418-431.

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Citations of this work BETA
The Role of Measurement in Establishing Evidence.L. McClimans - 2013 - Journal of Medicine and Philosophy 38 (5):520-538.
Hollow Hunt for Harms.Jacob Stegenga - 2016 - Perspectives on Science 24 (5):481-504.

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