No method, thus madness?

If you ask most medical school deans if they have a course, program, or center doing bioethics, they will enthusiastically assure you that they do. And their enthusiasm for bioethics grows exponentially in proportion to their interest in showing that they are doing something about managing research ethics issues at their institutions. The same can be said about the entire biomedical research establishment from private companies to independent research centers to professional organizations bioethics is on the masthead, the organizational chart, and the agenda of the annual meeting. Not to worry medicine's got ethics. Comments © The Hastings Center. Reprinted with permission. This article originally appeared in The Hastings Center Report, Volume 36, Issue 2, April 2006, pages 12-13. Publisher URL: http://www.thehastingscenter.org This journal article is available at ScholarlyCommons: http://repository.upenn.edu/bioethics_papers/43 If you ask most medical school deans if they have a course, program, or center doing bioethics, they will enthusiastically assure you that they do. And their enthusiasm for bioethics grows exponentially in proportion to their interest in showing that they are doing something about managing research ethics issues at their institutions. The same can be said about the entire biomedical research establishment— from private companies to independent research centers to professional organizations—bioethics is on the masthead, the organizational chart, and the agenda of the annual meeting. Not to worry— medicine’s got ethics. It is certainly fine to feature bioethics as a topic area. But there is mounting evidence that perhaps bioethics is not all or even primarily what the doctor should be ordering just now. Some of the problems now ailing medicine require admitting that what has befallen medicine and the health sciences is an epistemological crisis as much as a moral one. Now this may seem an odd claim since it is hard, or rather, completely impossible, to avoid the phrase “evidencebased medicine” in the august halls of academic medical centers in the United States, Europe, Australia, and New Zealand these days. There are journals, resource centers, toolkits, web sites, and more publications than anyone interested in evidence-based medicine could possibly ever read. So how could it be that a field that is embracing evidence at every turn, teaching about outcomes, drilling the need for verifiable data into the heads of the next generation, and extolling the virtue of evidence at every conference, meeting, seminar, and water-cooler, possibly be in the midst of an epistemological crisis? Where is the evidence?