Outcomes Research and the Quality of Health Care:

Beyond the dazzling achievements of high-technology medicine, the spiraling cost of health care and lack of access for many have long been the subject of national debate. Driven by the interaction of powerful economic forces, managed care is now taking over the health care system, while there is growing popular interest in alternative medicine. But amid the changing structures and financial incentives, much uncertainty still remains concerning the safety and effectiveness of medical interventions. The author, a mathematical scientist engaged in medical research and education for more than 30 years, has proposed the "ethics of evidence" as an approach to medical uncertainty, to be adopted as a vital component of biomedical ethics. The ethics of evidence comprises two imperatives. The first imperative calls for the creation, dissemination, and use of the best possible scientific evidence as a basis for every phase of medical decision making. Complementing it, the second imperative focuses on the need to increase awareness of, and come to terms with, the extent and ultimately irreducible nature of uncertainty. After a brief sketch of the genesis of this concept, the ethics of evidence is further explored here in the context of current outcomes research, the focus on quality of health care, and related problems of contemporary medicine.