Australasian Science: Australia's authority on science since 1938

Is Evidence-based Medicine in Palliative Care Doing More Harm than Good?

By Friends of Science in Medicine

Stringent regulations govern what is administered to us in the prime of our lives, but different values seem to apply when it comes to the terminally ill and the dying.

The full text of this article can be purchased from Informit.

Clinicians use evidence-based practices in most medical specialities to give their patients the best possible treatment. When it comes to palliative care, however, the literature is bombarded with articles about the challenges of obtaining quality evidence in this important aspect of medicine. Those challenges stem from a multitude of factors: problems with project design, recruitment, attrition, ethical issues and funding. In fairness, these difficulties affect clinical research in all medical disciplines, but they seem to be more prominent in treating the most vulnerable and physically impaired patients – those who are terminally ill.

A principal aim of palliative care involves prescribing pharmacological interventions to provide relief from symptoms and increase the quality of life for patients with incurable conditions. However, several drugs used in palliative care are not listed on the Pharmaceutical Benefits Scheme for use in palliative patients. This is largely because there is a lack of appropriately designed clinical trials providing evidence of efficacy and efficiency of the drugs used in palliative care.

What is more alarming is the use of pharmaceutical drugs designed for other purposes, where the benefit-risk ratio for palliative care patients is unclear. For example ketamine is commonly used to treat pain related to cancer, but it has been...

The full text of this article can be purchased from Informit.