Evidence: Its Meanings in Health Care and in Law

In April 2000 the Institute of Medicine (IOM) and the Agency for Healthcare Research and Quality (AHRQ) jointly hosted a one-day workshop to explore an intriguing and important intersection of medicine and law: the courtroom presentation of science-based medical evidence and expertise. This workshop was inspired by a concern that legal uses and interpretations of science-based medical evidence, particularly population studies and the findings of controlled clinical trials, may diverge substantially from the uses and interpretation of that evidence by the medical and health care researchers who produce it and of the practitioners and health plans that use it in making clinical decisions and policies. Recognizing that a preliminary discussion among professions was needed even to describe the nature of their differences, the IOM and AHRQ, at the instigation of John M. Eisenberg, director of AHRQ, convened about twenty clinicians, epidemiologists, health services researchers, health plan executives, practicing and academic lawyers, jurists, and social scientists in the field of legal medicine (see appendix for participants). Participants and presenters were asked to formulate empirical research questions concerning both evidence-based medicine (EBM) and judicial practices that might increase familiarity with, and therefore promote greater reliance on, the use of science-based medical evidence by the courts. Workshop participants were further asked to identify policy issues relating to the application of evidence-based medical findings that were emerging in the context of congressional consideration of patient protection legislation and reform of health plan liability law. (April 2001)