The Journal of Medicine and Philosophy · 3 authors, 3 centres
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This narrative review argues that the failed rollout of efavirenz as first-line HIV treatment in Zimbabwe is a case where prioritizing randomized controlled trial evidence over mechanistic reasoning about drug metabolism led to adverse public health outcomes, supporting the need to integrate both evidence types in clinical decisions.
This narrative review analyzes the case of efavirenz rollout in Zimbabwe to argue for the EBM+ movement, which posits that mechanistic reasoning should complement, not be disregarded by, randomized controlled trial (RCT) evidence. The authors present this as an example where an exclusionary focus on RCTs, as encouraged by traditional EBM, resulted in worse health outcomes.
