Andrew Park

Evidence-based medicine (EBM) has long deemphasized mechanistic reasoning and pathophysiological rationale in assessing the effectiveness of interventions. The EBM+ movement has challenged this stance, arguing that evidence of mechanisms and comparative studies should both be seen as necessary and complementary. Advocates of EBM+ provide a combination of theoretical arguments and examples of mechanistic reasoning in medical research. However, EBM+ proponents have not provided recent examples of how downplaying mechanistic reasoning resulted in worse medical results than would have occurred otherwise. Such examples are necessary to make the case that EBM+ responds to a problem in clinical practice that urgently demands a solution. In light of this, we examine the failed rollout of efavirenz as a first-line HIV treatment in Zimbabwe as evidence of the importance of mechanistic reasoning in improving clinical practice and public health policy decisions. We suggest that this case is analogous to examples commonly given to support EBM.

Reviewing works by James Alison, Alistair McFadyen, Andrew Sung Park, Ted Peters, and Solomon Schimmel, the author suggests that the status and function of the discourse/doctrine of sin highlight tensions between theology and ethics in ways that suggest the character, limits, and promise of religious ethics. This literature commends attention to sin-talk because it helps religious ethicists to render more adequately the dynamics of human agency, sociality, and culture and because it raises questions about the nature and task of theology, faith, and morality. Yet these volumes also indicate that religious ethics should pay more attention to particular sins