About

Dr. Ethan M. Balk is a Professor of Health Services, Policy and Practice. He is co-Director of the AHRQ-sponsored Brown Evidence-based Practice Center and Associate Director of the Center for Evidence Synthesis in Health. His career includes several years as a primary care physician and obtaining a Masters in Public Health with a focus on Biostatistics and Epidemiology. Dr. Balk has pursued a career specializing in systematic review, meta-analysis, and clinical guideline development. He served as Associate Director of the Tufts Evidence-based Practice Center for 14 years and later as Director of the Tufts Center for Clinical Evidence Synthesis before transferring to the Brown School of Public Health in 2014. Additionally, he was Co-Director of the National Kidney Foundation Center for Guideline Development and Implementation at Tufts-New England Medical Center, providing methodological and educational expertise for kidney disease guidelines. Since 2008, he has been a methodological expert consultant for the Society of Gynecologic Surgeons Systematic Review Group. Dr. Balk has authored over 300 publications on systematic reviews across a broad range of medical, surgical, health, and nutrition topics, and has led evidence review teams for numerous clinical guidelines.

Research topics

• Medicine
• Internal medicine
• Psychiatry
• Simulation
• Medical physics
• Clinical psychology
• Physical therapy
• Intensive care medicine
• Pathology
• Psychotherapist
• General surgery
• Endocrinology
• Surgery

Selected publications

• Sa1771 FIBER INTAKE AND LAXATION IN HEALTHY PEOPLE: CLINICAL INSIGHTS FROM A SYSTEMATIC REVIEW

  Gastrointestinal Endoscopy · 2026-05-01

  article1st authorCorresponding
  PublisherDOI

• A Qualitative Exploration of Barriers and Facilitators Influencing Nutritional Recovery in Survivors of Critical Illness After Hospital Discharge

  Journal of Human Nutrition and Dietetics · 2026-01-07

  articleOpen accessSenior author

  INTRODUCTION: After hospital discharge, survivors of critical illness often struggle to meet their nutritional needs, which can impair long-term recovery and quality of life. However, the factors influencing nutritional recovery in the early post-discharge period remain poorly understood. This qualitative study aimed to identify and describe the barriers and facilitators influencing nutritional recovery among critical illness survivors after hospital discharge. METHODS: A qualitative health research approach was adopted using qualitative description. A convenience sample of 15 adult critical illness survivors were recruited from medical, surgical, and cardiac intensive care units (ICUs) in New York City from August 2024 to April 2025. Semi-structured interviews were conducted virtually 3 months after hospital discharge. Data were analyzed using directed content analysis. RESULTS: Reported barriers to nutritional recovery included individual-level factors (physiological, functional, and psychological) and systems-level challenges (gaps in nutrition care continuity and inadequate healthcare team communication and support). Facilitators included family support, accessible nutrition services, multidisciplinary healthcare team involvement, and improvements in recovery over time. Patients consistently expressed a desire for regular post-discharge nutrition follow-up and individualized nutrition education tailored to post-ICU recovery. CONCLUSION: Collectively, these findings revealed that survivors of critical illness encounter numerous barriers to nutritional recovery after hospital discharge, but support from family, dietitians, and healthcare teams can help overcome these challenges. Continuity of dietitian-led care and tailored nutrition education may address unmet needs and improve the nutritional recovery experience of critical illness survivors.

  PublisherOA PDFDOI

• Pediatric-inspired regimens and HSCT for adolescents and young adults with acute lymphoblastic leukemia

  Blood Advances · 2026-01-29 · 1 citations

  articleOpen accessSenior author

  ABSTRACT: The best frontline treatment for acute lymphoblastic leukemia (ALL) in adolescents and young adults (AYAs) is unclear. To support a clinical practice guideline, we systematically reviewed and meta-analyzed evidence on (1) asparaginase-based (pediatric) vs non-asparaginase-based (adult) regimens and (2) allogeneic hematopoietic stem cell transplantation (HSCT) vs no HSCT for AYAs (aged 15-39 years) with ALL in first complete remission. Data sources were PubMed, CINAHL, and PsycINFO from inception to 29 November 2023. Eligible studies compared regimens or the use of HSCT and reported survival, remission, toxicity, or quality of life in AYAs. We included 19 studies (14 comparative, 5 single-group; N = 3607) comparing regimens and 7 studies (N = 7492) comparing HSCT and no HSCT. Studies were mostly of poor quality, with sparse randomized controlled trials (RCTs), yielding low-certainty findings. Pediatric regimens were associated with higher 5-year overall survival (OS; relative risk [RR], 1.40; 95% confidence interval [CI], 1.18-1.65), event-free survival (RR, 1.80; 95% CI, 1.13-2.85), disease-free survival (DFS; RR, 1.55; 95% CI, 1.32-1.82), and lower treatment-related mortality (TRM; RR, 0.29; 95% CI, 0.09-0.90). HSCT was associated with lower 5-year OS (RR, 0.72; 95% CI, 0.61-0.84) and DFS (RR, 0.78; 95% CI, 0.68-0.90) and higher nonrelapse mortality (RR, 2.70; 95% CI, 1.18-6.18) and TRM (hazard ratio, 6.88; 95% CI, 3.02-15.70). Relapse risk varied by time point. In AYAs with Philadelphia chromosome-negative ALL, pediatric regimens may improve survival; toxicity-related evidence remains limited. HSCT may lead to inferior OS and DFS. With a dearth of RCTs, low-certainty evidence highlights the need for high-quality studies and subanalyses of AYAs.

  PublisherOA PDFDOI

• ASH 2026 Guidelines for Frontline Management of Acute Lymphoblastic Leukemia in Adolescents and Young Adults

  Blood Advances · 2026-02-11 · 3 citations

  articleOpen access

  BACKGROUND: Adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL) represent a unique population. Treatment regimens can vary significantly depending on whether they receive care in a pediatric or in an adult setting. They also have distinctive care needs, social risk factors, and disease behavior compared to other age groups. OBJECTIVE: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians and other health care professionals in their decisions about the frontline management of ALL in AYAs. METHODS: ASH formed a multidisciplinary guideline panel including hematologists, AYA psychosocial care specialists, pharmacists, methodologists, and patient representatives with efforts to minimize bias from conflicts of interest. An evidence review team at Brown University supported guideline development, including performing systematic evidence reviews up to November 2023. The panel prioritized clinical questions and outcomes according to importance for clinicians and patients. The panel used Grading of Recommendations Assessment, Development and Evaluation (GRADE), including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment. RESULTS: The panel agreed on 15 recommendations and several good practice statements. CONCLUSIONS: Pediatric-inspired regimens containing asparaginase are recommended as frontline therapy compared to more traditional adult-inspired protocols, requiring significant supportive care and close follow up. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) isn't routinely recommended in first remission (CR1) but may be indicated for higher risk subsets or those with suboptimal responses to initial therapy. The use of targeted agents in frontline therapy is increasingly supported, though further research is needed to optimize this strategy.

  PublisherOA PDFDOI

• ASH 2026 Guidelines for Management of Relapsed/Refractory Disease in Adolescents and Young Adults with ALL

  Blood Advances · 2026-02-11 · 2 citations

  articleOpen access

  BACKGROUND: Adolescents and young adults (AYA) with relapsed or refractory acute lymphoblastic leukemia (ALL) face unique challenges as they experience greater treatment resistance, higher rates of toxicity, and present at a specific life stage with distinct priorities. OBJECTIVE: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support clinicians, patients, and other health care professionals in their decisions about management of AYAs with relapsed/refractory ALL. METHODS: ASH formed a multidisciplinary guideline panel including hematologists, AYA psychosocial care specialists, pharmacists, methodologists, and patient representatives with efforts to minimize bias from conflicts of interest. An evidence review team at Brown University supported guideline development, including performing systematic evidence reviews up to November 2023. The panel prioritized clinical questions and outcomes according to importance for clinicians and patients. The panel used Grading of Recommendations Assessment, Development and Evaluation (GRADE), including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment. RESULTS: The panel agreed on eight recommendations and one research-only recommendation, covering remission re-induction and consolidation. They focused on the following treatment modalities: immunotherapy, targeted therapies, allogeneic hematopoietic stem cell transplantation (allo-HSCT), and central nervous system (CNS)-directed therapy. CONCLUSIONS: Key recommendations include the use of blinatumomab and/or inotuzumab over chemotherapy for re-induction. Additional management of ALL subsets (T-ALL), CNS relapse, and the role of consolidation with allogeneic transplantation are addressed. Future research should evaluate these approaches with special attention to the unique AYA population and should evaluate quality of life outcomes.

  PublisherOA PDFDOI

• Nonpharmacologic and Pharmacologic Treatments of Adults in the Acute Phase of Major Depressive Disorder: A Living Clinical Guideline From the American College of Physicians (Version 1, Update Alert 4)

  Annals of Internal Medicine · 2026-03-09

  article
  PublisherDOI

• Screening for Breast Cancer in Asymptomatic, Average-Risk Adult Females: A Guidance Statement From the American College of Physicians (Version 2)

  Annals of Internal Medicine · 2026-04-17

  article

  DESCRIPTION: The purpose of this updated guidance statement is to guide internal medicine physicians and other clinicians on screening for breast cancer in asymptomatic, average-risk adult females. METHODS: The American College of Physicians updated its guidance statement on screening for breast cancer using high-quality clinical guidelines from national guideline developers around the world.

  PublisherDOI

• Sa1771 FIBER INTAKE AND LAXATION IN HEALTHY PEOPLE: CLINICAL INSIGHTS FROM A SYSTEMATIC REVIEW

  Gastroenterology · 2026-05-01

  article1st authorCorresponding
  PublisherDOI

• Prioritized health outcomes for adolescents and young adults with acute lymphoblastic leukemia

  Blood Neoplasia · 2026-03-26

  articleOpen accessSenior author

  The American Society of Hematology convened 2 multidisciplinary panels to develop guidelines for the management of acute lymphoblastic leukemia (ALL) among adolescents and young adults (AYAs). The objectives of this study are to (1) describe the process for selecting and prioritizing outcomes for 32 research questions relevant to the guideline development, (2) summarize the prioritized outcomes, and (3) describe the frequency of reporting of those outcomes in existing studies of AYAs with ALL. The panels prioritized outcomes for each of the 19 questions on frontline management, 9 on the management of relapsed/refractory disease, and 4 related to both topics. A 3-step process was used: (1) initial identification of outcomes, (2) online survey of all panel members to rate each outcome's importance, and (3) iterative discussions among the panels to finalize the prioritized outcomes. We examined the frequency with which each prioritized outcome was reported for systematically reviewed research questions. The panels prioritized 34 unique outcomes across questions (median, 7 outcomes per question). The most common outcomes were overall survival (27 questions [84% of questions]); relapse-, event-, disease-, or progression-free survival/relapse (27 questions [84%]); and quality of life (26 questions [81%]). Across 16 systematic reviews for which we found at least 1 study, each prioritized outcome was reported by a median of 25% (interquartile range, 20-48; range 0-79) of the studies. The outcomes prioritized by multidisciplinary guideline panels can inform future primary studies, systematic reviews, and guidelines on ALL, other blood cancers, and AYAs. Future research should involve the development and adoption of a core outcome set for ALL.

  PublisherDOI

• Fiber intake and laxation in people with normal bowel function: a systematic review

  American Journal of Clinical Nutrition · 2026-01-27 · 1 citations

  articleOpen access1st authorCorresponding
  PublisherOA PDFDOI

Frequent coauthors

• Peter C. Jeppson

  Island Institute

  904 shared

• Alexis A. Dieter

  893 shared

• Danielle D. Antosh

  Institute for Female Pelvic Medicine and Reconstructive Surgery

  847 shared

• Ambereen Sleemi

  760 shared

• Francisco J. Orejuela

  Baylor College of Medicine

  639 shared

• Gabriela E. Halder

  The University of Texas at Austin

  573 shared

• Kate V. Meriwether

  Island Institute

  565 shared

• Cara L. Grimes

  534 shared

Education

• M.D.

  Brown University

• Other, Biostatistics and Epidemiology

  Tufts University