Comments on: More On Evidence Based Medicine http://www.healthpolcom.com/blog/2008/03/06/more-on-evidence-based-medicine/ A Forum for Discussing and Analyzing Healthcare Issues Wed, 07 Jan 2009 04:51:12 +0000 http://wordpress.org/?v=2.3.2 By: Lorraine Johnson, JD, MBA http://www.healthpolcom.com/blog/2008/03/06/more-on-evidence-based-medicine/#comment-61 Lorraine Johnson, JD, MBA Sat, 15 Mar 2008 06:05:22 +0000 http://www.healthpolcom.com/blog/2008/03/06/more-on-evidence-based-medicine/#comment-61 It has been pretty apparent for some time that EBM is a tool of managed health care and more particularly intended to blunt the impact of any universal health care policy that may be crafted over the next 4 years. EBM can be an enormous barrier to care because in the hands of insurers it assumes that the evidence is all in and that if the research hasn't been done, then treatment can be denied or delayed until the research is generated. David Eddy once said that whoever controls the guidelines, controls medicine. He also said that "[i]n a field filled with uncertainty and doubt, the difference between ‘when in doubt, do it’ and when in doubt, stop’ could easily swing $100 billion a year”. (“Clinical Decision Making: From Theory to Practice” David M. Eddy, 1996.) The use of EBM to centralize medical decision-making, suppress clinical discretion, and reduce costs results in patients being denied care and innovation being quashed. The assumption that one can easily look to the "evidence" from abstract clinical trials that do not take into account the severity or course of illness in the individual as opposed to the statistical patient is fraught with danger. The bulk of medicine today is practiced in the gray zone of uncertainty, without the benefit of clinical trials. EBM is used by insurer to deny care, but even worse, is being used to preclude the use of other treatment options even when the patient is willing to pay for them. It is time for American to wake up and reclaim the medical ethical compass from insurers (including Medicare). Lorraine It has been pretty apparent for some time that EBM is a tool of managed health care and more particularly intended to blunt the impact of any universal health care policy that may be crafted over the next 4 years. EBM can be an enormous barrier to care because in the hands of insurers it assumes that the evidence is all in and that if the research hasn’t been done, then treatment can be denied or delayed until the research is generated. David Eddy once said that whoever controls the guidelines, controls medicine. He also said that “[i]n a field filled with uncertainty and doubt, the difference between ‘when in doubt, do it’ and when in doubt, stop’ could easily swing $100 billion a year”. (“Clinical Decision Making: From Theory to Practice” David M. Eddy, 1996.) The use of EBM to centralize medical decision-making, suppress clinical discretion, and reduce costs results in patients being denied care and innovation being quashed.

The assumption that one can easily look to the “evidence” from abstract clinical trials that do not take into account the severity or course of illness in the individual as opposed to the statistical patient is fraught with danger. The bulk of medicine today is practiced in the gray zone of uncertainty, without the benefit of clinical trials. EBM is used by insurer to deny care, but even worse, is being used to preclude the use of other treatment options even when the patient is willing to pay for them. It is time for American to wake up and reclaim the medical ethical compass from insurers (including Medicare).

Lorraine

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