Where’s the Evidence?

We’re beginning to hear a lot about the latest buzzword in health policy called “evidence-based medicine.” Simply stated, evidence-based medicine is where we look at the latest non-biased clinical information in deciding what is appropriate treatment or testing, for a particular disease or condition. As scientists, we hope to use information from randomized (which reportedly have less bias), controlled clinical trials to establish what really works. Many older studies may not have used a representative sample of patients, or were consistent in how those patients were diagnosed or treated. Even worse, some supposedly modern treatments were based on nothing other than anecdotal stories (“My grandmother always said to use vinegar and honey while turning counterclockwise and holding your nose. . .”). At its best, evidence-based medicine should allow us to use the most up-to-date, unbiased information to do things right with better results and with less harm to the patient. We can use the best medical evidence to develop quality guidelines that clinician’s anywhere in the country can access. This allows those clinician’s to provide the best care for their patients, with similar conditions, whether they live in Tulsa or Tucson.

Unfortunately in today’s political climate, the term evidence-based medicine seems to have taken on a sinister sheen. A recent study in Health Affairs suggests that consumers are unclear what this really means. When focus groups were conducted by researchers from the American Institutes for Research, they found that average consumers were unclear what the terms “quality guidelines” or “medical evidence” actually meant. Like many of us, the individuals in the focus groups believed they were already receiving high quality care from their physician and that it must already meet some “minimum quality standard.” Importantly, the focus groups believed that, “more care is better (high-quality) care” and “newer care is better.” They also believed that “more costly care is better care” and could not believe their physician would recommend anything less. In this study, they interpreted medical guidelines as “bargain-based” or simply an attempt to save money at the patient’s expense.

Of course, there has to be a middle ground. We recognize that some of what is evidence-based today will be a laughable episode on a sit-com in the future. Just as leaches and blood-letting went out of vogue, we’ll see current treatments fall by the wayside. But we also see where standardizing care can actually save lives. Whether you have a heart attack in Tulsa or Tucson, you want to be assured those clinicians are treating you with the best available knowledge that medicine has to offer. And believe it or not, it may not be high-cost. For a heart attack, one of the first medicines they may ask you to chew is a simple aspirin. Yes, that same aspirin your Mother gave you when you ran a fever as a child. A medicine discovered in 1897, costing only a few pennies, plays a vital role in stabilizing a heart attack. More importantly, don’t you want to be sure that no matter where you are your health care team knows this vital fact and makes sure you receive it right away? This is the power and the promise of evidence-based medicine. Don’t assume that all care is good care, or that you want the most expensive care that money can buy. You want the right care for you and you want it from professionals who are not afraid to ask if there is a better way to provide the care you deserve.

About Steve P. Sanders

A general internist writing and sharing ideas and art.

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