Wednesday, December 15, 2004
Evidence-based medicine questioned
[Press Release, "WAKE-UP CALL: Technocrats are Taking Over the Practice of Medicine," Citizens' Council on Health Care, 13 December 2004.]
As health care costs continue to rise, policymakers are beginning to become more desperate for methods of bringing them under control. In contrast to the bottom-up approach of consumer-driven health care, some are beginning to consider top-down solutions that result in government decrees of what can and cannot be done to treat medical problems - essentially a form of managed care, but operated by the government instead of a company. Evidence-based medicine is at the forefront of this discussion, and a new report suggests that the idea will not put the interests of the patient first:
"The public needs to understand that evidence-based medicine is an attack on the patient-doctor relationship. EBM is not individualized care. It is group-think medicine," says Twila Brase, president of CCHC and author of the report.
CCHC stresses the following five points:
1)* The term "evidence-based medicine" (EBM) cannot be taken at face value*. EBM/ is/ managed care. Same game, different name.
2)* Science, the purported foundation of EBM, is not incontestable*. In research, there are subjective choices all along the road to creating the "evidence" of EBM.
3)* Practice guidelines, used to implement EBM, have significant problems*. These include out-of-date, biased, conflicting with each other, lack of individualization, and single-disease focus.
4)* Under EBM, practice guidelines are becoming treatment mandates*. Financial consequences are increasingly a possibility for doctors who do not follow guidelines issued by health plans or government. Computer systems to track and report physician adherence are being established.
5)* Patient harm can result from EBM, and its treatment mandates*. Practice guidelines are written based on data collected from medical records of many patients. They do not focus on the care, or the unique circumstances and physiology, of individual patients. And, as has been reported in England, they can be used to implement health care rationing.
"Control over medical decisions is being shifted from doctors to data crunchers; from professionals at the bedside to bureaucrats in big offices," says Ms. Brase.
"The public should not be fooled by the nifty-sounding names. Evidence-based medicine is managed care masquerading as science."
[Press Release, "WAKE-UP CALL: Technocrats are Taking Over the Practice of Medicine," Citizens' Council on Health Care, 13 December 2004.]
As health care costs continue to rise, policymakers are beginning to become more desperate for methods of bringing them under control. In contrast to the bottom-up approach of consumer-driven health care, some are beginning to consider top-down solutions that result in government decrees of what can and cannot be done to treat medical problems - essentially a form of managed care, but operated by the government instead of a company. Evidence-based medicine is at the forefront of this discussion, and a new report suggests that the idea will not put the interests of the patient first:
"The public needs to understand that evidence-based medicine is an attack on the patient-doctor relationship. EBM is not individualized care. It is group-think medicine," says Twila Brase, president of CCHC and author of the report.
CCHC stresses the following five points:
1)* The term "evidence-based medicine" (EBM) cannot be taken at face value*. EBM/ is/ managed care. Same game, different name.
2)* Science, the purported foundation of EBM, is not incontestable*. In research, there are subjective choices all along the road to creating the "evidence" of EBM.
3)* Practice guidelines, used to implement EBM, have significant problems*. These include out-of-date, biased, conflicting with each other, lack of individualization, and single-disease focus.
4)* Under EBM, practice guidelines are becoming treatment mandates*. Financial consequences are increasingly a possibility for doctors who do not follow guidelines issued by health plans or government. Computer systems to track and report physician adherence are being established.
5)* Patient harm can result from EBM, and its treatment mandates*. Practice guidelines are written based on data collected from medical records of many patients. They do not focus on the care, or the unique circumstances and physiology, of individual patients. And, as has been reported in England, they can be used to implement health care rationing.
"Control over medical decisions is being shifted from doctors to data crunchers; from professionals at the bedside to bureaucrats in big offices," says Ms. Brase.
"The public should not be fooled by the nifty-sounding names. Evidence-based medicine is managed care masquerading as science."
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