Sick apples, medicinal oranges
Nope, I'm still gone. But last week I was thinking: Why are we so afraid of evidence-based practices? What is up with the cynicism about actually researching and acting on data?
U.S., as Part of Stimulus Bill, Will Compare Effectiveness of Medical Treatments
U.S., as Part of Stimulus Bill, Will Compare Effectiveness of Medical Treatments
I think research like this is terrific, incredibly important and, in fact, absolutely essential in our health care system. (It'd be nice if they did it for things like education policy too...) I do, however, have concerns about the USE of that information. In my mind, it should be used to determine gold-standard, first line treatments. However, I think there is the worrisome potential that the data will be expanded beyond that use, as a means of denying treatments that aren't shown to be as effective in the overall population. What people often don't understand (especially if they don't have a science/research background...or if their focus is solely the bottom line), IMHO, is that population outcomes cannot be assumed to apply uniformly to individuals. Just because treatment A works better than treatment B overall does not mean that all patients will respond/respond better to treatment A; there may be subgroups who are better served by treatment B, and it is not feasible to do research on every treatment to determine whether these groups exist and/or who they are. I think this is where doctors' clinical experience can be useful--if a doctor has experience with a particular group of patients where B has worked better than A, in spite of A's overall greater effectiveness, then it might be appropriate for s/he to use her/his discretion in that case, in spite of the anecdotal nature of his/her knowledge. I worry that 3rd party payers will use comparative effectiveness studies as a way to deny alternative treatments, possibly hampering access for a significant number of people. I worry that doctors will be forced to treat all patients the same, discounting individual variation.
ReplyDeleteDon't get me wrong--it is not the research itself that I in any way, shape or form take issue with. I think it is HUGELY important and will probably prove incredibly useful. I think its results should be used as the arbiter of most decisions--medical care should be based on fact, not habit or advertising. I just don't want it to be used as a way of straitjacketing the ability to treat patients as individuals or as a way to withhold treatments that are less effective in the population, but might still prove useful for a particular patient/group of patients. (I especially see this as an issue since samples can often be biased, and a LOT of research is done on young, white men, who are hardly representative of the population as a whole, and whose outcomes might not generalize to other groups. If the research is done in a non-biased way, though, this isn't an issue...so the point might be moot.)
Anyway...sorry for the treatise, I've been waiting to spew about this somewhere, because the reactiveness of people who don't want treatments compared (which I can't understand at ALL) is driving me batty, but so is the lack of acknowledgment that the application of this research is just as key as DOING the research!
I agree with you. There will always be a balance between data and clinical judgement. We just REALLY need more of BOTH, right?
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