Let’s Apply What We Know Evidence-Based Medicine Towards the Practice of Medicine Before Spending More On Effective Treatments

Over one billion dollars of the economic stimulus package will be used to study which procedures, drugs, and devices are the most effective to treat disease and carry the least risk to the patient (http://www.nytimes.com/2009/02/16/health/policy/16health.html?_r=1&scp=1&sq=Stimulus%20Bill%20Gives%20%241.1%20Billion%20for%20Comparative%20Effectiveness%20Research&st=cse, (http://newoldage.blogs.nytimes.com/). We already have scientific evidence that many of our most expensive tests and treatments are unneccessary, risky and very expensive, adding over $700 billion to our healthcare costs. One of the leading culprits is coronary care; $60 billion is spent on unnecessary angioplasties and coronary artery bypass surgeries. In additions, thousands of women are having  unnecessary Cesarean sections (that cost 50% more than natural delivery) simply because it  is more “convenient” and thousands more are having back surgery that in 90% of cases works no better than physical therapy. There are also countless examples of unnecessary use of expensive drugs and medical devices-all based on scientific evidence.

One problem we have is that doctors and hospitals don’t pay attention to the scientific evidence because doing so would cost them $$$$. Surgery makes $$$$$, prescribing pills makes $. If having more scientific evidence is so important we would be applying what we know to medical practice (http://www.thehealthcareblog.com/the_health_care_blog/2009/02/are-we-mature-enough-to-make-use-of-comparative-effectiveness-research-.html).  However, Medicare and private insurance companies continue to reimburse providers by the number of procedures they perform, not by whether the procedure was necessary and improved the health of the patient. Until we reform the payment structure, for example, pay by performance rather than procedure, we will continue to have treatments that are of little value and very expensive (but very lucrative for doctors). No one can argue that much of medicine is based on hunches rather than evidence (about 50%) and we need more research in this area, but let’s first spend the money on reforming healthcare reimbursement so what we do know about evidence-based medical care is applied in the medical community.

The public is also responsible for the increase in healthcare costs.  The public need to understand that more care does not equal better care-just because insurance pays for it doesn’t mean it’s better or should be done. We cannot and should not perform everything that is technologically possible on every patient without considering the scientific evidence supporting it. This is what is meant by rationing of care-using the scientific evidence supporting treatment options.

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