Remarkably, a doctor today can get more data on the starting third baseman on his fantasy baseball team than on the effectiveness of life-and-death medical procedures. Studies have shown that most health care is not based on clinical studies of what works best and what does not — be it a test, treatment, drug or technology. Instead, most care is based on informed opinion, personal observation or tradition.
They go on to say:
Similarly, a health care system that is driven by robust comparative clinical evidence will save lives and money. One success story is Cochrane Collaboration, a nonprofit group that evaluates medical research. Cochrane performs systematic, evidence-based reviews of medical literature. In 1992, a Cochrane review found that many women at risk of premature delivery were not getting corticosteroids, which improve the lung function of premature babies.
Even though this Op-Ed seems to be saying what we (HPfHR) are saying, there are several things that bother me.
The first is the statement that:
Studies have shown that most health care is not based on clinical studies of what works best and what does not — be it a test, treatment, drug or technology. Instead, most care is based on informed opinion, personal observation or tradition.
They give no reference for this, but I suspect that if there is literature on it, it is pretty old. As most healthcare professionals know, there has been a significant shift to evidenced based medicine over the last decade that has come from many sources, not just private groups like the Cochrane Collaboration or the Intermountain Healthcare Foundation. In fact most of the recent impetus has been physician driven and is increasingly more readily available for healthcare providers through publications of "Guidelines and Standards" or "Position" documents in major medical journals.
This brings up another thing that bothers me, namely that once again it is the politicians (and now baseball managers!) who are trying to tell the healthcare profession how to practice medicine! I think that we all would love to think that practicing medicine is similar to managing a baseball team. All we have to do is master some empirically derived formulas like "VORP (value over replacement player) or runs created — a number derived from the formula [(hits + walks) x total bases]/(at bats + walks)" and we can cure our patients and bring down costs!
Even though it seems absurd to healthcare professionals that all we need are a set of statistics and a good database system, this will be what is presented to the public by groups like the authors of this piece!
Finally, as to the statement:
Working closely with doctors, the federal government and the private sector should create a new institute for evidence-based medicine. This institute would conduct new studies and systematically review the existing medical literature to help inform our nation’s over-stretched medical providers. The government should also increase Medicare reimbursements and some liability protections for doctors who follow the recommended clinical best practices.
I think that although the "institute" sounds like our "Board" it has several significant problems. First is the involvement of the private sector. Although the private sector should have some representation on our "Board", I suspect that in this "institute", the private sector will hold too much sway and as usually occurs when the public and private sectors compete, costs will go up and efficiency will go down. Secondly this proposal will not work in the current system, since Medicare does not cover the entire population and the institute will have no control over spending.
Billy Newt and John, its a nice thought, but I think that you should let the healthcare professionals take control of this. We promise we won't tell you how to manage a baseball team! (BTW: How did the Oakland A's do this year? Was it 10/14 in the American League?)
Gil
Addendum: In the print addition of the piece, it states that the Intermountain Healthcare Foundation is part of Newt Gingrich's "Center for Health Transformation, a for-profit organization". So much for altruism...
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