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Inside Health Care: Show Me the Evidence


Are we really supposed to drink eight glasses of water a day?'  Just where did this common health advice come from? On The Health Care Blog, Brian Mossop, Ph.D., cites research that indicates that there is not one piece of data that supports this practice. 'The problem is many articles cited another study that cited another study, which in turn cited yet another'It's like a really bad version of the 'telephone game,'' says Mossop.

On Health Beat, Naomi Freundlich, M.A., cries out 'to stop 'resolutely ignoring' medical evidence.' She specifically refers to practices in cardiology:

'Even though many well-designed clinical studies conclude that drug therapy can reduce the risks of heart attack and death in people with stable coronary artery disease just as well as most expensive invasive procedures, many cardiologists continue to use interventions like propping open blocked arteries with costly stents instead of first trying medications.'

After an in-depth analysis of what is occurring in practice, Freundlich concludes:

'But it is vitally important that we bring clinical practice consistently in line with evidence-based medicine. The time is long past when we can just assume that every new device or that every new surgical intervention is better than an older one.'

On Gary Schwitzer's blog, Schwitzer cites Dr. Rita Redberg's recent New York Times opinion piece where she claims, 'Medicare spends a fortune each year on procedures that have no proven benefit and should not be covered.' Schwitzer points to examples of questionable care in Redberg's piece: colonoscopies for people over 75 years-old, screening for prostate cancer in men 75 years and older, vertebral fractures procedures, cardiac stents for stable coronary artery disease, and implanting cardiac defibrillators in those who will not benefit from them.

Howard Brody, M.D., references a recent article in The Journal of the American Medical Association in his blog post, 'The Sources of Uncertainty in Medicine':

'We want to know, for good medical practice, about effectiveness (does something work in real life practice?) and cost-effectiveness (is it worth the cost, considering other alternatives?) but usually we have to settle for data on efficacy only (could it possibly work based on evidence gathered in a select population under more or less unreal conditions?)'

Reliance on efficacy data and the absence of real effectiveness data leads to two serious problems--indication creep and prevention creep'Indication creep is using a drug good for some things for other things for which it is not as good and where it poses risks of adverse reactions'Prevention creep is using a test that is helpful in some circumstances in other circumstances where it's guaranteed to generate too many false positives to be useful.'

Brody says that doctors try to treat people based on the best available evidence. Even when the evidence is flawed, doctors lean toward treating instead of not treating, which may lead to harm and wasted resources. Brody blames industry marketing for contributing to 'indication creep.'

Freelance writer, Brian Mossop, Ph.D., contributes to The Decision Tree blog. Naomi Freundlich, M.A., is a Senior Research Associate at The Century Foundation and contributes to the Health Beat blog. Publisher Gary Schwitzer blogs on Gary Schwitzer's blog. Director of the Institute for the Medical Humanities at the University of Texas Medical Branch and family medicine physician, Howard Brody, M.D., Ph.D., blogs on Hooked: Ethics, Medicine, and Pharma.

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Evidence-Based Medicine   CFAH Staff   Make Good Treatment Decisions   Inside Healthcare  

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