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Health treatments? Show me the evidence

Health writer and policy wonk Shannon Brownlee and University of California-Davis physician and researcher Michael Wilkes wrote an editorial in Wednesday’s Sacramento Bee that highlights, yet again, the urgent need to develop truly evidence-based guidelines for medical care (hat tip,  Gary Schwitzer’s Health News Blog). They write:

Patients go to the doctor looking for effective treatment, and this being the 21st century, they assume that their doctors’ recommendations will be based on up-to-date science.
Yet all too often that’s not the case. According to the prestigious Institute of Medicine, only about half of the treatments, surgeries, tests and minor procedures that doctors recommend are backed up with sound medical evidence. The other half? Doctors have only theory, tradition or marketing by the pharmaceutical and medical device industries to guide them.
This lack of valid science hurts patients and costs the nation billions in wasted dollars annually. Take lumbar fusion surgery for simple lower back pain — pain that isn’t caused by cancer or a major accident. Between 1993 and 2003, spending for lumbar fusion rose 500 percent, despite an almost complete lack of sound evidence that this invasive, potentially risky procedure is effective. It might relieve pain for some patients — and worsen it for others. Surgeons and patients simply don’t have the information they need to predict ahead of time who is likely to benefit and who will be harmed.

Undertreatment is also a problem, note Brownlee and Wilkes:

Even when sound evidence exists, patients don’t always get the care they need. About 25 percent of heart attack patients don’t receive an aspirin and beta blocker within 24 hours of being admitted to the hospital, despite solid science showing that these drugs can cut the risk of a subsequent heart attack by 20 percent.
The same is true for countless other conditions and tests. In some cases, the root cause is poorly trained doctors, but most of the time, we just don’t have effective ways of monitoring quality and providing doctors with timely, reliable evidence.

Why aren’t we hearing more about the issue of medical evidence in the current turbulent health care debate? Here’s Brownlee and Wilkes’ answer:

Maybe because doctors have not always been truthful in telling people what they know and don’t know. Many physicians are either unwilling or unable to take the time needed to fully explain where uncertainty exists. As a result, 65 percent of California voters are under the mistaken impression that most or nearly all of the health care they receive is backed up by scientific studies.

But I think health consumers must also own up to their own part in this medical charade, particularly those lucky ones with full health care coverage — and who therefore can (and often do) demand unnecessary medical tests and procedures or the very latest and thus most expensive (but not necessarily the most effective) medications.

If we’re going to wrestle down our nation’s health care costs, we’re all going to have to become more rational — and evidence-based — about our medical care choices.

And I, for one, haven’t seen a lot of rational behavior yet.

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