Evidence-Based Medicine: A Way to Decrease Waste

Efficiency and effectiveness are both qualities that all healthcare organizations should always strive for. This week, I decided to look into the blogosphere for ways in which these two qualities can be achieved. I was able to come across a couple of blogs that really inspired me. They both touch upon the importance of evidence-based medicine in reducing the amount of money wasted each year, thus improving both efficiency and effectiveness. It is quite often that we hear that the United States is one of the countries that spends the largest percentage of GDP in healthcare, yet there are always complaints about the quality not being up to par. This can be partly attributed to the amount of money wasted each year on unnecessary procedures that have no real effect on the patient's health.

The first blog I explored is called The Healthcare Blog. I specifically read a post by Maggie Mahar entitled A Blueprint for Healthcare Reform. In this post she argues that "unnecessary care doesn't just waste dollars: it can be hazardous to your health". Because of this, she stresses the idea that reduced utilization can lead to better outcomes, and supports this through the findings of Dr. John Wennberg. The other post I looked at showed a different side of the problem of evidence-based medicine: the lack of it in the United States. In a blog named Gooznews.com, Merril Goozner wrote a post titled FDA Proposes Lack-of- Evidence Based Medicine Policy. He explained that the FDA is trying to get a policy passed which would allow pharmaceutical companies to give journal articles advertising the off-label uses of the specific medicines to physicians. This would of course incentivize more studies for the other uses of the medicine, but unfortunately it would not be in a controlled and supervised manner and findings from these trials can lead to misleading information regarding the true benefit of the medicine for the off-label use. Through his article, he is able to convey the inefficiency of this policy, and the harmful effects it could have on our healthcare system.

I have attached the comments I made in regards to their arguments, and hope that you will take the time to read what these authors have to say to better understand the need for evidence-based medicine.

Comment 1 - First and foremost, I would like to thank you for this very insightful post. I myself had never read or heard any of Dr. Wennberg's work, and find it very intriguing that knowledge in this subject has been so prominent yet no one has seemed to be doing much to fix the problem of waste in our healthcare system until very recently. I would have to agree with much of what was written in the previous comments in terms of why so much money is being disposed of so carelessly. Both the fear of malpractice law suits as well as the lack of flowing knowledge between patient and physician can often lead to overusing treatments and procedures. I think that because of this it is very important that we do keep in mind this idea of evidence-based medicine, and really focus on the patient's actual needs. I found the concept of "Manifest Efficacy" to be really relevant to this issue as well. Although I had never heard the actual term, the concept of it is one that is very familiar. I think that it is very much the responsibility of the physician to be looking out for their patients because most of these people are not very knowlegdeable of what many procedures entail and thus trust their caregivers wholeheartedly, never really questioning what is being done to them, instead believing that it is what is best for their health. I believe that in order to move into a more patient based healthcare system, new ideologies that promote this type of environment need to be accepted by Healthcare organizations. An excellent example of this can be seen in the new rules established by the Institute for Healthcare Improvement. These rules re-define the way HCO's manage healthcare, and really do a great job at trying to cut down some of the waste. Some of these rules include 1) Treating health as a continuous process 2) Letting knowledge flow freely between caregiver and patient 3) Customizing Care 4) Letting the patient be the source of control and decision-making, and so forth. By living up to these types of expectations, there is a shift in the mentality of how to access the necessary care for each individual, and thus a better quality of care is provided.

In regards to the rewarding quality rather than quantity, I believe that the gradual shift towards a pay-for performance method of reimbursement might provide the necessary incentives for providing better quality of care. While this might not be the only answer, it might serve as a stepping stone for future change.

Comment 2 - Merrill, thanks so much for giving insight on this new policy that is trying to be enacted. As a policy major, I am appalled at the idea of a policy such as this one even being brought to the table. I cannot believe that anyone would really think that this would be beneficial for either physicians or patients. Not only does this pose a possible threat to patients, but it could potentially be more costly for physicians and even the pharmaceutical companies if these drugs prove to have adverse effects when using them for off-label purposes. I am curious to know if the people who would be put in these so-called clinical investigations are aware of what they are putting themselves through. Even if they did, you are correct in saying that the result of these studies could be misconstrued. Who can assure us that the proved benefits of taking a medicine are not the result of another confounding factor. It makes me very weary of where the FDA's heart really is if they are willing to propose something that could potential even take someone's life. While pharmaceutical companies might make more money rapidly, the long term effects and cost for the country cannot be measured. It is imperative that we keep the same type of test and trials that we have been doing in order to ensure knowledge of the true benefits of these drugs. I would hate to see so much money go to waste trying to recover from such a crisis that a policy like this poses.