Health Care Thoughts: Evidence Based Medicine
by Tom aka Rusty Rustbelt
Health Care Thoughts: Evidence Based Medicine
Evidence based medicine is one of the center pieces of PPACA (Obamacare) and is generally viewed as THE enlightened way to practice medicine and to direct dollars more effectively. Problem is, there is a “whose ox just got gored” issue.
The American Psychiatric Association is currently revising guidelines for autism spectrum diagnoses, and early research indicates some high cognition youngsters may have their diagnosis dropped or altered. This could result in an alteration or loss of services (caveat: it is very early in the process).
It has been suggested over the past couple of decades the diagnosis was expanded, perhaps past the bounds of science, as parents scrambled and pleaded for help. Parents and educators are concerned. What parent can blame them?
In 2009 new recommendations were published for breast cancer treatment and there was a firestorm of criticism. Breast cancer is an emotional topic (justifiably so).
We tend to associate less treatment with neglect or negligence.
But, if we are to follow evidence based medicine then we have to go with evidence. Right? Many difficult decisions lie ahead. (My own physician has cut back testing at my annual physical based on new guidelines, so I have a personal stake in this.)
PS: New guidelines on bone densiometry (osteoporosis test) are coming soon and will probably indicate less testing for women once a baseline is established.
dunno. sounds fuddled to me.
recent book “The Anti Romantic Child” convinced me that “autism” was not the right diagnosis, but that there were kids that could really use some help. not all of which, unfortunately, is helpful, and some of which is harmful.
so it’s not so much whose ox i worry about, as whose “evidence.” some “tests” and procedures “work” and some do not.. or not enough, or not for everyone but for some whom the science has not clearly distinguished.
problem of course is that if the public is going to pay for it, we end up with a bureaucratic decision making process which might be less harmful than the pfree enterprise process, but more public, as it were.
Related article if anyoneis interested:
http://marginalrevolution.com/marginalrevolution/2012/01/an-economic-and-rational-choice-approach-to-the-autism-spectrum-and-human-neurodiversity.html
As someone who works in the biotech industry, and has experience in the field of “super bugs” (MRSA) I think there is a little bit of evidence based medicien as the media cure of the month hype wave thing going on here.
EBM is good, but it is DARN hard and DARN $ and it is DARN hard to find honest people who don’t have a financial or emotional stake
Not only that, we just don’t know a whole lot about a lot of stuff
A good example is this morning’s excellent report on NPR on depression and Prozac: Prozac may not actually, as a chemical, do much for depression, but it did do a lot for people, because it made depression into a chemical imbalance, which mean’t that people could come out of hte closet with their depression
This is an example of, it is really hard to predict how things will turn out, and we know very little, and EBM is not as good as people say
Another example, Avastin, the miracle breast cancer /colon cancer drug from Roche/genentech
I’ll bett dollars to donuts, we ever do a serious study, benefits will be limited: but try telling that to desparate cancer victims, ….I’m not saying EVB is bad, just don’t expect miracles
Pharmacy Dropshipper