Monday, April 13, 2015

An organized agenda against evidence based medicine

Who, you might ask, could possibly be against evidence based medicine? Certain policy experts are, it turns out. Their anti-EBM agenda is largely hidden due to pervasive ignorance of what EMB is. Those among them who understand EBM (and not all do) might prefer to keep it that way.

And who are these policy experts? They make up that large and influential group referred to in a recent post by Retired Doc as the Medical Progressive Elite. Before going on it is important to point out what many fail to understand about EBM which is that merely citing population based evidence is not enough. Rather, EBM by definition requires the expertise of the individual clinician to apply the best available evidence to the unique attributes, preferences and values of the individual patient. The progressives referred to in Retired Docs post oppose EBM because they downplay the importance of the individual clinician acting on behalf of the individual patient. From the post:

The Medical Progressive Elite's haunting fear is that someone,somewhere is making their own medical decision with input from their private physician...

The last thing that the third party payers and the medical progressive elite want is that medical decisions be made a physician- patient "dyad".This situation is ripe for a classic Baptists and Bootleggers scenario,the medical elite sincerely believing that medicine is too complex and expensive to be left to the judgment of patients with advice from their physicians...

The “dyad” referenced above consists of two of the three key elements of EBM: the clinician and the patient. Remove those two elements and you are left with evidence, but without the “dyad” how can the evidence be effectively applied? Through core measures, care pathways and central authority according to the elite. Again from the post:

This medicine-is-too important-to-be left-patients-and-their- physicians view is made crystal clear in the following quote from the book,"New Rules" written by Drs. Don Berwick and Troyen Brennan:

"Today, this isolated relationship[ they are speaking of the physician patient relationship] is no longer tenable or possible… Traditional medical ethics, based on the doctor-patient dyad must be reformulated to fit the new mold of the delivery of health care...Regulation must evolve. Regulating for improved medical care involves designing appropriate rules with authority...Health care is being rationalized through critical pathways and guidelines. The primary function of regulation in health care, especially as it affects the quality of medical care, is to constrain decentralized individualized decision making."

But those methods for applying evidence, rules, pathways and authority, have demonstrated failure time and time again.

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