refers to medical practices that undergo rigorous assessments in clinical trials
and other research methodologies
so that their effectiveness as well as safety can be established. The adoption
of practices based on evidence offers the best treatment options for patients.
‘American doctors do not appear to be completely open to adopting evidence-based medicine into clinical practice.’
During the reassessment of practices that
are already approved and in clinical practice, it is sometimes found that these
practices are not associated with the same benefits that they were expected to
cause when they were first approved. For example:
- A study published
in the New England Journal
of Medicine way back in 2002 demonstrated that an orthopedic
procedure called arthroscopic debridement and lavage does not help in
relieving pain and improving function in patients with osteoarthritis.
Similar evidences of lack of benefit were noted for the orthopedic procedures
spinal fusion and subacromial decompression.
- A recent study
published in the Lancet
indicated that stent placement in an artery of the heart to keep it patent
when done for non-emergency cases does not produce significant benefit and
relief of pain when compared to a sham surgery where the stent was not
used. Thus, the benefit appears to be more likely due to a placebo effect
of the procedure rather than the stent itself.
are the Benefits of Adopting Evidence-based Practices?
medicine provides the best treatment options for patients in
terms of effectiveness and safety.
practices can bring down the cost of treatment. Several individuals
receive medications and undergo costly and unnecessary tests, which do not
have any proven use and may even be harmful. This results in a lot of
wasteful expenditure and drains the financial resources of the individual
as well as the state which could have used those resources for procedures
that have proven usefulness.
treatment can be used not only to underplay some treatments, but also to
promote treatments that are beneficial and are not adequately used.
Why the Reluctance?
Despite the above benefits, it is
estimated that only half the treatments in clinical practice are supported with
adequate evidence. Some of the reasons suggested for the reluctance in adoption
of evidence-based practices in clinical medicine include the following:
- Once a treatment
is introduced and people know about it, it is suddenly difficult for
doctors to convey to their patients that the treatment is no longer
regarded as useful.
- Several doctors
get influenced by the advertisements of pharmaceutical companies and
medical device manufacturers who promote their own products, instead of
heeding to evidence-based medicine. They thus end up using procedures and
medications that may not be really useful for the patient.
- Some doctors
prefer to go with the treatments that they have been comfortable using.
practices are often based on large clinical trials, which require
financing. The use of taxpayer's money for evaluating the benefits of
treatment has been questioned.
can Evidence-based Practice be Encouraged?
As a part of the
"Choosing Wisely" campaign, launched in 2012 by the American Board of Internal
Medicine Foundation in partnership with Consumer Reports, medical societies are
advised to develop a list of treatments that have minimal clinical benefit to
patient. Unfortunately, the list did not change the ground reality, with
patients still being prescribed tests like imaging tests for uncomplicated
headaches, cardiac imaging for patients without a history of heart problems,
and routine imaging for patients with low-back pain.
One suggested approach
to extend the use of evidence-based practices is that treatments should be
thoroughly evaluated before being introduced. However, such an approach could
affect breakthrough treatments from reaching the market early.
Another possible way
would be for insurance companies to pay for evidence-based practices, and if
the patient would like to undergo any unproven procedure, they would have to
pay the additional amount from their pockets.
In their book
Unhealthy Politics: The Battle over Evidence-Based Medicine,
based on surveys, the authors found that though people are anxious
to know about the benefits and risks of treatments, they fear that the findings
could result in the rationing of medical care or tie the doctor's hands, who
may not be able to prescribe a treatment even if he/she feels it could benefit
a particular individual. They also found that the public has great faith in
their doctors, and if doctors were to promote evidence based medicine, the
public would accept it more easily. Thus, the
final say in the introduction of evidence-based medicine is in the hands of the
- Why American doctors keep doing expensive procedures that don't work - (https://www.vox.com/the-big-idea/2017/12/28/16823266/medical-treatments-evidence-based-expensive-cost-stents)