I first came across this story a few weeks ago when Obama was asked questions about health care reform by Jon La Pook at CBS news. Here is the crucial bit of the interview

Dr. La Pook: “ …... So they have on the one side their intuition as a physician, in their bellies, and then there's the evidence-based medicine that we talk about, and they clash a lot at times, so how do you make that doctor do the right thing or give him the right incentives?”

What was interesting was how Dan reported the interview, changing from the usual one way interview to more of a conversation, in which Obama was potentially trying to get to grips with understanding the issues surrounding EBM, particularly with respect to the potential overuse of elective angioplasties (30% are deemed unnecessary). In the ensuing week we saw those opposed to Obama’s healthcare try to link the reforms with cost cutting measures and with EBM.

“If we don't drive down costs, then we're not going to be able to achieve all of those other things." Which ones he didn't say, before stressing the need for "evidence-based care”,

Later in the week Obama had obviously been working hard studying Evidence-Based Medicine. I’m not sure which text he’d read but at a press briefing on the 22nd of July Obama, in response to a question, said:

“Part of what we want to do is to make sure that those decisions are being made by doctors and medical experts based on evidence, based on what works…. Right now, doctors a lot of times are forced to make decisions based on the fee payment schedule that's out there. … 'You know what? I make a lot more money if I take this kid's tonsils out … I'd rather have that doctor making those decisions based on whether you really need your kid's tonsils out, or whether … something else would make a difference…. So part of what we want to do is to free doctors, patients, hospitals to make decisions based on what's best for patient care.”

Of course this brought a response from the American Head and Neck Surgery association who were adamant they make their decisions based on evidence. So in a week the republican movement, eminent cardiologists and ENT surgeons were pretty fed up with the idea of health coverage for all based on evidence. Possibly, maybe, perhaps or is it definitely? (I’ll let you the reader decide) this is due to income reductions for stopping unnecessary procedures that don’t benefit patients. Muir Gray refers to this as value and waste in healthcare, using the Toyota term muda to refer to waste - namely the use of resources that does not add value to the outcome. This is the reason Obama is turning to Evidence-Based Medicine to press ahead his healthcare agenda for determining value and waste in the US.