Why is Obama talking up Evidence-Based Medicine?
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.
Is organic food a waste of money?
“Organic” is just one of the many labels thrust on the socially conscious, along with “carbon-neutral”, “eco-friendly”, “green”, “fair-trade” and “ethical”. Such labels are powerful marketing tools for the relevant industries, and people are even prepared to pay more if they feel they are doing good, particularly for their health. But are the claimed benefits backed up by evidence and should we be sceptical?
AIDS in Africa - lessons we should have learned
If you read about the early history of the HIV/AIDS epidemic in America, it is hard to not be struck by the public health consequences of apathy and discrimination of policymakers, health service providers and researchers. These were my feelings when I read “And the Band Played On: Politics, People, and the AIDS Epidemic”, by Randy Shilts, a few years ago. The tragedy is that many of the same issues Shilts wrote about 22 years ago are still alive in Africa today.
Time to improve access to medical school
A couple of weeks ago, I spent the evening in London, with three other doctors, talking to sixth-formers from “non-traditional backgrounds” (a euphemism for low socio-economic status) about studying medicine. A friend from medical school organised this careers event on behalf of Teach First, an independent charity that aims to broaden access to education. These were 16- and 17-year olds achieving high grades despite being in inner-city schools, where their peers were not pursuing A-levels, let alone higher education.
Do you know the right age to start cervical cancer screening?
I guess the best blogs to write are the ones about subjects you don’t know the answer to. However, it always astounds me how many people can advise you on the answer about an important issue despite not knowing what the evidence actually says. So, when the recent British Medical Association conference voted on this issue (two thirds voted for the lowering of the age of screening to 20), my first thought was I would abstain, primarily due to lack of knowledge about the evidence-base on cervical cancer.
Statins - are they worth it?
Last week, the press reported that relatives of people with familial hypercholesteraemia are not being adequately screened in the UK, despite their increased risk of heart attacks, which could be prevented by early treatment with statins. However, the more important story was about statins themselves.