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Why is Obama talking up Evidence-Based Medicine?

Carl Heneghan
Last edited 17th March 2010

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.

republicans telling us whats Killing Grandma

Great blog post on

This Republican fear-mongering about healthcare reform killing grandma is really burning my butt: I have delivered "everything", I know what "everything" looks like, I know its dark side. I also know that they are spreading deliberate and self-serving lies to bring Obama his Waterloo, and that these lies will ultimately hurt not only grandma, but the rest of us as well. Let me tell you what I mean....................

at http://evimedgroup.blogspot.com/2009/08/whats-really-killing-grandma.html

Rural America may be the worst affected

In rural America, skepticism of health care reform

'In rural America, many are too poor to afford basic care. People who can afford doctors often can't find them. The lack of health care in small towns like Walsenburg is a problem Congress is just beginning to address.'

It cant get much worse, see:

Conservatives still worried about EBM

Nice follow up article at the walll street journal, on the problems facing the US

Injecting Value Into Medical Decisions
In Debate on Reform, Many Say Quality Should Trump Quantity, But What’s Best Isn’t Always Clear


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