27 December 2008

Evidence Based Medicine

What is evidence based medicine? The words themselves seem to mean that science should be used to make medical decisions. Well, this is all fine and good. Without a doubt, scientific evidence should be used to help make medical decisions. But, all decisions involve varying proportions of fact and value judgments. For instance, the decision as whether to continue medical care in dire circumstances involves some fact, but mainly value judgments. So, right off the bat, there is one problem with the words "evidence based medicine." It implies that all judgments in medicine should be based on scientific evidence.

Another problem is that many use the term "evidence based medicine" to mean that having total access to evidence will improve medical decisions. "Evidence based" can be turned on its head: What evidence is there that total access to genetic information and medical charts will improve medical decisions? What is meant by access? Who gathers information and what will it be used for?

Let's return again to "evidence based medicine." What is it and who decides what it is? There often are three individuals or organizations involved: the patient, the doctor, and the entity paying for the medical care. Suppose the paying entity, which is usually the government or an insurance company, carries out a study showing cost savings that would be recognized if a certain course of medical care were pursued. How much should that information be used in making a medical decision?

This is just a taste of the problems that the phrase "evidence based medicine" brings with it.