Re: EBM -- was Testerone
From: art fougner, md (evsono@pipeline.com)
Sun Mar 4 10:21:42 2001
No doubt smallpox vaccination would have not been reimbursed since it
was not validated by EBM.
art
At Sun, 4 Mar 2001, DoctorJoe@aol.com wrote:
>
>In a message dated 3/4/01 8:34:51 AM, mperloe@ivf.com writes:
>
><< While evidence based medicine (EBM) has allowed us to abandon many
>ineffective treatment regimens, unfortunately it has been used to refuse
>coverage for many treatments that have not yet undergone EBM validation. We
>must be careful not to fall into the trap that equates a lack of evidence
>(EBM double blind randomized clinical trial) with lack of clinical benefit.
>If we remove clinical judgement from the picture and reduce medicine to
>merely allocating patients to the appropriate EBM clinical pathway, we will
>be become medical technicians and provides and not healers. >>
>
>Ditto that.
>
>What the EBM clinical pathways are basically SUPPOSED to do is set a
>"standard" so a patient won't get SUBstandard care. However, if an EBM
>pathway doesn't exist, or a physician individualizes a patient outside of the
>pathway (giving, in effect, SUPERstandard care), then he/she is at risk from
>the reimbursement angle, as well as the "peer-review" angle (other physicians
>taking aim at a competitor for doing "unnecessary" medicine).
>
>So while EBM clinical pathways, or just clinical protocols and pathways of
>any kind, are good to keep mediocre doctors from falling below standard, they
>also run the risk of "dumbing down" medicine and also perhaps helping to run
>the best doctors out of town.
>
>Joe P.
>
>P.S. Just as an aside... (or a post script... hehe)
>
>The "evidence" which makes up many EBM protocols is not always applicable to
>the patient in question, depending upon where you are. A good example is the
>Canadian tocolytic study (by Hannah et al?), which used ritodrine and
>concluded that tocolytics don't work for longer than 48 hours, etc, etc.
>This, and studies like it, are often used to define "standard", at least for
>protocol development, of tocolytic drugs.
>
>However, as we years ago decided in a resident journal club, that paper gave
>results of a study of a drug we DIDN'T use, on patients we WOULDN'T use it
>on, in a way we WOULDN'T use it.
>
>So how, if we were out in a private hospital, let's say, would we be held
>accountable for a protocol based on such data? We SHOULDN'T be, but we COULD
>be...
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
