Who’s Afraid of Evidence-Based Medicine?

In all the chaos surging around the conversation in the United States as people grapple with health care reform, there’s one area where people seem to be particularly confused: evidence-based medicine. A practice widely adopted in the rest of the world, evidence-based medicine still seems to be something people in the United States are afraid of, especially thanks to the fact that conservatives framed it with scaremongering language like ‘death panels’ to make it seem like something that would inevitably lead to the utter collapse of the US health care system; after all, in a country where medical practice was based on the best available evidence, obviously the most vulnerable members of society would be dropping like flies, unlike now. Oh, wait.

The basic premise of evidence-based medicine is that treatment shouldn’t be provided unless there’s evidentiary support for it. In the case of national health programmes, evidence-based guidelines are used to determine what the government will and will not pay for, using the results of studies involving lookback reviews, clinical trials, and other resources. If a given medication hasn’t proved effective with a specific disease, for example, the government will not pay for it. If the chance of success is slim and the costs are high, the government might likewise refuse to pay.

Evidence-based medicine can also involve some tough costing decisions. If a cancer medication would extend a patient’s life by a month, but the patient would live in considerable pain and distress and require a lot of medical support, is it worth funding? From one perspective, yes, because the patient should be able to make an informed choice about it and the government shouldn’t determine the patient’s medical outcome. From another perspective, no, because the funds in the medical trust are limited, and could be used more efficiently and appropriately. That doesn’t mean the patient couldn’t use private-pay insurance to fund the treatment, or couldn’t pay for it personally.

The fact is that evidence-based medicine is sometimes hard, but it’s the most fair way to distribute medical resources. And it’s also used to improve the overall quality of care for patients by ensuring that they get the best treatment possible when it will be most effective. While individual caregivers still use their judgment to make the best decisions for their patients, given the specifics of given cases, these guidelines can help them determine what the options are, and which options to pursue in a particular situation. Maybe patients with a similar course of symptoms have done well on a medication the physician hadn’t considered, for example, in which case evidence-based medicine would actually help a patient considerably.

Yet, people in the US seem terrified of the idea of seeing evidence-based medicine applied here, convinced that it means they’ll be sentenced to death by government guidelines. The fact is that US insurance companies, who oversee the bulk of ‘health care’ in the US, are already doing this; and they’re not using medical evidence to determine what to pay for, but a cost-based metric. Their goal is to determine what they can get away with not paying for, rather than to explore what might be the best option for a patient who needs treatment. They won’t pay for a cancer medication that extends life because it’s too expensive, regardless as to the options available and what kind of quality of life it might offer the patient.

People in the US seem firmly convinced that their health care system is the best in the world, and they’re very rooted in the idea of individualism above all else. While every body is different and every medical situation is different as well, evidence-based medicine provides a guideline for exploring treatment options and making informed choices, with a wealth of information on possible outcomes, what to expect during treatment, how patients tend to perform in response to given treatments, and more. If anything, it’s a boon to both patients and physicians, and it’s irritating not to see it treated that way.

One thing it does, for example, is spare patients unnecessary procedures. Evidence-based medicine can radically reduce the risk of false positives from unnecessary aggressive medical testing, for instance, which in turn means that patients don’t have to undergo costly, uncomfortable, and grueling followup tests and treatments for conditions they don’t even have. Not getting a pap smear every year, for example, doesn’t mean that European women are wandering around with massive untreated cellular changes wreaking havoc in their bodies. It does mean that European women are less likely to have costly followup tests when an annual pap turns up some random funny-looking cells, as happens with too-frequent testing. Testing every three years under evidence-based guidelines strikes the perfect balance between false positives and waiting too long, potentially allowing cancerous cells to develop.

It also protects the right to access treatments if they’re deemed effective and appropriate according to evidence-based research, which is also good news. People should be excited about the fact that evidence-based medicine considers patient needs and then cost, rather than the other way around. While obviously the expense of treatment is weighed, if it’s effective, it’s covered, and if there’s a clear rationale for a given treatment in a particular situation, it will be approved. This is a stark difference from the more haphazard application of medical treatment and standards of care in the US, where it’s very difficult for any kind of coherent decisionmaking to occur in terms of what kind of treatment is appropriate and who should pay for it.

We should be embracing the application of science and mathematics to the practice of medicine in the United States to create more tools for health care providers to use in the quest to keep quality of life good and health care options broad. Instead, people in the US apply their fear of math and science to medicine, too, thereby missing out on the potential for radical beneficial reforms in the medical system.