By ROBERT LASZEWSKI
I want to call your attention to an important survey done by the California-based Campaign for Effective Patient Care. They surveyed California voters on their understanding of evidence-based medicine.The bad news is that patients think their health care treatment is generally evidence-based even though that assumption is highly questionable. The good news is that patients want it to be evidence-based.At a time when we hear anecdotal evidence, particularly from town hall meetings, that people don't want any "interference" between them and their doctors they do seem to appreciate they need to get all of the facts when making a treatment decision.Here is the survey summary. You can access all of it here.
Quick Summary of Evidence-Based Medicine Poll ResultsA Summer 2009 Lake Research Partners poll of 800 California voters released by the Campaign for Effective Patient Care brings a fresh perspective to the health care debate raging across the country.Voter opinions about evidence-based medicine could not be more timely. The under- and over-use ofmedical treatment threatens patients’ well-being and wastes lives and resources. The prestigious Institute of Medicine reports that only about half of doctors’ treatment decisions are based on evidence.The poll of California voter attitudes offers three important insights for policymakers:1) Voters know that medical treatment should be based on solid evidence and they mistakenly believe that most of the care they are receiving is evidence based.
- Most voters assume that medical decisions are guided by evidence. A larger percentage feels this way about their own treatment than about everyone else’s (65% vs. 51%).
- 84% of voters are confident that they get the information they need to make informed medical decisions and are overly optimistic about the ability of the current system to put new evidence into practice.
2) When voters are educated about the failures in our system, they want reform.
- 79% of voters believe that it is a serious problem when doctors fail to provide necessary treatment; 80% feel it is a serious problem when doctors provide unneeded medical treatment, and; 80% are more likely to support reforms when they learn about failures of the current system.
3) Voters are astute. They support specific and sensible evidence-based health-care reforms.
- 88% of voters strongly support ensuring that doctors have access to scientific evidence.
- 92% of those polled would require doctors to disclose the existence of scientific evidence supporting effective treatment. 90% would require disclosure of the absence of such evidence.
- Additionally, 72% of voters want health care reform that ensures doctors are paid based on whether their treatment is supported by scientific evidence, and not solely on how much treatment doctors provide.
Robert Laszweski has been a fixture in Washington health policy
circles for the better part of three decades. He currently serves as
the president of Health Policy and Strategy Associates of Alexandria,
Virginia. Before forming HPSA in 1992, Robert served as the COO, Group
Markets, for the Liberty Mutual Insurance Company. You can read more of
his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog, where this post first appeared.
More on THCB by this author:
Categories: Uncategorized
California Health care sucks. The Mexican Doctors try to turn children gay with drugs if they are white. They torture white patients due to England sending them child slaves in the past. They allow them to kill people without the victim’s families being able to be compensated due to a 1970s law. They suck and allow murder. They also let Dr.’s such as Dr.Klein of the Bay Area sew women up too tight and other torures ect to try to force them to sell thier children. That state tries to sell babies all the time that are white to use as slaves. It sucks. Someone needs to put these bastards in line. They allow Dr.’s whose relatives work in Healthcare and the funeral industry to work hand in hand to kill for profit. This is not acceptable. Kick some ass America. They suck.
You have to ask yourself the question:
“Do patients/people on average know what evidence-based medicine is?”
You have to answer that question before you can survey people on what they think about it.
I side with Margalit that the poll is probably not worth much since there probably is widespread ignorance.
And how can laypeople appreciate EBM when even the professionals do not get it straight?
First, MD as hell wants to suggest that all these studies don’t matter because the “absence of evidence” does not suggest that a treatment doesn’t work. But no one with knowledge of EBM would claim that. But convincing proof of a treatment not working (e.g. in a RCT compared to placebo), THAT tells us sthg about the treatment.
Others complain about commercial bias, e.g. publication bias and outright forgery. I think that is as valid of an argument against EBM as claiming that air travel is impossible because of a plane crash.
There are interesting conceptual problems with EBM that are worth discussing, esp. when EBM is understood as relying on RCTs only – the stroke neurologist Lou Caplan summarized them very well a few years ago.
But this poll as well as the reception here suggests that a lot remains to be learned about EBM, for medical pros and laypeople alike.
Over the last 25 years, clinical research has been largely privatized. Three-quarters of the clinical studies published in the three most respected medical journals (the New England Journal of Medicine, the Journal of the American Medical Assn. and the Lancet) are now commercially funded. As a result, our medical knowledge grows not in the direction that best improves our health but toward corporate profits.
And many journal articles are biased in favor of their sponsors’ products. A 2003 report in the Journal of the American Medical Association found that clinical studies funded by drug companies are three times more likely to conclude that the sponsor’s drug is the treatment of choice, compared to studies of the same drug that were not commercially funded. The disturbing conclusion is that most of the evidence in what doctors believe to be “evidence-based medicine” is more infomercial than dispassionate science.
Comparative-effectiveness research has the potential to tell us which drugs and treatments are safe, and which ones work. This is not information that the private sector will generate on its own, or that the “industry” wants to share. Companies want to control the data, how it is reviewed, evaluated, and whether the public and government find out about it and use it.
Comparative-effectiveness research can help doctors and patients, through research, studies and comparisons, undertand which drugs, therapies and treatments work and which don’t. No corporate bureaucrat between the patient and the doctor. Doctors will still have the ultimate decision, along with the patient.
“Scientific evidence”. This term is used over and over in the questionnaire for this poll. What does it mean?
“Scientific evidence” sounds like a good thing to have, no doubt about that. But do the voters really understand what comprises “scientific evidence” in the context of medical care and the survey they responded to?
I didn’t see any introductory explanation regarding the possibility of having “scientific evidence” to support multiple courses of treatment, even contradictory ones. Nothing to inform the respondents that today’s “scientific evidence” may be totally refuted in a couple of years.
I guess what people are saying is that they want their doctors to keep up with the literature and share the latest published studies with their patients.
That’s fair.
I didn’t see anybody ask how the voters would feel if treatment they wanted was denied (no antibiotics for a cold) based on “scientific evidence”.
The evidence can mean whatever you want it to mean. For instance, the evidence against balloon angioplasty or stenting of minimally symptomatic coronary artery lesions is strong yet it continues to be frequently carried out and insurance carriers pay for it and, more strikingly, voting patients want it and demand it.
Indications are forever a changin, guidelines are outdated by the time the ink is dry, and individual differences between patients (just with diverse genetic machinery) render many so called indicated therapies dangerous to any one patient.
The human element of medical care is being meaningfully ignored by HIT vendors, HIT professors, HIT zealots, O’Bama policy wonks, and the likes of ONC Blumenthal, czarette DeParle, and Sibelius.
Evidence-based medicine is nothing more than a reason to deny payment eventually.
The absence of evidence for a practice does not constitute the existence of evidence against a practice.
Furthermore the absence of evidence for a practice does not mean a particular practice or treatment is not efficaceous.
All research begins with a theory and a bias. There is very little evidence for anything in medicine.
I find that many in the community are so enamored by evidence-based clinical trials they wish to restrict their health decisions to the results of such studies. They appear to be unaware of how much of that “evidence” has been fabricated by BigPharma, who has made an art out of purchasing peer-review to suit their purposes. Remember Vioxx, peer-reviewed, evidence-based, FDA approved, and a complete sham?
Then there were the 26 peer-reviewed evidence-based clinical trials that were completely fabricated by Wyeth to fraudulently prove the safety and efficacy of Premarin and Provera.
This was a new high in peer-review corruption and evidence fabrication. The old title went to Scott Reuben, paid by Merck, Pfizer and Wyeth to falsify the data in 21published studies, including fake patients, reporting non-existent trials, and listing co-authors without their knowledge or consent. These phony studies supported Bextra, Celebrex, Lyrica, and Vioxx.
I belong to a small group of researchers who periodically read peer-reviewed studies and come to personal conclusions as to whether we think they are fake or not. Of course, they hide the ball so well we cannot be sure, but we are comfortable following our instincts. I would guess that the majority of the studies read supporting drug efficacy fail our informal veracity test, while close to 100% of the studies showing either lack of efficacy and/or adverse drug effects pass our veracity test. Common sense might predict such an outcome.
Roy Mankovitz, Director
http://www.MontecitoWellness.com