Anecdotal medicine or evidence-based medicine, that is the question. When you go see your trusted doctor, do you want him to diagnose and prescribe based on his or her decades of experience? Not to say there are not great doctors out there that have great experience, but there is a better way. How about if the doctor could make a phone call to IBM’s Watson or access a database and ask the following question. I have a patient who is a 43-year old African American who is taking medications x, y, and z and has symptoms a, b, and c. What do you recommend? Watson or the database provides a recommendation based on examining the diagnosis and outcome for 250,000 similarly situated persons. That is evidence-based medicine. The doctor still decides, but is guided by substantial evidence.
The healthcare.gov website is dominating the news, but there are many other websites that are part of the Patient Protection and Affordable Care Act (ACA). One of them is the Patient-Centered Outcomes Research Institute (PCORI), an advisory committee that was chartered under the ACA to implement a new approach to medical care based on comparative effectiveness research (CER). The purpose of CER is to inform healthcare decisions by providing evidence on the effectiveness, risks and benefits of different treatment alternatives. The source of the evidence is research that compares drugs, tests, procedures, medical devices, and methods of healthcare delivery. The Washington Post called CER a “rigorous review of what works and what doesn’t” (see Panel will review medical outcomes to find what works for their full story).
When a doctor is not sure, and no doctor can know everything, he or she often orders tests. Many of the tests are duplicative or unnecessary and add hundreds of billions of dollars to the cost of American healthcare. The concept of CER seems simple enough but, of course, it will face political hurdles. Congress seems to have a way of passing a law and then not providing the funding to implement it or, in this case, passed a law, provided the funding, but then barred the government from examining the cost effectiveness of medical practices in the most straightforward way. Is it possible that the PCORI may find tests, procedures, or drugs that are not effective? We know the answer is yes. Is it possible that the revenue streams from such tests, procedures, or drugs is associated with a business whose lobbyists influenced the legislation? I think we know the answer to that also. The Post said that the alternative to CER, with its imperfections should be a much more tolerable alternative to “throwing money into the cash-gobbling health-care industry with little measurement or accountability”.