Originally posted on our collaborative site, Ourblook.
OurBlook interview with Dr. Margaret Lewin, medical director of Cinergy Health
Please provide your definition of evidence-based medicine.
ML: Evidence-based medicine is the practice of medicine in which decision-making is based on evidence acquired from carefully-controlled clinical trials.
What are the pros of evidence-based medicine?
ML: The pros are that these decisions are statistically most likely to achieve the desired clinical result given the current state of knowledge and might lower the costs of delivering healthcare.
What are the cons of evidence-based medicine?
ML: The cons are that .
– There are only a limited number of clinical trials whose outcomes are conclusive enough to answer the enormous number of clinical questions.
– Controlled clinical trials are expensive and usually take years to reach their conclusion; even then, they usually require confirmation by other trials.
– Medical science continues to advance at such a pace that clinical trials cannot keep up with the questions raised.
– It is likely that many treatment options not proven by evidence-based medicine will be rationed (i.e., they will not be reimbursed by public or private insurance).
How do you apply it in your own practice?
ML: When clinical trials give evidence of superior results of a given therapeutic intervention, I recommend that intervention.
Would there be a significant impact on the U.S. healthcare system if it were implemented much more widely?
ML: Medical problems could be solved more efficiently and effectively, leading to better clinical outcomes.
Does the reform legislation now before Congress carry provisions for evidence-based medicine and if so, are they adequate? If not, what should be added?
ML: These bills at least give lip-service to Comparative Effectiveness Research (CER) … but it is not clear that this research will be funded adequately over either the short- or long-term. The question of rationing has been addressed but not answered.
How does evidence-based medicine affect the legal malpractice problem that plagues healthcare providers?
ML: If a medical decision is based on such evidence, one would hope that even bad outcomes could not be attributed to malpractice by the practitioner.
With prescribed treatment plans for various diseases, it almost sounds that there could be no deviations. Is that true, and if so, how can U.S. healthcare improve if new and different treatments can’t be used?
ML: Deviations would have to be justifiable by other means, leading to the risk of malpractice action should the outcome be unfavorable; these deviations may not be covered by either public or private plans.
It would still improve, but much more slowly … awaiting the results of clinical trials before new approaches and modalities could be widely used. This delay would, however, probably encourage more clinicians to enter their patients in clinical trials and would similarly encourage those patients to enroll in the trials.
Is there anything else you’d like to say about evidence-based medicine?
ML: This is an important concept which, if fully implemented, could lead to better outcomes and lower costs. The current state of knowledge is inadequate for basing a healthcare system on this concept … and rigidity could lead to rationing unacceptable to the American people, who are used to having access to all options in care.
A graduate of Case Western University School of Medicine, Dr. Lewin earned her undergraduate degree from Purdue in aeronautics, astronautics and the engineering sciences, and she holds an M.S. in applied mathematics from Rensselaer Polytechnic Institute. Board-certified in internal medicine, she is an assistant professor of medicine at Weill Medical College of Cornell University. She also is immediate past president of the New York County Medical Society. Her decades-long volunteer work has included service to many local projects and organizations and has been enriched by her medical missions to the Third World.
No comments:
Post a Comment