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.
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