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What’s wrong with “evidence based medicine”?

John Goodman has a great critique of how the U.S. government is more-or-less compelling doctors to follow “evidence-based medicine.” Some excerpts:

Washington telling the medical community how to practice medicine. Even though a recent study finds little relationship between the inputs Medicare wants to pay for and such outputs as patient survival, and even though the latest pilot programs show that paying doctors and hospitals for performance doesn’t improve the quality, we are about to usher in the era of big brother medical care. …

What if there were a rule that says you can’t do anything during the week unless it is on the calendar by Sunday. Call this “calendar-based scheduling.” Instead of being an aide, the calendar would quickly become an oppressive barrier to your freedom of action. …

So what’s not to like [about evidence based medicine]? A lot, it turns out. …

  1. First, in most areas of medicine, there are no treatment guidelines; and where there are, they are often unreliable, conflicting and incomplete. …
  2. Second, even where there are well established guidelines, they are inevitably written for the average patient. But suppose you are not average. Is your doctor free to step outside the protocols and give you care based on her training, knowledge and experience? …
  3. Third, guidelines are often written by people who are not disinterested. One study found that 56% of the doctors who helped write guidelines for treatment of heart ailments had potential conflicts of interest. …
  4. Fourth, evidence-based guidelines are based on studies; and these studies often exclude entire segments of the population. …

Finally, the whole idea behind guidelines and protocols is that it is appropriate to treat patients with similar conditions the same way. But individuals are individuals. They don’t always respond to treatments the same way.

Read Goodman’s whole post on what’s wrong with evidence based medicine.