Are High Health Care Costs Tied To Evidence-Based Medicine?

by Dr. Elaina George

Did you ever wonder exactly what evidence-based medicine is? The National Center for Clinical Excellence bases it in on the philosophy “that as much medical practice as possible ought to be carried out using proven algorithms based on empirically valid evidence from controlled scientific experiments, rather than individual clinical judgment.”

Stehoscope

Congressional health care reform relies heavily on both Evidence-based guidelines and evidence-based individual decision making to set the standards of care for medical treatment and outcomes. In fact, House bill 3962, in an effort to control costs, creates a new layer of government bureaucracy that inserts itself between the doctor and the patient. A national health commissioner and task forces will evaluate and decide everything from what medications a physician will be allowed to prescribe for a patient, to what surgery will be approved, to what outcomes will be expected for a particular medical condition. The ‘universal healthcare Czar’ along with the task forces will also decide whether or not hospitals will be reimbursed for care rendered based on predetermined outcomes. For example, if a patient is re-admitted within a prescribed number of days after discharge, the hospital will not be reimbursed for care given. It does not take into account factors such as how ill a patient may be. This new layer of government effectively removes the power of the individual physician and patient to decide what is the best course of treatment.

Why should you care?

You should care because the application of evidence-based medicine can potentially limit health choices of both patients and physicians.  In the reformed healthcare system recommended by Congress, alternative treatments will be pressured to end, and physicians who practice alternative medicine in extreme cases will be criminalized. The money in the system will continue to flow to well funded studies underwritten by the pharmaceutical industry, and those companies without deep pockets will continue to be unable to afford the cost of  in depth studies to critically evaluate the efficacy of such treatments. Alternative treatments will fail to pass the standard of evidence-based medicine precisely because they lack the funds to enter the game, and thus the cycle will continue. In short, if alternative treatments are not evaluated by the guidelines of evidence based medicine, they will never be accepted as a valued treatment option.

It can also be argued that evidence-based medicine has exponentially increased the cost of health care. In theory, the essence of evidence-based medicine is science. However, in practice it has become more about money. The system has become one where the pharmaceutical industry has been given the edge. For example:

  • Many of the prescription drug trials are not independent

They are often funded by the very drug companies that stand to gain if their drug is found to be effective in trials and is approved

  • The relationship between medical societies and the pharmaceutical industry raises questions.

Over the past 10-15 years there has been a change in the parameters of our most common diseases (hypertension, obesity and high cholesterol ). For example, in the past normal blood pressure was 120/80, and now  it is 115/75. In fact,those with a blood pressure of 120/80 are now considered to be pre-hypertensive and are eligible for medication. The body mass index (BMI) number for obesity decreased from 40 to 30 while the parameters for being overweight have expanded from a BMI of 27.8 in 1995 to less than 25 today. High cholesterol (LDL) is now < 200 instead of the old parameter of  < 250. The change in parameters have meant both a dramatic increase in the number of people who meet criteria for treatment with prescription drugs along with a resultant rise in the cost of healthcare. The question that has yet to be answered - why are we less healthy despite taking ever increasing amounts of prescription medication?

  • There is a tight financial relationship between the pharmaceutical industry and the medical industry.

The AMA, medical education and the underwriting of medical research has given the pharmaceutical industry a great advantage in the shaping of medical opinion and by extension evidence-based medicine.

  • There is a revolving door between those who work for the FDA and those who have worked in the pharmaceutical industry.

This cozy relationship raises the importance of Big Pharma and relegates natural/alternative methods to junk science. Inherently, this should make those of us who are critical thinkers question the statements that summarily denigrate the supplement industry which makes products, that in many cases are in direct competition with the drugs that are manufactured by pharmaceutical companies, but don’t need patents.

A more balanced approach to our healthcare system is necessary. If the same standard is applied to both alternative and conventional treatments, each will be given a level playing field to determine efficacy. This change would go a long way towards accomplishing the task of improving the health of Americans without bankrupting them.

Let’s try something new like  promoting prevention and wellness instead of just talking about it or actually giving  doctors and patients the freedom to choose how they approach health choices. No one can argue with the fact that a healthier population, will lead to a significant decrease in healthcare costs.  The current system clearly is not working.


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Posted Feb 17th 2010 at 7:03 am in Congress, Economics, Healthcare, Politics | 54 Comments