Negative Results in Evidence Based Medicine: Huh?

Tim Christie writes in the Eugene Register-Guard that Evidence Based Medicine (EBM) has taken full root. Once personal experience, medical authority, or anecdotal evidence were the physicians' bases for a medical decision. With the latest data from randomized controled trials and meta-analyses streaming to their palm pilots, EBM is used by clinicians to make treatment decisions. EBM standards are also used by journals to pick publishable papers and by continuing education programs to teach docs.

And lets not forget about a payers interest in paying for interventions that actually work. Really, isn't this just common sense? Dr. Norman Kahn, of the American Academy of Family Physicians: "Physicians yearn to deliver what works," "So when they learn there is evidence for this vs. no evidence for that, they are rapid adopters."

The missing piece in this account is that sometimes, as we've seen lately, "no evidence" really means "suppressed negative results." - Dominic Sisti

A First Federal Step into Evidence Based Medicine

New York Times' Gina Kolata argues that Medicare's new policy of requiring evidence of efficacy for any new or expensive care for recipients amounts to a huge step into evidence based medicine. While she does not put the move into international context, it will be interesting to see scholars do so. Kolata's take is that this is a big move overall:

At issue are questions that will determine the future and price of health care: Do new cancer drugs costing $10,000 to $20,000 a dose help in many situations where they are now being prescribed? What are the long-term effects of weight-loss surgery, costing $30,000 to $40,000 per operation even when there are no complications? How well do implantable defibrillators for heart patients, each costing $35,000, work? Will PET scans to look for early Alzheimer's disease, costing $1,670 per scan, make any difference?