"Best practices?" Eh, not so much

[Greenbeard]

What do we know at the beginning of the 21st century? Medicine has a long way to go.

(Reuters Health) - Even when following medical guidelines to the letter, doctors often use treatments that have little or no scientific support, U.S. researchers said Monday.

They found only one in seven treatment recommendations from the Infectious Diseases Society of America (IDSA) -- a society representing healthcare providers and researchers across the country -- were based on high-quality data from clinical trials.

By contrast, more than half the recommendations relied solely on expert opinion or anecdotal evidence.

"Despite tremendous research efforts, there is still a lot of uncertainty as to what is the best patient care," said Dr. Ole Vielemeyer, an expert in infectious diseases at Drexel University College of Medicine in Philadelphia and one of the study's authors.

[...]

Doctors across the world look to guidelines when deciding how to treat patients, and insurance companies may use them in coverage decisions.

Because they are drafted by leading experts in the field, they are generally understood to reflect the best medical knowledge available. "People commonly associate guidelines with practicing evidence-based medicine," said Vielemeyer.

But often the relevant clinical studies simply haven't been done. In the absence of evidence, the recommendations end up depending largely on who's on the guideline-drafting panel and any assumptions or opinions they may bring to the process.

Three cheers for more science, more clinical trials, and more clinical decision-making support.

And a plug for a simple concept, known as comparative effectiveness research (CER):

The health reform legislation (1), the IOM priority-setting committee (2), and the Federal Coordinating Council for CER (3) define “CER” similarly. The IOM report states that CER is “the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. The purpose of CER is to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve health care at both the individual and population levels” (2).

[ame=http://www.youtube.com/watch?v=k7OLCbjuidE]The 23rd century perspective.[/ame]