[tri-med] Re: Evidence-based medicine

Everyone agreed that this term throughout the medical community is a 
method of sharing knowledge improving health care.

 Indeed, evidenced based medicine is simply looking at the average outcome of a 
condition so that the best treatment can be offered. 

The intent is to improve health by ensuring that clinicians provide care that 
sound research has proven is optimal. 
EBM is great for the majority of situations. 

The problem is when this approach is applied to a genetic label. The average 
outcome of tri13/18 suggests that palliative treatment only is optimal. 
The average outcome suggests overwhelmingly that there is futility in providing 
aggressive care. 

As I understand it, the present American system is based on autonomy and the 
rights of the individual. 

If a doctor suggests palliative/comfort care and the parent disagrees and wants 
to try more aggressive treatment, they stand a chance at obtaining it because 
the law support consent/autonomy. 
At this point in time, the medical literature does not provide clear evidence 
regarding which babies might benefit from treatment. (there is a subtle 
suggestion that tri13 without holoprosencephaly tend to do better)
If Health care reform were to lead to LEGISLATION based on EBM, this 
legislation, as I understand it, would supersede patient/parent autonomy, and 
that is the fear. 

Question/Answer from the other night: 

Question from Steve Koff of the Cleveland Plain Dealer: "Can you
guarantee that this legislation will lock in and say the government
will never deny any services, that that's going to be decided by the
doctor and the patient, and the government will not deny any coverage?"

The
President: "No. The whole point of this is to try to encourage changes
that work for the American people and make them healthier...We want to
create an independent group of doctors and medical experts who are
empowered to eliminate waste and inefficiency in Medicare."

The reporter's question is based on the patient's autonomy but the answer is 
about the American people as a whole in the big picture. 

Obama, it seems, is taking a utilitarian approach and trying to maximize the 
good (in this case the health) for the entire population. 

Barb





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