The Problem with Evidence Based Health Care

Evidence Based Medicine is the idea that our medical decision-making should be governed by data from well-designed research trials, and indeed, clinical research defines the basis for much of what we do and the standards of care we deliver. Well-designed research gives us a strong inductive justification for diagnosis, testing, prevention, and treatment and is generally considered stronger than theory or expert opinion. Many practitioners may believe that only high quality clinical research should guide health care, and perhaps in an ideal world that may be true. But in actuality, evidence based health care runs into conflict with many other modalities of health care decision making. One of these became very real recently and that is politically defined health care. Though many find the influence of politics on medical decision making distasteful, the reality is that it is here to stay. From the political fallout of recommending less breast cancer screening to a failure of a movement to push for universal health care, we find that the delivery of health care is influenced by politics, media, and public perception. In a similar vein, health care economics greatly influence medical decision making. In fact, a substantial amount of clinical research goes into determining whether something is cost effective or not. Tests, treatments, or interventions may be beneficial for a patient but if they are too expensive, they won't happen. Even though we insulate doctors as much as possible from these less noble influences, ultimately, health care is guided by a myriad of factors, only one of which is what scientifically is best for a patient.