Kulujen jne. alentamiseksi eri puolilla maailmaa on näkynyt suuntausta ns. tutkimuksiin perustuvien hoitosuositusten kirjoittamiseen (suom.huom. esim. Suomessa käytössä olevat "käypä hoito" -suositukset). Amerikan lääketieteen keskuksen (Center for Medicine) puheenjohtajan P. Pittsin mukaan "tutkimusten pohjalta tehdyt analyysit ovat vääristeltyjä eivätkä huomioi lainkaan yksilöiden välillä olevia suuria eroja (60 %). Tällöin suosituksissa ehdotetut hoidot eivät voi olla kovin tehokkaita. Sillä ei saavuteta mitään että sairastuneet pakotetaan hoitoihin jotka johtavat lisäkärsimyksiin."
One-Size Medicine Does Not Fit All
By PETER PITTS
Published: August 27, 2007
Guarantees are hard to come by. Even with medicine, doctors would be hard-pressed to tell patients that the drug they're prescribing is certain to work. After all, thanks to different medical histories, personal biochemistries, and physiologies, everyone is different. There's no such thing as a 'me-too' patient.
That's why patients and their doctors often try a variety of different drugs before finding one that works - because there's no such thing as a 'me-too' medicine. But in the interest of saving a few bucks, such personalized treatments may soon become a thing of the past.
To keep costs down, insurance companies, government health administrators and HMOs are increasingly turning to something called 'evidence-based medicine' (EBM) to figure out whether the pill a doctor wants to prescribe is worth paying for.
By looking at broad swaths of the population in randomized clinical trials, health statisticians believe they can determine whether certain medicines are going to be effective relative to their cost. Such calculations allow healthcare providers to avoid spending extra money on treatments they think won't work.
Put another way, EBM looks to solve your medical problems by looking at people with whom you have little, if anything, in common. The analyses and guidelines that flow from these studies are so flawed that they generally eliminate about 60 percent of the variation that actually exists among individuals.
By discounting the ways in which people differ, such methods inevitably eliminate treatments that could be very effective.
This fundamental misunderstanding is being advanced by politicians grasping for answers to questions on health care. For an example, look no further than Reps. Tom Allen, D-ME, and Jo Ann Emerson, R-MO, whose Enhanced Health Care Value for All Act would increase spending on one-size-fits-all, top-down solutions.
The bill would authorize $3 billion of investment on new research 'on the comparative effectiveness of health care services (including prescription drugs, medical devices, procedures, and other treatments) to inform health care providers' decisions.' Senator Hillary Clinton also has advocated a similar program.
If only these lawmakers looked to the countries that have already gone down this road, where the consequences have been disastrous.
Take Britain, where the National Institute for Clinical Evidence employs comparative effectiveness studies in evaluating whether to pay for new and often expensive medicines. All too often, new treatments are disregarded in favor of existing treatments, because the new medicines aren't 'better enough' to justify the added expense.
This isn't limited to Britain, either. Australia, New Zealand, and Canada have also turned down cutting edge treatments for no reason other than fear of the expected cost. By ignoring the experiences of other countries, the Enhanced Health Care Value for All Act should instead be called the Denial of Care Act.
There's no value added by forcing patients into treatments that will lead to prolonged illness..
Peter J. Pitts is president of the Center for Medicine in the Public Interest and former associate commissioner of the Food and Drug Administration.