Public Health

Who Says How Much Evidence Is Enough?


These days just about everyone says data should drive decisions in health care. Results would be better and costs might just be lower.

x-ray illustration of aching back

hide captionWhat to do for an aching back?

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Take, for instance, Joshua Hirsch, an interventional radiologist at Massachusetts General Hospital who tells the Boston Globe, "I bow at the altar of evidence-based medicine."

Yet, he still recommends vertebroplasty, an injection of glue to relieve pain from cracked backbones, despite recent studies that showed the minimally invasive procedure was no better than a shot of Novocain.

Backers of vertebroplasty point to shortcomings in the negative studies. Experience tells them that injecting the glue soon after a fracture may give better results than waiting. Others pick apart the critical studies and call for more research.

Down the road the government may get more involved in serving as arbiter, with some $1.1 billion in the economic stimulus package enacted in February going to comparative effectiveness research. Already the Agency for Healthcare Research and Quality puts together some guidelines, though many boil down to calls for additional research.

So who decides what to do in case of a tie? Your insurance company's stance on paying for a procedure may shape your decision. But in the end, it might be you and your gut feeling. As orthopedic surgeon James Weinstein wrote in an editorial about the vetebroplasty studies in the New England Journal of Medicine:

When faced with several choices for which the evidence is less than clear, patients and doctors must thoroughly review the options together. Informed choice helps to educate patients about treatment options and allows them to recognize that a decision can be based on their values and preferences.

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