'Evidence-Based' Rx Miscues

Article excerpt


Hillary Clinton, Barack Obama and John McCain have been traveling the country laying out their solutions to the problem of escalating health-care costs. One plan they all favor is ramping up federal funding for so-called "evidence-based" medicine.

The theory behind evidence-based medicine is simple: If the government were to run clinical trials testing the effectiveness of drugs and medical technologies, and then use the results to determine what to cover, taxpayers would avoid paying for treatments that aren't effective enough to justify their price tag.

Sounds great, right? Too bad that in practice, evidence-based programs are largely driven by the political imperative to cut costs - not the medical imperative to give patients the best care possible.

That was certainly the case for CATIE, or the Clinical Antipsychotic Trials in Intervention Effectiveness. This federally funded, $40 million study concluded new "atypical" nonpsychotic drugs are no more effective at treating schizophrenia symptoms than are older drugs. Because this finding flatly contradicted psychiatrists' real-world observations, CATIE had no impact on which drugs were prescribed for schizophrenia.

Like most large-scale trials, CATIE took a one-size-fits-all approach to medicine. Evidence-based programs encourage this approach. The underlying assumption is that the same care can be applied to every patient suffering from the same disease.

Modern science disproves that notion. Everyone has a unique biological makeup. Health-care professionals need to be given the autonomy to tailor their treatments to the specific needs of their patents. …