If physician decisions were based strictly on Cochrane

First, a disclosure. I am President and Board Chair of the not-for-profit Lundberg Institute in California, which is dedicated to Archie Cochrane.

What would happen if we in American healthcare actually followed the teachings of the revered Archie Cochrane? I’m sorry. You don’t know what those teachings are? … and you don’t even know who Archie Cochrane was? Oh my …

Click www.lundberginstitute.org, no registration required, and then click to Dedication. Mission, Platform, Resources, and you can learn what he and it are all about.

In 1972, Archie Cochrane of the U.K. wrote that because resources for healthcare would always be limited, they should be used for treatments that have been proven to be effective. His influential book provided strong advocacy for controlled clinical trials.

Evidence-Based Medicine (EBM), a term, best I can tell, that was first published by David Eddy in JAMA in 1990, was further defined by Sackett and colleagues of McMaster University in the BMJ as “… the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” The Cochrane Collaboration and the Cochrane Centers sprung from this inspiration.

The notion of Evidence-Informed Medicine surfaced in 2001 from Sackett’s revised statement that “Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values.”

Many studies and statements by experts say that somewhere between 25 and 40% of American medical decisions are not based on sound evidence of effectiveness. Since physician decisions drive the majority of cost of medical care, strictly applying Cochrane’s teachings would “save” the U.S. something like $700,000,000,000 to $1 trillion per year. But think about it.

Fifteen million Americans are employed in healthcare. Some four to six million would then lose their jobs, bumping the unemployment rate well into double digits.

And what would all that freed-up money be spent for? Cocaine, gasoline, gadgets, high-calorie food, taxes, porno, the Pentagon, Wall Street bonuses?

Maybe spending a lot of it on education would make sense. Or maybe medicine should just keep on spending to do its part to keep the economy going, regardless of effectiveness, as long as it is safe.

Did I say safe? Oh! But that’s another topic for another column.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit MedPageToday.com for more health policy news.

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