“Hot packs, ultrasound, massage, gravity traction and neuroprobe 2x/day x 6 weeks.” That was the most memorable order I remember in 23 years working in physical therapy. This worker was spending three hours in therapy between the two sessions. At that time, such care was standard practice. Evidence-based (EB) medicine today finds that such care actually offers the patient no greater benefit than the natural effects of time on the healing processes in the body. Yet, despite the research, the practices of “more is better” pervade not only therapy, but also medicine. It’s really causing confusion for the consumer and confounding the scientists.

I came across an article in Health Affairs from March 2010 examining the consumers’ perceptions of EB medicine. EB proponents have long presumed that when presented with reasonable and balanced evidence, consumers would make appropriate decisions. What they found was exactly the opposite. The public doesn’t understand the concepts, nor the terminology. However, the necessary transition of medicine from being considered primarily an “art” to a “science” is hampered by what the public erroneously believes. Consumers believe:

• All medical care meets minimum quality standards. Yet they were quick to make excuses for the physician whose level of care was below the standards.
• Medical guidelines impair the ability of the doctor to provide care. Even more bizarrely, there is a belief that guidelines also provide safe legal cover to do nothing else.
• More care and newer care means better care, even though we know that the over-prescription of antibiotics in the past has given us much scarier bugs to contend with, and sadly, some medical products are approved only after the research shows the outcomes of their use is no worse than current products.
• Less expensive care is poorer quality care. 

At a time when the current administration has made strides toward implementing a nationalized healthcare program, it is illogical to believe that the practices of medicine and its associated health services will continue to be a largely unregulated sector, placing the sole economic decisions of appropriate treatment at the feet of the doctor. The sectors that the government provides funding for have already taken steps towards EB approaches. For all of the faults and headaches it gives healthcare providers because of limited reimbursement, Medicare has provided a statistical goldmine for EB medicine by tracking costs and outcomes. The Centers for Medicare and Medicaid Services have used the data to determine what will be covered. More importantly, they have determined what will not be covered—sometimes to the outrage of the patient.

This is inherently the challenge for EB medicine: the need to take an intellectual scientific concept and make it consumable for the average newspaper reader. It’s a marketing dream and nightmare. Our clinic fights this challenge on a daily basis by educating our patients and clients about how and why we choose to do certain things. More importantly, why we choose not to do certain things. iBi