As you’re probably well aware, the U.S. Preventive Task Force released new breast cancer screening guidelines last November. And the ensuing furor highlighted a huge issue, one that will only become more and more prominent as America’s health-care delivery system makes its way down the rocky path to reality.
Evidence-based medicine. Remember those words, because you’re going to be hearing them over and over again in the coming months.
So, what is evidence-based medicine – or evidence-based care, or outcomes, or evidence-based anything else?
A simple definition (thanks, Wiki) is that evidence-based medicine is “applying the best available evidence gained from the scientific method to medical decision making.”
In other words, collect data, and use it to make decisions around medical care and treatment.
On the face of it, this process seems to make sense. We do it ourselves every day. For instance, we notice that the intersection of Main and Elm streets is always busy at 5 p.m. Therefore, we avoid that intersection at 5 p.m.
Easy, right?
Yes, when the evidence and its interpretation involve simple matters of little import. Not so, when people’s lives are at stake.
In coming to the conclusion that medical care should be delivered in the most efficient, effective way possible, proponents of evidence-based medicine reduce the importance of the human factor. Relying strictly on the statistical analysis of data, they note the following:
•For every 1,000 women receiving a mammogram, 470 women will get a false-alarm call-back, necessitating an additional mammogram or MRI;
•33 of those 470 will receive a biopsy that turns out to be negative;
•For every 1,000 women receiving a mammogram, less than one woman’s life (.7 life) will be saved due to that mammogram having identified breast cancer that was then successfully treated.
Evidence-based medicine would conclude that clearly, this is an awful lot of screening for very little benefit – statistically speaking. With an average cost of $125 per mammogram, you’re already at $125,000 to save .7 life, without even adding in the 33 biopsies and 470 additional screenings.
It’s costing multiple hundreds of thousands of dollars to save less than ¾ of a life. Is this the most efficient, effective way to deliver health care in America?
Absolutely not, proponents of evidence-based medicine argue.
But what would one of these statisticians say if the .7 life saved was that of his wife?
And here, friends, is the heart of the issue – the great divide separating advocates of evidence-based care, and opponents.
The statistics in this mammogram-guideline debate aren’t simply numbers on a sheet of paper. They represent people. Mothers. Wives. Daughters.
That .7 woman is one whose death could create a long-lasting ripple effect, tearing up her family, affecting her community, injuring her workplace… wounding her children irreparably.
