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About the Site:

This is the blog for the book Medical Decision Making: A Physician's Guide, by Alan Schwartz and George Bergus (Cambridge University Press, 2008). The book is now available from Cambridge University Press

About the Authors:

Alan Schwartz, Ph.D. is an Associate Professor of Medical Education and Pediatrics at the University of Illinois at Chicago College of Medicine, where he teaches and conducts research on physician and patient decision making.

George Bergus, M.D., M.A. is the Dr. William and Sondra Myers Family Professor of Family Medicine at the University of Iowa Carver College of Medicine, and Co-Director of the Family Practice/Psychiatry Residency program. He holds a Certificate of Additional Qualification in Geriatrics.

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Comparative effectiveness and evidence-based medicine

April 25th, 2008 by Alan Schwartz

A strange commentary in the Washington Times this week entitled “‘Evidence-based’ Rx miscues” makes claims about evidence-based medicine (EBM): both what the terms means and what it implies for health policy. The author suggests that EBM is equivalent to “one-size-fits-all” medicine that removes physician autonomy in pursuit of a “political imperative to cut costs – not the medical imperative to give patients the best care possible.”

Dr. Roy Poses, a well-respected physician who has done a lot of work studying physician probability judgment (one example of which is mentioned in Chapter 7 of Medical Decision Making) has posted a rebuttal on the Health Care Renewal blog. Dr. Poses demolishes the misrepresentation of EBM that appears in the original article (as well as asking some on-point questions about the author’s interests in the matter), and does it quite effectively, so I won’t repeat his criticism here. Instead, I’ll focus on some other misunderstandings in the original commentary: that cutting health care costs is at odds with the medical imperative to improve care, that patients are so biologically unique that studies of patient groups has little value, and that EBM reduces physician autonomy.

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