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James Joyner points us to a disturbing study in the latest edition of the Journal of the American Medical Association. There, a crew of researchers examined the research support two decades of cardiology guidelines -- that is, the recommendations your doctor might use to decide how to treat you. Their conclusion? There really isn't any:
Although there is significant variation among individual guidelines in available evidence supporting recommendations, the median of level of evidence A recommendations [i.e., those supported by more than one randomized trial] is only 11% across current guidelines, whereas the most common grade assigned is level of evidence C, indicating little to no objective empirical evidence for the recommended action. . . . Interestingly, our findings are reflective of a specialty — cardiology — that has a large pool of research to draw on for its care recommendations. Guidelines in other medical areas in which large clinical trials are performed less frequently may have an even weaker evidence-based foundation.That last sentence is especially important: Cardiology, as compared to other disciplines, has rather a lot of data. But not nearly enough. This is the other side to the argument over comparative effectiveness review. The information emerging from those studies may or may not make health care, in the aggregate, cheaper. Just as wasteful interventions might fall out of favor, pricey new procedures might prove stunningly effective and enter into wide use. But it will almost undoubtedly make medical care better. The thing is, those pricey new procedures that might be proven effective? They have few advocates today. And those interventions that might lose their reputation? They're making a lot of people a lot of money right now.
