Evidence-Based Medicine In The United States—De Rigueur Or Dream Deferred?

Abstract

Although evidence-based medicine (EBM) is an important concept for promoting value in health care, meaningful application of EBM tools in commercial settings has proceeded slowly. Barriers to the use of EBM include patient preference, physician resistance, the lack of automated decision support systems, managed care failures, lack of research on which to base decisions, and the inherent subjectivity of interpretations of evidence. Political concern has mirrored these barriers; consequently, Medicare still lacks clear authority to apply many evidence-based decision tools. Dialogue and consensus will be critical in bridging public concern and the eagerness of researchers to apply EBM. Ex p e r ts a n d researchers have long predicted the inevitable adoption of evidence-based medicine (EBM) in clinical practice and when making decisions on public resources. The principle of using the best evidence to make decisions for a patient or population makes sense. EBM can be a tool for assessing the effectiveness of a new technology and designing medical benefits around proven technologies. Has it lived up to its promise? Earl Steinberg and Bryan Luce describe its prominence in all levels of clinical decision making, suggesting that it is de rigueur, an accepted standard. 1 In fact, the evidence suggests that major barriers persist, and the gap in thinking about applying evidence to medical decisions between researchers and the public remains formidable.

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