As health care administrators attempt to control escalating costs, their buzzwords have become cost-effective and evidence based—rallying cries that even physicians (also called gatekeepers) have taken up. As a group, we physicians have been made to believe that reducing costs while gathering evidence to prove effectiveness of therapy is the physician's responsibility. As a consequence, scant attention is being paid to maintaining our traditional purpose, which has always been to provide the best care possible for one patient at a time. However, an increasing number of physicians, and more recently patients as well, have become convinced that emphasis on new goals will result in deterioration of the latter unless physicians staunchly defend quality-based patient care.
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A case in point is the continuing criticism1,2 of the outcome of the Asymptomatic Carotid Atherosclerosis Study (ACAS).3 Our 39-center, US- and Canadian-based, prospective, randomized, clinical trial adhered
Toole JF. Quality-Based Medicine. Arch Neurol. 1997;54(1):23-24. doi:10.1001/archneur.1997.00550130013008