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October 5, 2011

Evidence-Based Practice and Health Advocacy Organizations

Author Affiliations

Author Affiliations: California Lyme Disease Association, Marysville (Dr Johnson) (johnson.lorraineb@gmail.com); and Center for Lesbian, Gay, Bisexual and Transgender Social Science and Public Policy, Hunter College, New York, New York (Dr Warren).

JAMA. 2011;306(13):1443-1445. doi:10.1001/jama.2011.1405

To the Editor: Dr Rothman's Commentary took issue with health advocacy organizations, claiming that they emphasize individualized decision making and access to care but minimize the value of EBM and ignore costs.1 Although Rothman's comments apply to many groups, we believe she overgeneralizes.

Both population-based recommendations and individualized decision making can play a role in evidence-based health care, depending on whether the science is uncertain or involves trade-offs contingent on patient values and preferences.2 Preserving patient choice within the context of evidence-based decision aids improves patient adherence and health outcomes and reduces rates of invasive elective surgery and the use of menopausal hormones and prostate-specific antigen screenings.3