Author Affiliation: Department of Family Practice, Medical College of Virginia, Virginia Commonwealth University, Fairfax.
Policy Perspectives Section Editors: Robert
J. Blendon, ScD, Harvard School of Public Health, Boston, Mass; Drummond Rennie,
MD, Deputy Editor (West), JAMA.
Research advances are generating a growing body of clinical trial and
other data on the effects of tests and treatments on outcomes, but there is
no information resource within the health care system that systematically
puts that information in perspective. Policy makers, clinicians, and individuals
lack a ready means to compare the relative effectiveness of various interventions
in prolonging survival or preventing the occurrence or complications of a
disease: information that is critical in setting priorities. A crude analysis
of preventable deaths suggests that evidence-based primary prevention (getting
the population to stop smoking, exercise, lower cholesterol levels, and control
blood pressure) would prevent considerably more deaths per year than would
various evidence-based treatments for cardiovascular disease. Examining evidence
from this perspective calls attention to mismatched priorities—most
health care expenditures in the United States go toward treatment of diseases
and their late-stage complications and relatively few resources are devoted
to primary prevention and health promotion. Similar analyses at the individual
level can help patients put personal options in perspective. This article
proposes a bibliographic evidence-collection center and simulation modeling
program to estimate potential benefits and harms of competing interventions
for populations and individuals. Such evidence-based projections would enable
policy makers, clinicians, and patients to judge whether they give due priority
to the interventions most likely to improve health. With the steady growth
in research data, the need for a system that enables society and individuals
to put evidence in perspective will become progressively more urgent.
Woolf SH. The Need for Perspective in Evidence-Based Medicine. JAMA. 1999;282(24):2358–2365. doi:10.1001/jama.282.24.2358
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