As the debate over the president's health care plan heats up in the coming months, it appears inevitable—and logical—that ideas for eliminating treatments that are ineffective will be brought forward as a way to control costs. The work of Wennberg1 and others has demonstrated that "standard practice" varies widely from one place to another, resulting in potential waste. The idea of concentrating our resources on interventions that really work is laudable. Both overuse and underprovision of medical care drive up the costs that society pays.
The problem is that identifying the "best" treatment is not easy. Randomized clinical trials (RCTs) are generally considered the gold standard, but are coming under increasing criticism. Concerned scientists representing several schools of thought explored the issues in some depth at a New York Academy of Sciences conference, "Doing More Good Than Harm: The Evaluation of Interventions" (New York, NY; March 22 through 25,
Hillis A. Cost Containment: Death Knell or New Opportunity for Randomized Trials? Arch Ophthalmol. 1994;112(2):174–175. doi:10.1001/archopht.1994.01090140050020
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