Industry must help to marshal the evidence for evidence-based medicine

VIENNA — The debates over evidence-based medicine, which have been waging more or less continuously since the movement first gained currency in the 1990s, are about to reach fever pitch.

President Obama has made evidence-based medicine (EBM) a central pillar of health care reform in the United States and the recent kickoff of his health care overhaul effort is heightening scrutiny of the benefits and drawbacks of EBM on both sides of the Atlantic.

No one would argue that medical care can and should be improved by applying research findings about best practices and outcomes. Yet in Europe, where EBM has evolved far more rapidly than in the United States, we have witnessed firsthand some of the challenges associated with the development of guidelines from clinical research, as well as the limitations of the evidence-based model.

For one thing, creating and updating evidence-based guidelines requires enormous resources—at a time when health care systems around the world are focused on containing skyrocketing costs.

Ultimate intent

In addition to the cost of creating successful EBM guidelines, there is also the complex matter of disseminating them. This has proved particularly challenging in Europe, where guidelines and policies have to be applied across the vastly different care systems of the countries within the European Union and adapted to local needs and cultural preferences.

Also, many clinicians remain skeptical of the ultimate intent of EBM. While proponents maintain that EBM is intended to improve the quality of care and resolve the disparities in outcomes between certain geographies and health systems, there is evidence to support critics’ claims that some payers are using the guidelines to deny reimbursement or funding for more-expensive procedures. Without the right guidance, those instances could become more common and lead to health care rationing and/or stifle the development of the innovative treatments and devices necessary for advancing health care and improving patient outcomes.

Group effort

Because orthopaedic procedures represent such a significant — and growing — portion of the surgical care delivered globally, the way the EBM dialogue plays out has the potential to impact our community more dramatically than any other specialty. It is, therefore, incumbent upon us all — practitioners, researchers and industry — to not only participate actively in the ongoing EBM dialogue, but to actively develop the research, insights and key learnings that will guarantee the adoption of the most effective EBM models.

In Europe that means working closely with organizations such as the National Institute of Clinical Excellence (NICE) and the United Kingdom’s National Healthcare Service (NHS) — pioneering organizations in the EBM movement and the primary drivers of its advancement. There’s a fine balance between standardizing best care practices and the rationing of care and it is up to all of us to help EMB’s proponents strike it right.

For more information:
Stuart Simpson is Group Marketing Director, Stryker Orthopaedics EMEA.