More danger of EBM…

EBM danger 7
Dr. Michael J. O’Connell, New Hampshire, commented when like minded individuals think about the destruction or mutilation of the ‘art of medicine’ as the primary danger of Evidence Based Medicine (EBM), there is also a potentially far greater danger, a danger that Google tells me no one is looking at or critically thinking about.

Let’s assume EBM as part of the insistent Obamacare drumbeat, continues its progression and eventually infiltrates all of the payors, and worse, influences all their policies of treatment for which they will and will not pay.  In that situation doctors/providers would have little choice but to do what the policies dictate, again policies predicated on the best ‘randomized controlled’ studies available.  Is this going to be a good thing?  Does anyone see the likelihood of huge compounded mistakes, simply because EVERYONE’S attention will be directed toward the treatment ‘recipe’ as dictated by the insurance industry?

Let me give a hypothetical example to make my case.  Let’s look at the treatment of high cholesterol.  Currently, the literature is replete with fairly solid observational studies that demonstrate the correlation of high cholesterol with a higher incidence of heart disease and death by same.  Other studies have refined this correlation somewhat to indicate that cholesterol held by high density lipoproteins (HDL) is more tolerable, more acceptable than that held by low density lipoproteins (LDL).  So called “statins,” drugs which have been in the planning stages since the 1970s, can, according to RCTs (randomized controlled trials) rather dependably reduce the ‘bad’ cholesterol.  Ergo, statins have become a standard of care for patients with high cholesterol, particularly for those with most of that cho
lesterol held by LDL.  So insurance policies have, or soon will include statins as mandated for most cases of ASYMPTOMATIC hypercholesterolemia.  What is the harm you say?

The problem is that the theory, upon which hundreds of billions of dollars is spent each year, that by blocking the body’s ability to make its own cholesterol a patient’s risk of cardiovascular disease leading to early demise, is a constantly shifting theory, and one that from 30,000 feet, doesn’t hold together.  As we all know, the cholesterol produced by our bodies is only a small portion of that which appears in the bloodstream of most Americans.  Dietary contribution swamps the manufactured portion.  However, by disregarding this fact, and diverting attention to a pill, an answer that most Americans jump at, Pharma makes a lot of profit, Americans lower their cholesterol by a small but dependable amount, and the elephant (and I DO mean elephant) in the room is ignored or seriously downplayed.  The single cause of high cholesterol is consumption of animal products, which lead to obesity and storage of excess cholesterol due to the inactivity obesity invites.EBM danger 9

So can you see that EBM, which is thought to “illuminate” the value of thousands of treatments going forward, has a great chance of incentivizing treatments that are not in the macroeconomic sense cost effective, are of marginal (but statistically significant) value in changing a number, and promotes a pill rather than the all important counseling for lifestyle change (“you are obese, you must limit eating cholesterol laden meals, you must exercise daily, you must lose weight”)?

EBM will eventually place a chokehold on the decision making process of doctors!

About Dr. Michael J. O'Connell, New Hampshire
Dr. Michael J. O'Connell of Barrington, New Hampshire, has forged a distinguished career spanning over three decades, as entrepreneur, physician, businessman, philanthropist and healthcare consultant. As former owner, administrator and CEO of a 225+ employee multi-specialty medical practice, Dr. O'Connell has dedicated his entire professional life to helping patients with family medicine and especially those experiencing chronic pain and all aspects of addiction. Since selling his family of healthcare businesses, he has never once contemplated retirement despite his rich and fulfilling journey, but instead has turned his focus to consulting in an industry starved for courage and creativity. Having weathered many political, technological and legal challenges, there is hardly a storm he has not confronted, a tempest he has not quelled, an urgent need he has not met. While the talking heads and self-proclaimed experts in the field have assumed the conventions and standards of the times, Dr. O'Connell does not believe in merely reflecting the herd mentality, but rather in leading the charge. Eschewing political correctness, Dr. O'Connell says and does what needs saying and doing, and not what the mindless masses expect. In addition to the continual education afforded by his variegated life experiences, Dr O'Connell earned his BS in Biochemistry at the University of NH in 1975, his Medical Degree from Dartmouth College in 1981, interned at Walter Reed Medical Center in 1982, Residency/Fellowship at UCSF in1986, and finished his Masters in Healthcare Administration at UNH in 1995. Dr. O’Connell enjoys many outdoor activities, including rock climbing, snowboarding, hiking, and golf. Through the decades Dr. O'Connell has supported many non-profit charities to include the St. Charles Home in Rochester NH, the Tri City VNA and Hospice, Hyder House, and Cocheco Valley Humane Society. To the latter organization alone Dr. O'Connell has donated over $180,000 and pledged another $250,000 in the “Bring-Us-Home” campaign for a new building. His “Matching Donations Christmas drive” has generated over $175,000 in charitable giving from the community. In addition Dr. O'Connell has participated in many dozens of other volunteer and donation efforts locally as well as in Africa and the Dominican Republic. For a listing of how I gave back to the community during my career and continue to do see:

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