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What’s Wrong with Evidence-Based Medicine?

Every health-care system prioritizes coverage, quality, and cost – often focusing on one or two at the expense of the others. But efforts to raise quality through the application of evidence-based medicine could actually decrease the standard of care.

SEATTLE – Every health-care system balances coverage, quality, and cost – often focusing on one or two at the expense of the others. European systems, for example, tend to focus on coverage and ensure universal access to care; in the United States, by contrast, quality appears to be paramount.

But, whatever one’s view is about the proper priorities, it is clear that the US has room for improvement in all three areas. Fortunately, efforts are underway to address each of them. And efforts in the US have implications for other countries as well.

The US Patient Protection and Affordable Care Act (the landmark legislation now widely known as “Obamacare”) aims to widen coverage, while so-called accountable care organizations, such as Kaiser Permanente, try to contain costs by aligning the interests of providers and payers. However, efforts to raise quality through the application of evidence-based medicine (EBM) risk ignoring what we know about human cognition and expertise, and may undermine the vital role played by a physician’s expert judgment.

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