In posts such as here and here, it's become apparent that "Evidence Based Medicine" (EBM), while perhaps reasonable in theory, is probably unreasonable in practice with the ethics of healthcare in 2008.
One cannot have evidence based rules for anything, let alone healthcare, if the evidence is tainted.
Think clinical research and the drivers of "publish or perish" are the only domains where this evidentiary taint can occur?
From a medical colleague, a talented ER physician:
So, it seems, evidence based medicine is not only threatened by commercial taint of clinical trials and research, it's also potentially threatened by the drivers and behaviors of the Data Merchant component of the healthcare IT ecosystem.
Correct me if I am off track on the issue of the "full-circle web" of information exchange - an exchange that starts with the sanctity of the private physician patient relationship.
OK, I have a private relationship with my patient, but the perverse laws say that our relationship and the information ‘collected’ is no longer sacred. It may be used without consent under the guise of 'Treatment, Payment or Healthcare Operations' (TPO).
From the Miller School of Medicine Privacy & Data Protection project glossary:
HIPAA bundles a large number of functions into the term "health care operations." This expansive list is important for many reasons, most notably because HIPAA requires no permission from patients for uses and disclosures of protected health information (PHI) for "treatment, payment or health care operations (TPO)."
Covered entities may obtain a consent for TPO-related uses and disclosures, but the practice is optional under HIPAA. (It may nonetheless be required by state law.)
Additionally, the prescription information ‘exception’ from that sensitive relationship is fair game for the data-miners to sell to Pharmacy Benefit Managers (PBMs) and the like.
The so-called ‘Publishing’ company, Wolters Kluwer, who by the way unashamedly writes friend of the court briefs supporting the data merchants and miners (e.g., Amicus Briefs supporting the plaintiffs; IMS and Verispan), is now buying one of the most widely used point of care "Evidence based medicine" tools, Up-to-date. This is a software application for physicians to practice ‘evidence’ base medicine.
Verispan is a subdiary of one of the largest EHR vendors, McKesson. Without sounding like a nut-case full of crazy conspiracies ...
Is not this bizarre web not only destroying the trust between the patient and the physician, but additionally eroding the trust of what actually is ‘evidence’ based medicine?
I thought the rigor of science was supposed to be the driver and best influence of my decision making process for my patients, not the pull of ‘Pharma and Friends’ puppet stings.
I guess as a physician I am just marginalized to an assembly-line worker for big Pharma.
As an aside:
- the direct to patient(consumer) marketing expenditures of Pharma – est. $30 billion / year.
- the entire NIH budget $28 bil/yr.
Who polices them, I ask?