Megan McArdle vs. Cookbook Medicine

I think about this a lot when people start talking about “evidence-based medicine” and how it can help us control health care costs. The question is, “evidence of what?” … The more we rely on a central board to make decisions for huge numbers of people, the more tempted we are going to be to rely on metrics which can be collected, aggregated, and mined for data. Where does that leave the thyroid patient with “normal” blood levels . . . and a collection of vague, frustrating–but nonetheless very real–symptoms?

 As it happens, I found a younger endocrinologist who treats more aggressively–to a level around 1. Last month, I started on low dose thyroid hormone…. three weeks later I realized I wasn’t so cold any more. And today, it occurred to me that the permanent frog in my throat seems to have hopped away.

 I don’t want to come out against evidence-based medicine; we should always be trying to figure out what works and what doesn’t, and to reimburse providers accordingly.

 But I do question what constitutes evidence. Will evidence-based medicine push us even more towards looking at numbers rather than listening to patients?

 Entire post worth reading.

Comments (4)

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  1. Linda Gorman says:

    Yes, well worth reading.

  2. Simon says:

    It’s a tough balance of internal vs external validity.

  3. Mike Ainslie says:

    Medicine has always been an Art and a Science. Both are important and indivisible. Patients demand and deserve both. This is why cookbooks will fail. If they succeed than all Health Care can be via Internet. Anyone for Wikimedicine?

  4. Devon Herrick says:

    Public health advocates and medical experts understand the benefits of using data from billions of observations — from hundreds of millions of people — to construct a better understanding of health and medicine. However, there is a delicate balance between the benefits of data collection versus the temptation to use the findings to ration care or manipulate the findings to benefit one group financially.