NCPA - National Center for Policy Analysis


January 4, 2005

On both sides of the political aisle, "evidence-based medicine" (EBM), or "best practices," is increasingly viewed as the solution for everything from health care cost-containment to medical errors to medical malpractice reform. To challenge these assertions, the Citizens' Council on Health Care (CCHC) has released a report on EBM and clinical practice guidelines.

Under the guise of science, the report says control over health care decisions is shifting from health care professionals to statistical technocrats - researchers, managed care executives and government officials who use patient medical data (population statistics) - to write practice guidelines based on their own interpretation of the data. The report reveals:

  • "Evidence-based medicine" is the foundation upon which HMOs and other managed care organizations operate.
  • Although there are many concerns about the "evidence" of EBM and the validity of practice guidelines, "evidence-based guidelines" are often embraced by policy makers.
  • "Evidence-based guidelines" and "best practices guidelines" are rapidly finding their way into legislation, and becoming law.
  • Practice guidelines are turning into practice directives, causing concern that patients will be harmed - and health care rationing sanctioned; pay-for-performance initiatives in the public and private sector have begun to penalize physicians who do not comply with these treatment protocols.
  • Evidence-based medicine - and guidelines turned directives - are an attack on the patient-doctor relationship, individualized care, the personal autonomy of patients and the professional autonomy of physicians.

Despite the growth of the guideline industry, the report cites problems with relying on guidelines in the court of law. Some states and Congress have adopted, or considered adopting, guidelines as legal standards to protect physicians against medical malpractice litigation. However, legislative approval may not pass the muster of judges and juries concerned more with individual patient rights and guideline integrity.

Source: Twila Brase, RN, "How Technocrats are Taking Over the Practice of Medicine: A Wake-up Call to the American People," Citizens' Council on Health Care, December 13, 2004.


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