BETTER POLICY TO PROMOTE THE EVALUATIVE CLINICAL SCIENCES

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Abstract
The failure to evaluate the outcomes of surgical practice, diagnostic tests and the uses made of hospitals contrasts sharply with the careful evaluations now mandated for drugs. This double standard for truth in medicine compromises the rationality of medical decisions with significant, deleterious consequences for patients and the health care economy. The uncertainty physicians face about the scientifically correct way to practice medicine results in large variations in the costs and quality of care, even among sophisticated medical communities. The examples of variations between Boston and New Haven are discussed in this paper. Uncertainty about the scientifically and ethically, correct way to practice medicine is not inevitable. The double standard for truth can be removed by extending science policy to include the systematic assessment of different treatment theories physicians use in treating common illnesses. Experience (discussed in this presentation) shows that such assessments result in a substantial improvement in the scientific basis of medicine that is of value to patients, physicians and all who are concerned about the quality of care. Information that will improve the scientific basis of medicine for patients, physicians and policy makers can be obtained within a few years—as few as two or three—and without regulation. Conditions should be targeted for assessment that affect the most patients and are of importance to those concerned about cost and quality. It is imperative that the assessments be conducted according to high scientific standards and become an integral part of a nation's medical research program. My paper elaborates on the need for the program, strategies for assessments and the principles that should guide science policy. It also gives an example of an assessment project.

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