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Perception vs. Reality: Evidence-Based Medicine, California Voters, and the Implications for Health Care Reform

Comprehensive reforms to increase the use of valid evidence in medical practice are overdue and could significantly improve health outcomes for patients. A Summer 2009 Lake Research Partners poll of California voters, commissioned by the Campaign for Effective Patient Care and summarized in this document, provides valuable insight into voter attitudes about evidence-based medicine, and shows strong support for related health care reforms.

The case for reforms that support the collection and dissemination of scientific evidence to inform health-care decisions is clear. According to the prestigious Institute of Medicine, half or less of what physicians do is actually backed up by valid research. 1 All too often physicians lack the reliable, unbiased evidence they need to predict whether the drugs, tests, devices, surgeries, and hospitalizations they recommend are likely to prove beneficial to their patients.

Even when evidence exists, it sometimes goes unused. Patients routinely fail to get treatment that could help them, sometimes because they lack insurance, but often because doctors simply do not follow existing science that would help them to decide which treatment is best.

The dearth of evidence has profound consequences for patients and for the nation. Not surprisingly, given the absence of evidence, it is estimated that as much as 20 to 30 cents of every health care dollar may be spent on useless treatment, drugs, tests, procedures, and hospitalizations that offer no improvement in outcomes. 2 Such unnecessary care wastes billions of dollars a year, 3 and sometimes wastes lives. 4 It leaves patients vulnerable to harm from medical error, hospital borne infection, and the additional risks inherent in any invasive treatment. 5

Contrary to the fears of some critics of system reforms, the increased use of scientific evidence in medicine will not lead to rationing care, nor will it interfere with relationships between patients and their doctors. Rather, sound evidence allows doctors to give their patients the preventive care they need, ensure the best treatments for disease, and avoid mistakes that can lead to harm.

Many experts agree that the time for the nation to invest in research to fill the substantial gaps in medical evidence is now. The 2009 American Recovery and Reinvestment Act included $1.1 billion to fund studies aimed at comparing the effectiveness of various health-care treatments. This investment represents a down payment on the studies needed to allow doctors to base treatment decisions on credible scientific evidence. It will begin the work of ensuring that patients of all races and ages have access to treatment that is tailor-made for them. The fund will help disseminate the information doctors and patients need to share in medical decisions.

While experts concur about the urgent need for evidence, until now there has been little data about voters’ opinions on the topic. The polling data in this report represents an important first step in probing what voters think about these crucial topics. The poll asked California voters a series of questions on a range of views about the importance of evidence-based medicine. The results are meant to inform advocates and policymakers about where voters stand on this important issue.

The poll indicates that some voters are overly optimistic about the current use of evidence in treatment decisions. A majority of voters believe that most health care is now based on scientific evidence. A higher percentage of voters feel this way about their own health care. In spite of this misperception, the poll shows widespread and strong support for common-sense reforms. For example, voters strongly support ensuring that both doctors and patients have access to scientific evidence about effective prevention, diagnosis and treatment. To ensure such access, voters overwhelmingly support requiring doctors to notify patients if there is a treatment backed by scientific evidence. Voters similarly believe they should be told if there is no scientific evidence supporting a recommended treatment.

Although a slim majority of voters believe that doctors are providing the proper amount of treatment, nearly three quarters of voters support reforms that would change payment methods to ensure that treatment is based on evidence and not just the volume of services delivered, as is currently the case for much of the health care system.

Given this support, it is surprising that public demand for policies to support more use of evidencebased medicine is not stronger, especially considering the fact that only about half of the treatment doctors provide is based on evidence, and the well-documented harm patients suffer because of this. However, policymakers should be careful not to interpret the lack of voter outcry on this issue as a sign that evidence-based medicine is not important to voters. Voters understand the importance of medicine being well grounded in science. If voters are not more outspoken on these issues, it may be because they mistakenly believe they are already receiving care based on scientific evidence. Regardless of their misperceptions about the current state of medical evidence, voters demonstrate a keen instinct for sensible reforms. Policymakers should use the guidance voters have provided to craft and enact policies that will guarantee true quality and accountability in our health care system.

For the full report, please see the PDF at right.

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