Evidence Based Medicine


Systems Can Work: Rooting Out Variation and Saving Millions in San Diego

By Russ Mitchell, Kaiser Health News

Among other changes, Scripps Health streamlined its ER admission process, slashing wait times and saving $29 million. (Taber Andrew Bain/Flickr)

Among other changes, Scripps Health streamlined its ER admission process, slashing wait times and saving $29 million. (Taber Andrew Bain/Flickr)

A hundred managers at Scripps Health jam shoulder-to-shoulder into a break room in San Diego. CEO Chris Van Gorder goes at them like a football coach down by 3 at halftime.

“What are we trying to do in our health care system?”

“Reduce costs!”


“Health care is too expensive.”

“The solution is going to come from Washington D.C., right?”

There was a cost difference of $6,000 between two Scripps hospitals performing the same cardiac procedures.
“Ha ha ha ha.”

“Sacramento then, right?”


“The solution,” says Van Gorder, pumping an index figure toward his team, “is going to come from right here.”

Van Gorder, an ex-cop turned hospital executive, rescued troubled Scripps from near insolvency a dozen years ago as its new CEO. Now, he’s put Scripps in the middle of a cultural transformation aimed at saving hundreds of millions of dollars a year by — get this — coaxing physicians and managers at Scripps to work together, and standardizing care across every hospital in the system.

Just this week, we’ve seen how lack of standardization leads to a nearly-inexplicable price range of $11,000 to $125,000 for a standard hip replacement across the country. Continue reading

Sex Doesn’t Burn Weight and 4 More Popular Myths About Dieting Debunked

Woman's feet on scale.

(Justin Sullivan/Getty Images)

I don’t cover a lot of dieting stories here on State of Health. I figure you get enough of that elsewhere. For example, here are 88 million places I found by Googling “How can I lose 10 pounds?”

But I love evidence-based medicine. So when a group of respected researchers shatter widely-held beliefs about weight loss, I’m there. In Thursday’s New England Journal of Medicine, a group of researchers does just that.

In the review, the researchers categorized as myths those “beliefs held to be true despite substantial refuting evidence.” In other words, people have been repeating these ideas for so long, everyone thinks they’re true. But they’re not.

So, here we go:

Myth #1: Small changes — eating less or exercising more — done over time will yield large weight loss.  This myth comes from the idea that a pound is equal to 3,500 calories. But the short-term studies that looked at burning 3,500 calories to lose one pound were done 50 years ago. More recent research shows that individuals will burn calories differently as they lose weight. So the 100 calories you’re burning in exercise today will affect your body differently than the 100 calories you burned, say 18 months ago, when you started these small changes. Note that it’s not to say that exercising more — or eating less — is pointless (you will see why later in this post).

Myth #2: If you lose a lot of weight really fast, you’ll just gain it back really fast; you’ll have better long-term results if you lose weight slowly. When researchers actually looked at the studies, they found “no significant difference” between the two approaches in relation to long-term weight loss. Continue reading

Sorry, There Is No Silver Bullet

Drugs were a major component of interventions reviewed. (bennylin0724: Flickr)

Drugs were a major component of interventions reviewed. (bennylin0724: Flickr)

If a medical study shows that a treatment has a big effect, how much should you trust it? According to a provocative report published today, not very much.

A group of researchers from across the country — including Stanford Medical Center — and Brazil, looked at more than 85-thousand analyses. (In other words, they reviewed a LOT of research). They found that just under 10 percent of studies found a “very large treatment effect,” defined as a five-fold difference in people who received the intervention versus the control group.

But here the rub: more than 90 percent of the time, those “very large effects” don’t hold up after further research.

Dr. John Ioannidis at Stanford led the study, which is published today in the Journal of the American Medical Association. In an interview he told me, “Most of the time … these very large effects largely evaporated, they became substantially smaller. It’s not that they necessarily went away competely, but they were much, much smaller than the initial study.” Continue reading

In Medicine, Don’t Believe Everything You Know

(Pmccormi: Flickr)

(Pmccormi: Flickr)

By Eve Harris

How do you know your doctor is right? Ideally you and your doctor have a relationship based on trust. That is, you believe she knows the best options to recommend to you. You may think your doctor is right, but — how does your doctor know she’s right? We’d like to think physicians are relying on the latest evidence of medical practice. But not all physicians do that.

I recently joined in a robust, four-day discussion designed to address this issue at the 14th Rocky Mountain Workshop on How to Practice Evidence-Based Health Care. Doctors, policy makers and yes, journalists gathered to explore what many patients might have thought they were already getting: evidence-based health care, also called evidence based medicine.

In evidence based medicine, a hierarchy of evidence guides decisions about patient care. But at the same time, evidence based medicine recognizes that evidence alone is not sufficient. That’s because treatment options come with risks, and different patients will react differently to different risks. It’s not a simple matter of “Drug X” or “Treatment Y” has a five percent higher likelihood of success. If “Treatment Y” involves a risk or side effect a patient finds unacceptable, then this patient’s preference is part of the decision process.

Decision makers must always acknowledge these trade offs.

Continue reading