National Consumers League

Medicine based on the evidence, right? Not necessarily


By Rebecca Burkholder, NCL VP Public Policy, Health The practice of medicine is based on the best evidence, right? Not necessarily, as I am learning at the International Cochrane Colloquium in Colorado this week. Many health care treatment decisions are still made without up-to-date, reliable evidence on their benefits and possible harms. There have been many individual studies on a specific drug or treatment, but, surprisingly, often no one has looked at all the studies together and what they tell us. The Cochrane Collaboration is an international organization, with more than 11,000 contributors from around the world, that reviews existing research on health care interventions so that health care practitioners, consumers, and policymakers can make well–informed decisions about health care. So what does that mean? Basically, after carefully looking at all the studies done on a drug or procedure, Cochrane puts out a review on whether the treatment works or not (or if there is not enough evidence). The goal for Cochrane is that with evidence health care practitioners and patients can make good choices about health care. Here’s an example of what Cochrane reviews found: Giving women at risk of preterm birth a single course of corticosteroids speeds up fetal lung development and should be considered routine for preterm delivery to reduce the number of babies who die or suffer breathing problems at birth. Other reviews have found that remaining upright during the first stage of labor can reduce labor by an hour, that weight-loss surgery is more effective than other strategies for shedding pounds but may not be safe, that statins given to the elderly do not reduce the risk of Alzheimer’s or other dementias, and that Echinacea doesn’t get rid of a cold any faster than doing nothing. Cochrane has reviewed the evidence to answer such questions as - Will taking the dietary supplement glucosamine help relieve the arthritis in my knee? Should I treat my asthma with allergy shots? Is there a cure for morning sickness? Unless consumers (as well as health care practitioners) have good evidence on whether a drug or procedure works and the benefits and risks, we are in the dark. Armed with evidence, we can, in consultation with our doctor, make informed decisions about our health care and figure out what is best for us Check out the Cochrane reviews, and those that have been translated for consumers, at the Cochrane site. And the next time your doctor recommends a drug or treatment, don’t be afraid to talk to your doctor about the evidence.