Dr. Sandeep Jauhar (Op-Ed NY Times, Dec 11) questions the use of standard accepted medical guidelines in the management of patients. He is correct in pointing out that there have been such treatment guidelines published by a myriad of medical specialty organizations, outlining what current evidence indicates is the best method of evaluating and treating various conditions. These organizations have committees of recognized experts in their respective fields who review all available published data that may pertain to a particular disorder/procedure. Their conclusions are then published in the medical literature - not only as guidelines, but with "guidelines" as to how to evaluate the recommended guidelines.
The "guidelines" to evaluate the guidelines look at the statistical validity of the populations studied: (A)were multiple populations studied, (B)were there limited populations studied, or (C)were there only very limited populations studied. Based on the data analyzed, the experts then classify procedures/treatments according to apparent benefits v. possible risks. Class I indicates that the data clearly indicates that the procedure/treatment is very beneficial and is highly recommended. Class II concludes that benefits are not conclusive, may indeed be worthwhile, but suggest additional studies. Class III is comprised of treatments/procedures that have not been shown to be helpful or may actually be harmful.
Evaluating these criteria, and then following the suggested treatment/procedure outline is what is called evidence-based medicine. This is the way to manage patients - this is the way to manage disease. When a treatment/procedure is found to work in a significant majority of people (evidence-based), physicians should use it! Denying the validity of such recommendations, is to deny the validity of using properly collected statistical data. On what else can conclusions and recommendations be based?
Dr. Jauhar argues that such "homogenized health care" is not always the best treatment. Of course not. There are always times when any one individual will react negatively to a recommended course of therapy, or where it might be contraindicated for one reason or another. He concludes that personalizing care is better. Of course it is. But until individual genomic analysis allows medicine to personalize care (and it is moving in that direction), so called "homogenization" is not to be denigrated.
Remember - what works well for the significant majority of a population will, in the vast majority of instances, work well for you too! Though you are an individual and have your own personal genetic makeup, your genetic similarities to others is vastly greater than any differences - and you are far more apt to have the same benefit/risk result to a recommended guideline as your neighbor.
The "guidelines" to evaluate the guidelines look at the statistical validity of the populations studied: (A)were multiple populations studied, (B)were there limited populations studied, or (C)were there only very limited populations studied. Based on the data analyzed, the experts then classify procedures/treatments according to apparent benefits v. possible risks. Class I indicates that the data clearly indicates that the procedure/treatment is very beneficial and is highly recommended. Class II concludes that benefits are not conclusive, may indeed be worthwhile, but suggest additional studies. Class III is comprised of treatments/procedures that have not been shown to be helpful or may actually be harmful.
Evaluating these criteria, and then following the suggested treatment/procedure outline is what is called evidence-based medicine. This is the way to manage patients - this is the way to manage disease. When a treatment/procedure is found to work in a significant majority of people (evidence-based), physicians should use it! Denying the validity of such recommendations, is to deny the validity of using properly collected statistical data. On what else can conclusions and recommendations be based?
Dr. Jauhar argues that such "homogenized health care" is not always the best treatment. Of course not. There are always times when any one individual will react negatively to a recommended course of therapy, or where it might be contraindicated for one reason or another. He concludes that personalizing care is better. Of course it is. But until individual genomic analysis allows medicine to personalize care (and it is moving in that direction), so called "homogenization" is not to be denigrated.
Remember - what works well for the significant majority of a population will, in the vast majority of instances, work well for you too! Though you are an individual and have your own personal genetic makeup, your genetic similarities to others is vastly greater than any differences - and you are far more apt to have the same benefit/risk result to a recommended guideline as your neighbor.
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