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Do we need a new word for evidence? I ask because of the book Evidence-Based To Value-Based Medicine, by three MDs (Melissa Brown, Gary Brown, & Sanjay Sharma). They claim that medical practice is evolving from evidence-based medicine to an even higher quality of patient care, what they describe as value-based medicine: An approach that measures patient-perceived value and integrates relevant costs provided by health care interventions, allowing a more accurate measure of the overall worth to stakeholders. The authors present ways to evaluate medical treatments in the context of the patient's quality of life: A quality-adjusted life-year (QALY) is used to measure the total value conferred, taking into account improvements in both the length and the quality of life.
Well, I can't argue with that -- I just think it's unfortunate that we've gotten to the point where information about how to improve a patient's perceived quality of life isn't considered "evidence." But last week, I spoke with the long-time CEO of a highly regarded HMO... and the medical community really doesn't use the word "evidence" except when referring to findings from clinical practice or formalized studies.
What would the new word be? I don't know what we would call this broader view of information about improving outcomes --- we could distinguish between "Big E" evidence (generalizable, formalized knowledge) and "little e" evidence, which is localized and/or individualized. But I realize "evidence" is an egghead word for lots of people, so that might not be the best way to get everyone onboard.
First, let's define evidence. Generally speaking, it's the information we use to make up our minds (yes, that could be just about anything). Evidence is usually defined as information that “tends to prove or disprove something” and is “helpful in forming a conclusion or judgment.” Anything can be evidence. It's what kind that matters. In the legal profession, they use rules of evidence to specify what is considered acceptable. And the Cochrane Institute has identified levels of evidence to distinguish between various forms and sources: While an individual study, an expert opinion, and a systematic review of an entire body of research are all forms of evidence, they aren't necessarily equal. These levels work pretty well for classifying empirical research, but the problem is that it leaves out other valuable forms of knowledge (the "little e"), and doesn't factor in values about a patient's preferences and quality of life. Which brings us back to where we started... should we start calling it value-based medicine instead?
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