Learning What Works in Health Care

Professor Eric Patashnik on the politics of evidence-based medicine

More than half the medical treatments that Americans receive lack scientific evidence of their effectiveness, according to the Batten School’s Eric Patashnik, Professor of Public Policy and Politics. The widespread use of expensive medical services of unclear benefit is one reason why the U.S. spends 18 percent of GDP on health care—double the average of other wealthy democracies—yet it has fewer doctors per capita and lags behind many other nations on population health indicators. When the government attempts to learn what treatments do the most good for people, however, critics often complain about “rationing” and “interference with the doctor-patient relationship.” Given these challenges, scholars are examining best practices to implement evidence-based medicine in a way that providers, patients, and policymakers can embrace.

To advance this research, Patashnik will publish “Doctor Knows Best: Physician Endorsements, Public Opinion, and the Politics of Comparative Effectiveness Research” this fall in the Journal of Health Politics, Policy and Law, with co-authors Alan S. Gerber, Yale University; David Doherty, Loyola University Chicago; and Conor M. Dowling, University of Mississippi. The study was supported by grants from the Robert Wood Johnson Foundation, the Smith Richardson Foundation, and the Yale Center for the Study of American Politics. Their research found that while many Americans mistrust government, and are generally suspicious of health insurance companies and the pharmaceutical industry, they overwhelmingly trust physicians and view doctors as faithful advocates of patient interests.

“The effectiveness of many medical treatments and procedures remains unknown, despite the astonishing cost and technical sophistication of the health-delivery system,” Patashnik said. “Physicians, patients, and payers often lack the information they need to identify what treatments work best for what conditions. As a political scientist, I want to examine whether it is possible to increase public support for reforms to solve this very serious health-care problem.”

Patashnik’s research shows that, in general, the public finds arguments against requiring doctors to follow evidence-based clinical guidelines more convincing than arguments in favor of them. Eight in 10 respondents were somewhat or very convinced that requiring doctors to follow guidelines would prevent them from tailoring care to the needs of individual patients. Eight in 10 agreed with the argument that “no outside group” should come between doctors and patients, and more than seven in 10 believed that guidelines would be used to ration care.

With such public skepticism about evidence-based clinical guidelines, Patashnik said, “our paper suggests that the medical profession has a huge opportunity to convince the public of the need for evidence-based medicine, but if individual physicians or medical societies resist its implementation—out of a fear that it will threaten their professional autonomy or incomes—the project is virtually certain to fail.”

Professor Eric Patashnik on the politics of evidence-based medicine

RELATED CONTENT

MORE FACULTY NOTES

Profile of Chris Ruhm/Economics of Health Research

Faculty Updates

FALL 2013 CONTENTS