Proof of a therapy's effectiveness — Washington state leads the way
I’ve written before about what we call Evidence-Based Medicine. The idea is that doctors shouldn’t do things for which we lack good evidence that it works. That seems like a silly notion — don’t doctors know what they’re doing? In fact, a good portion of medical practice rests upon tradition or fairly weak anecdotal evidence. This matters a lot when we’re talking about high-risk things — nobody should be subjected to risk without potential benefit. It also matters a lot when we’re talking about expensive things. Good estimates are that about a third of what doctors do helps little, if at all.
The state of Washington pays for the healthcare of about 700,000 people, and has taken the lead in trying to do transparent, out-in-the-open evaluation of some expensive medical interventions. If they don’t work, they won’t be covered. No exceptions. Most of the decisions taken thus far are for expensive surgical procedures, things that are fairly easy to assess. You can read about it here. It will be much more difficult to do this for the vast majority of situations, in which the data are more murky.
As a nation, I think we must do something like this. We certainly shouldn’t do things that don’t work. More than that, we can’t afford to keep doing so.