Evidence-Based Medicine: Just What the Doctor and the Health Ministers Should Order

A point scored for those who believe that medical practice should be based on hard evidence: the Quebec College of Physicians has come out against running head-long into use of the Zamboni angioplasty technique for treating multiple sclerosis. Their stand comes at a time when high tech medicine is making headlines, with many decrying both rising health care costs and long wait times for access to health services.

Nine studies have been undertaken to test the usefullness and safety of the procedure, but only one comes even close to reproducing the results of the Italian doctor, according to Dr Marc Girard, president of the Quebec Association of Neurologists. Two studies--one in Germany, the other in Sweden--have not even found the vascular problems the Zamboni procedure is designed to correct among their subjects. Because the intervention--now offered in 18 other countries--is not without risks, he and the other Quebec physicians say that the results of carefully designed studies must be available before giving the okay to widespread use of the procedure.

Their stand has repercussions far wider than Quebec or one disease. "Advances" in medicine frequently are expensive, but how effective they are is often not evaluated. Dr. Maurice McGregor, former dean of McGill University's medical school who is active in evaluating medical technology, argues that these changes are usually paid for by cutting in other parts of health budgets.

He wrote recently that to avoid continuing impoverishment of the health care system, hospital financing should require stricter accounting procedures and "a specific review of techonologies before their acquisition." The issue is far from academic since "our healthcare system is currently marred by prolonged wiat times, leading to deamsn for 'fundamental' reforms and increased privatization."

It would seem that the Zamboni procedure is only the tip of the iceberg. Let's see what sort of stick-handling the provincial health ministers can give us.