Mandated Health Treatment Regulations Are Often Reversed

(p. A25) After spending nearly two decades in medicine, I am still amazed by how spare the evidence is on which we doctors base our medical decisions. Treatment guidelines, often accompanied by a de facto mandate, are frequently reversed.
Only a few years ago, for example, beta-blocker drugs were routinely recommended for almost all patients undergoing noncardiac surgery. Since then, research has shown that these drugs may significantly increase the risk of stroke at the time of surgery. I remember colleagues questioning the beta-blocker recommendation for certain patients and being admonished for not being “evidence-based.” I shudder to think how many patients were left disabled by strokes because of the blanket adoption of this standard.
What is in vogue today is often discarded tomorrow. Hormone replacement therapy for women after menopause is an example of a once widely implemented treatment that we have now largely abandoned. In September, in response to new research, the American College of Cardiology revoked a major recommendation on heart-attack treatment. “Science is not static but rather constantly evolving,” said its president, Patrick T. O’Gara, in explaining the decision.
. . .
Instead of being allowed to deliver “patient-centered” care, many physicians feel they are being co-opted by regulations. Some feel pressured to prescribe “mandated” treatment, even to frail older adults who may not benefit. Guidelines are supposed to assist and advise. But all too often, recommended care in certain situations becomes mandated care in all situations.

For the full commentary, see:
SANDEEP JAUHAR. “Don’t Homogenize Health Care.” The New York Times (Thurs., DEC. 11, 2014): A25.
(Note: the online version of the commentary has the date DEC. 10, 2014.)

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