The Quality of Medical Evidence: Implications for Quality of Care

Abstract

Prologue: Most of the proposals advanced in the 1980s for rationalizing the use of medical care derived chiefly from an economic model —more consumer cost sharing, the development of alternative health delivery systems, and new financial incentives. One of the working assumptions of the analysts and policymakers who designed these proposals was that the scientific basis of medicine was solid. If purchasers of care could only determine how to make providers more efficient, they reasoned, the growth of medical costs could be moderated. In this paper, David Eddy and John Billings call into question that assumption. They make a case for why it is imperative that the medical profession get on with the job of examining more closely the scientific basis of medical practice. Eddy holds a medical degree from the University of Virginia and a doctor of philosophy degree in applied mathematics from Stanford University. Eddy, who currently directs the Center for Health Policy at Duke University, is the J. Alexander McMahon professor of Health Policy Research and Management. Eddy operates at the intersection of math and medicine, applying probability theory to the uncertainty of approaches to care. Billings holds a law degree from the University of California, Berkeley, and has been actively involved in a variety of health care activities for a decade. Billings, who is currently an independent consultant, wrote this article with Eddy while serving as a visiting professor at Duke. He served as one of the first staff directors of a community-based (Salt Lake City) health care coalition (1979–1980) and was executive director of The John A. Hartford Foundation for four years (1981–1985).