>To begin with, if you are the manufacturer of the currently accepted 'best
>practice' drug,
This is another problem. Phrases like 'best practice' and 'best evidence'
are protective coverings on a core of ignorance. They are, in fact,
confessions of ignorance. David Eddy, before he became a shill for the
insurance industry, wrote eloquently about this. There just isn't enough
scientific (there, I said it) evidence to support much of anything we do in
medicine. How much back surgery in the US is indicated? 10%? 2%? It
certainly is nowhere near 100%.
>The mechanism in the past to
>arbitrate between these two competing interests was to invite the clinician
>to use the magic of 'clinical judgement' to decide who should be treated at
>all, and what with.
That hasn't changed. Most practice guidelines are the consensus of a group
of experts agreeing on what their clinical judgment is. Usually, to be
chosen for such a group one has to have a very high reputation that
correlates well with lack of clinical activity.
>Plus, I
>think clinicians already know that they are sinking under the load, and
>would welcome a way out.
I think most clinicians, in contrast to most lawyers, for example,
genuinely want to help their patients/clients. I think that the inherent
good will of most doctors is actually quite high. They would welcome
something that actually benefited patients.
John
