Where's the evidence for home care?
CMAJ 1998;159:136
In response to: A. Byrne
See also:
The logic of Dr. Byrne's position is elusive. It may be true, as Dr. Coyte is reported to have said, that there is only weak evidence supporting home care as a cost-effective delivery system, but there are many types of home care that make abundant common sense beyond the probing reach of either health economists or supporters of evidence-based rationing. Or is Byrne suggesting that potential solutions with weak evidence warrant only modest funding? This would represent a new but unappealing approach. In any case, the absence of evidence should never be confused with evidence of absence. It would be hard to justify a randomized controlled trial to show the obvious benefit of home care that respects personal choice and improves quality of life for many. Therefore, Byrne's apparent willingness to accept rationing on the basis of nonexistent or imperfect scientific studies remains surprising. No wonder some of us are alarmed by the misappropriation of evidence-based medicine by governments trusted with health care decisions.
Stuart M. MacLeod, MD, PhD
Professor
Clinical Epidemiology and Biostatistics,
Medicine and Paediatrics
McMaster University
Hamilton, Ont.
hnmccu@idirect.com
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