To Reform U.S. Health Care, Start with Systematic Reviews

摘要

With passage of The Patient Protection and Affordable Care Act (Public Law 111-148), the United States has taken an important step toward health care for all. But can "good" health care for all be achieved? The United States has lagged behind Canada, Europe, Australia, and now China (1) in making a national commitment to creating and utilizing research evidence on "what works" as an integral part of clinical practice and health policy (2). This approach, termed "evidence-based health care," has been defined as "the integration of best research evidence with clinical expertise and patient values" (3). Evidence-based health care is not without its critics. Some have rejected it as "cookbook medicine" (4, 5), apparently ignoring that evidence is not the only ingredient in the approach and that the alternative ignores the scientific underpinnings of medicine.