Recent legislation mandates comparative-effectiveness research (CER), which seeks to find which treatments work best in the “real world” of medicine. It recognizes that randomized clinical trials reduce the variables to a minimum and provide conclusions only for the average patient. Individuals and subgroups of patients are often ignored by our dependence on double-blind studies. CER will work through generating questions by “data mining” of large group practices and electronic medical records (EMRs). It is estimated that 50-78% of research conclusions are changed by further research and that at least 48,000 key clinical questions remain to be answered in family practice alone.
Obviously, integrative medicine approaches diagnosis and treatment radically different than conventional medicine. Patients who do not respond to standard treatment often thrive under the guidance of an alternative practitioner. However, integrative patients and practitioners are reluctant to utilize EMRs because of privacy issues. The most important source of new knowledge in medicine awaits discovery in the records of integrative patients. A way must be found to make the knowledge known while unquestionably preserving the privacy of the patients who have benefited.
See Djulbegovic, Mia and Benjamin, Implications of the Principle of Question Propagation for Comparative-Effectiveness and “Data-Mining” Research.
JAMA,(click here) January 19, 2011, P. 298-299.