TY - JOUR
T1 - The political contexts of evidence-based medicine
T2 - Policymaking for daily hemodialysis
AU - Gordon, Elisa Jill
N1 - Funding Information:
The author thanks Ash Sehgal, MD, for suggesting the initial research idea. Thanks also go to Libby Bogdan-Lovis, Helen Lambert, and Thomas Prohaska for helpful comments on an earlier draft of this paper. The author appreciates the insightful comments by two anonymous reviewers. A shorter version of this paper was presented at the 102nd Annual Meeting of the American Anthropological Association, November 19–23, 2003, Chicago, IL. Dr. Gordon is supported by grant DK063953 from the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.
PY - 2006/6
Y1 - 2006/6
N2 - Policymakers and clinicians increasingly rely on evidence-based medicine (EBM) to make decisions about insurance coverage and clinical treatment. Conflicting value judgments about evidence and pressures exerted by stakeholders render health policymaking a political process. This paper examines how value judgments become embedded in the process of improving medical outcomes by focusing on health policymaking. Specifically, this paper highlights how EBM is variably used as a standard for decision-making depending on perceived risks by policymakers and what is on the competing agenda. I draw upon the case study of the policymaking process for the recent US bill, H.R. 1004: Kidney Patient Daily Dialysis Act, which would legislate daily hemodialysis (DHD) as a new renal replacement therapy modality, and provide federal medicare funding of hemodialysis from 3 to 6 times per week. DHD constitutes an ideal case study with which to explore the political underpinnings of EBM. The interpretations of substantial outcome data showing medical, quality of life, and hypothetical economic improvements of DHD over conventional dialysis are currently being contested in the medical and political spheres. Accordingly, the drive for what some stakeholders view as better evidence through randomized clinical trials is central to the debate and policymaking process. This paper underscores how the demand for, the interpretations, the funding for, and the use of evidence render EBM a political endeavor with vital ethical implications for clinical care.
AB - Policymakers and clinicians increasingly rely on evidence-based medicine (EBM) to make decisions about insurance coverage and clinical treatment. Conflicting value judgments about evidence and pressures exerted by stakeholders render health policymaking a political process. This paper examines how value judgments become embedded in the process of improving medical outcomes by focusing on health policymaking. Specifically, this paper highlights how EBM is variably used as a standard for decision-making depending on perceived risks by policymakers and what is on the competing agenda. I draw upon the case study of the policymaking process for the recent US bill, H.R. 1004: Kidney Patient Daily Dialysis Act, which would legislate daily hemodialysis (DHD) as a new renal replacement therapy modality, and provide federal medicare funding of hemodialysis from 3 to 6 times per week. DHD constitutes an ideal case study with which to explore the political underpinnings of EBM. The interpretations of substantial outcome data showing medical, quality of life, and hypothetical economic improvements of DHD over conventional dialysis are currently being contested in the medical and political spheres. Accordingly, the drive for what some stakeholders view as better evidence through randomized clinical trials is central to the debate and policymaking process. This paper underscores how the demand for, the interpretations, the funding for, and the use of evidence render EBM a political endeavor with vital ethical implications for clinical care.
KW - Daily hemodialysis
KW - End-stage renal disease
KW - Ethics
KW - Evidence-based medicine
KW - Health policy
KW - USA
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U2 - 10.1016/j.socscimed.2005.11.024
DO - 10.1016/j.socscimed.2005.11.024
M3 - Article
C2 - 16376472
AN - SCOPUS:33646094465
VL - 62
SP - 2707
EP - 2719
JO - Social Science and Medicine
JF - Social Science and Medicine
SN - 0277-9536
IS - 11
ER -