EBM: Regression to the Meanest

  • by: |
  • 05/15/2007
As if we needed another example of the folly and bias of large studies, the following excerpt from http://www.scientificamerican.com says it all:

Gordon H. Guyatt, a professor of epidemiology and biostatistics at McMaster University in Hamilton, Ontario, who coined the term "evidence-based medicine," collaborated with 16 of his colleagues in an exhaustive survey of existing studies on the outcomes of various medical procedures in both the U.S. and Canada. Their work appears in the inaugural issue of the new Canadian journal Open Medicine, and comes at a time when many in Canada are debating whether or not to move that country's single-payer system toward for-profit delivery of care. The ultimate conclusion of the study is that the Canadian medical system is as good as the U.S. version, at least when measured by a single metric—the rate at which patients in either system died.

Here's what the authors left out to get to their conclusion:

"We included published and unpublished prospective or retrospective observational studies comparing health outcomes (mortality or morbidity) in Canada and the United States for patients of any age with the same diagnosis."

Unpublished? So we have no way of knowing if the study design or results are any good. Ok, next.

"We excluded randomized trials, studies that identified the patients on the basis of the occurrence of one of the adverse health outcomes of interest, and national disease-specific mortality studies that failed to define the population at risk (that is, those with the disease of interest)."

Translation: We excluded anyone who was sick.

"For instance, we excluded studies of national rates of death from cancers because lower mortality may be due either to a lower incidence of cancer or to better care for those with the disease."

That's right folks, better care is not considered a factor in determining which health system is better. Can you say George Orwell?

In otherwords, if you are healthy and "use" the Canadian health system you die at a slower rate than in the US. Wow.

This, from the person who coined the term evidence based medicine.

For those fans of EBM here's the link. Steffie Woolhanler, Canadian health system symp is a co-conspirator on this piece of propaganda.


Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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