One Size Fits Some

Jerome Groopman is skeptical  of "comparative effectiveness research":

What may account for the repeated failures of expert panels to identify and validate "best practices"? In large part, the panels made a conceptual error. They did not distinguish between medical practices that can be standardized and not significantly altered by the condition of the individual patient, and those that must be adapted to a particular person. For instance, inserting an intravenous catheter into a blood vessel involves essentially the same set of procedures for everyone in order to assure that the catheter does not cause infection. Here is an example of how studies of comparative effectiveness can readily prove the value of an approach by which "one size fits all." Moreover, there is no violation of autonomy in adopting "aggressive" measures of this kind to assure patient safety. But once we depart from such mechanical procedures and impose a single "best practice" on a complex malady, our treatment is too often inadequate.

Read the whole piece. I found it eye-opening and as always with Jerry, as fair as it is profoundly and deeply humane.