The threat of evidence-based practice

A lot has been said about the benefits of evidence-based practice in recent months, especially as it relates to improving the effectiveness of medical care under health care reform. One model in particular, Intermountain Health Care in Utah and Idaho (http://intermountainhealthcare.org/Pages/home.aspx), has drawn national attention for low-cost care with significantly improved outcomes. President Obama has gone so far as to suggest that all medical facilities should rely on strict metrics and "care by committee" to lower health care costs nationwide. As a music therapist and an aspiring physician, this idea is unsettling to me. I'm not bothered by protocols clearly supported by data, washing hands for example, or following a checklist to prepare a patient for surgery. Unfortunately, data hungry as we may be, the vast majority of medical maladies are not so clearly understood and even less clearly described by what quantitative means we have available.

This lack of statistical significance is even more evident in quantitative anayisis of behavioral health issues and complex disorders such as autism. That's not to say that quantitative studies can't provide helpful guidelines for treatment of all sorts of clinical issues, but there is a dangerous trend of setting protocols for virtually every clinical presentation, and much of it is based on financial and legal motivations in the insurance industry. Saddest of all is the seeping of this medical groupthink into music therapy. The allure of labeling one's approach as "evidence-based" is difficult to resist when most people in the general public wouldn't know how to begin to take a closer look at that evidence. The fact is, much of the evidence out there is from music therapy studies with very small groups, which makes them fairly insignificant statistically, but compelling trends just the same. One of my goals as I struggle through the quagmire of American medical education is to figure out how to respect the lessons of our vast, quantitative medical knowledge about the human body without forgetting the singularity of the human being.