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Missing Evidence
January 03, 2017

Missing Evidence

It’s time to wrap up the holiday celebrations, finish up the last of the buttery leftovers, and sneak the remaining crumbs of decadent desserts. It’s also time to take stock of 2016. Did we exercise enough or eat right or spend enough time with the children or get that credit card debt under control?

With that last bit of fudge, we start planning how we will do better in 2017. It’s a worthwhile task, though it may be accompanied by a little more self-loathing than is beneficial.

Surprisingly enough, the Patient Protection and Affordable Care Act (Obamacare) asks the same question about medical research each year: Where does it come up short? Obamacare requires the United States Preventive Services Task Force (USPSTF) to provide an annual report to Congress. This report points out gaps in the medical evidence. These gaps point the way for future research.

The most recent evaluation came in the form of the Sixth Annual Report to Congress on High-Priority Evidence Gaps for Clinical Preventive Services. It identifies six key areas where the gaps warrant further research. Otherwise we can’t make recommendations based on solid scientific evidence. The areas identified include:

Each listed topic lacks sufficient research for evidence-based recommendations. Do you take a baby aspirin each day? You might be surprised to learn the science is not settled on its use to prevent heart disease. And we just don’t know how much e-cigarettes help smokers kick the habit.

This does not necessarily mean these things don’t work. It just means we don’t have the research to say they offer more benefit than risk.

In addition, the USPSTF looked at gaps in research affecting specific populations. These groups may be under represented in the body of existing research. Or there maybe genetic differences that necessitate separate recommendations. They found three areas that need more in depth study:

No regulations require that the research now be pursued. Identifying areas where evidence is lacking is quite different than finding the resources to get that research done. So the list may not look all that different next year.

For patients, though, recognizing these evidence gaps is a valuable tool. Make it your New Year’s Resolution to bring up this report with your doctor before you agree to any of the above interventions. Ask him what it is that makes him believe this is a good decision for you. There isn’t enough evidence to make a generalized recommendation. It must be an individual decision based on your specific circumstances.

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