David Cundiff, MD

David Cundiff, MD, was first present in the Integrator in a column in which he took on the Cochrane Collaboration. (See

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Cundiff's book

In this column, Cundiff, author of Money Driven Medicine, focuses on two of the eight key factors in health reform which were listed by the Bravewell Collaborative following the recent Bravewell-funded Institute of Medicine Summit on Integrative Medicine and the Health of the Public.

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Challenges in Bravewell's Focus on Evidence-Based Medicine and Reimbursement as Reform Factors

David Cundiff, MD

Of the Bravewell Collaborative’s eight "key factors that should be included in health reform," six would probably appeal to the vast majority of stakeholders. However, the two factors that relate to allocation of resources present major challenges to finding a practical way forward with health care reform:

(1). Evidence-based medicine (EBM) is the only acceptable standard.  Researchers and practitioners alike concurred that health care should be supported by evidence and urged further research and testing to expand the evidence base for integrative models of care.

(2). The reimbursement system must be changed to a system that rewards outcomes rather than procedures with changes that incentivize physicians to focus on the health outcomes of their patients.

Let me address a major problem with basing medical resource allocation on EBM.

Sponsor of the HEDIS measures

Randomized controlled clinical trials and other tools of EBM are mostly funded by special interests and interpreted by researchers paid by those special interests. For that and other reasons, the evaluation of EBM trials is and will remain CONTROVERSIAL. Therefore, health care reform should not be predicated on being able to find the right, all-knowing, unbiased experts to draw up government-endorsed guidelines determining what interventions should and should not be covered by insurance.

For example, the National Committee for Quality Assurance (NCQA), a private, non-profit organization markets “Health Plan Employer Data and Information Set” (HEDIS), a tool used by more than 90% of America’s health plans to measure performance on important dimensions of care and service. Employers, consultants and consumers use HEDIS data to help them select health plans. HEDIS data also are the centerpiece of most health plan "report cards" that appear in national magazines and local newspapers. Corporate financial sponsors of HEDIS include the following drug companies: Boehringer Ingelheim Pharmaceuticals, Inc., Merck & Co., Inc., McNeil Pediatrics, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc., Pfizer Inc., Daiichi Sankyo, Inc., Sanofi Pasteur, Abbott, Lilly, Bristol-Meyers Squibb, and Novo Nordisk.