The Guidelines International Network of North American (G_I_N NA) conference Evidence-Based Guidelines Affecting Policy, Practice and Stakeholders was held this week at the New York Academy of Medicine (NYAM). David Eddy began his keynote stating this was most certainly his last public lecture, as he is moving into retirement. I certainly hope not.
Though he doesn’t know it, David Eddy has been a virtual mentor for my own career as a clinical epidemiologist who practices evidence based medicine. His experience in medical training was identical to mine with the discovery that medical decision- making was not at all rational. So after his clinical training in the 1970s, David Eddy got a PhD in engineering mathematics at Stanford and began his long history of bringing systematic evaluation of evidence to medical care.
He summarized some of this in his lecture, which he renamed Evidence Based Guidelines, Looking Backward and Forward. You can learn quite a bit about his experiences, as well as his important contributions to the history of EBM on his website http://www.davidmeddy.com/ Rather than summarize the look back, I encourage you to read it in his own words. You might also want to read his perspective on the origins of EBM here http://virtualmentor.ama-assn.org/2011/01/mhst1-1101.html
Looking forward, David Eddy made what he anticipated would be controversial recommendations. Among them:
· We need to move beyond Markov models (Dr. Eddy is one of the developers of the method)
· We need to stop using Cost/QALY as a measure since we can’t trust the measurement of either the numerator or the denominator
· We should replace population based guidelines with single, integrated individualized guidelines that:
o Span all conditions
o Include all important information
o Calculate the risk of all important outcomes
o Calculate the change in risk with all potential treatments
Then give the information to the physician and patient and let them decide
· Replace current, process-based performance measures with single, integrated outcomes based quality measure
You can read about individualized guidelines in the Annals of Internal Medicine publication of Dr. Eddy’s paper: http://annals.org/article.aspx?articleid=746954 and about the global outcomes metric in the Health Affairs publication of Dr. Eddy’s paper: http://content.healthaffairs.org/content/31/11/2441.full
As always, David Eddy is way ahead of the rest of medicine. We only now have medical specialty societies making recommendations for cancer screening intervals that agree with the evidence based recommendations made by Dr. Eddy more than 30 years ago. You can learn more about his current innovative work at Archimedes developing models to help us evaluate the risks and benefits from all possible therapies for patients with multiple disease here http://archimedesmodel.com/
I sincerely hope that what I heard was not David Eddy’s Swan Song (read the Wikipedia definition he provided for a Swan Song here http://en.wikipedia.org/wiki/Swan_song ) I’d like to think that many others will get to hear his intelligence, wit and his passion for the use of evidence to guide clinical care and its improvement.