Sacramento, CA - Patient advocacy groups, physician experts and ethnic healthcare organizations have joined together to form the Alliance for Better Medicine (Alliance), a California-based coalition working to develop appropriate "evidence-based medicine" (EBM) that reflects the state of the art in scientific knowledge and effective healthcare. Too often the phrase "evidence based medicine" is invoked to justify a policy or regulatory restriction without understanding how these policies affect outcomes and the need for each patient to receive the most appropriate, individualized medical care.

In line with this mission, the Alliance today submitted public comments to the Oregon Evidence Based Practice Center, which invited feedback on their review of evidence related to Alzheimer's and anti-depressant medications. Alliance members, whose expertise covers many disease categories, plans to comment on the Oregon reports whenever their methodology is flawed or their conclusions are not in line with these principles.

"Often these reports conclude that all drugs in a class are equally effective and therefore interchangeable," said James S. Grisolia, MD, Epilepsy Foundation board member and member of the Alliance. "Medicine is not 'one-size-fits all.' Making that assumption about Parkinson's, Epilepsy or Alzheimer's medications not only deprives consumers of the best, personalized care now, but will discourage the research and development of better treatments."

"The Alliance for Better Medicine is necessary for California to lead lawmakers, government agencies and consumer groups to only use scientifically valid and medically supported applications of evidencebased medicine," said Rusty Selix, Chairman of the Alliance. "It is imperative that we use evidence-based medicine in its intended manner to reduce costs without compromising the individualized care of EBM is most commonly defined as "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient." Another definition is "the right treatment for the right person at the right time in the right setting."

However, in efforts to manage costs, EBM has more recently been used to justify limited access to medications - usually older, cheaper and less effective - and restrictive policies which do not consider the specific needs of the individual patient or the clinical experience of the physician.

"When determining evidence-based health policy, it's important to remember that the least expensive treatment may not be the most economical in the long run, nor does it necessarily produce the best outcome for the patient," said Mike Nichol, PhD, Chair of the Department of Pharmaceutical Economic Policy at the University of Southern California and member of the Alliance. "The value of a treatment must be determined as opposed to simply looking at cost." Nichol and his colleagues have conducted dozens of focused studies comparing different medicines or procedures for their impact in managing serious diseases and improving healthcare outcomes. He added that it is particularly frustrating to see policymakers and organizations publish reports without adequately detailing the limitations of the data they are using, which can lead to claims that undermine the needs of patients.

At the epicenter of the debate is the Oregon Evidence Based Practice Center, which is based out of the Oregon Health Sciences University. This Center conducts reviews of evidence looking at the comparative effectiveness and safety of different medications within a class and issues reports on their conclusions. Unfortunately, these reports are based on limited evidence and often fail to acknowledge differential impacts upon minority groups.

Although the evidence may be valid, it is not sufficient to draw conclusions about the relative effectiveness of all drugs for all patients. Nonetheless, this Center has been gaining support from other consumer groups and government regulators.

"The time has come for us to move away from narrow definitions of evidence-based medicine. The time has also come for us to expand the evidence base of clinical decision making by ensuring diversity in clinical trials.

The Alliance is strategically placed to move this agenda forward," said Kwabena Adubofour, MD, President of the Stockton chapter of the National Medical Association, Associate Clinical Professor of Internal Medicine at the UC Davis Medical Center in Sacramento and member of the Alliance.

Although the Alliance was only recently formed, its members have already become highly engaged in the following EBM-related debates.

• Last month, members of the Alliance raised sufficient enough concern to delay consideration of Assembly Bill 71 for further discussion next year. AB 71 would have created a Web site using selective research based on limited patient populations to draw conclusions regarding the safety and effectiveness of prescription drugs.

• Alliance members also were vocal during the recent American Medical Association annual meeting, where conflicting resolutions on EBM were being considered. Resolution 704 called for evidencebased medicine to take into account individuals varied responses to medications and the clinical expertise of physicians in their practice. In contrast, Resolution 535 promoted narrow cost-based medicine, and specifically endorsed the Oregon Evidence Based Practice Center and the use of evidence-based preferred drug lists. Resolution 704 was adopted while Resolution 535 was tabled in a committee.

"The need for an organization to engage in the EBM debate on behalf of patients is long overdue," said Loretta Jones, Executive Director of Healthy African American Families and member of the Alliance. "Although our individual groups advocate on separate issues, the Alliance enables us to join forces on this common area of concern."

Alliance member organizations include the Depression and Bipolar Support Alliance of California; the Epilepsy Foundation of San Diego County; the Epilepsy Foundation of Los Angeles; the Epilepsy Foundation of Northern California; Healthy African American Families; the Hispanic American Allergy, Asthma and Immunology Association; the Huntington's Disease Society of America, Northern and Central California Chapter; NAACP Beverly Hills branch; the National Kidney Foundation of Northern California; the Hydrocephalus Association; the California Black Health Network; the National Mental Health Association; the Mental Health Association in California; the Multiple Sclerosis California Action Network; Cure Arthritis Now!; and the National Association of Cancer Patients, California Chapter.

For more information, visit the coalition's Web site, www.allianceforbettermedicine.org, which is designed to inform the public about current and emerging issues related to EBM.