Evidence-based medicine and cost-effectiveness

Most available medical management techniques compare the practice patterns of providers with other providers but overlook the inherent value of interventional medical therapies to patients and society. The authors present a methodology for objectively evaluating the quality and cost-effectiveness of medical interventional therapies, and comparing them to each other using the common denominator of cost per quality-adjusted life-year ($/QALY). Advantages of this methodology include the fact that it: (1) compares the cost-effectiveness of different treatment regimens, (2) incorporates patient preferences, (3) employs evidenced-based medical data, information that is most reliable and reproducible, (4) factors in the effect of treatment on the quality of life and length of life, (5) offers an evaluation of the clinical efficacy of a treatment, (6) identifies both superior and marginal treatments, (7) maximizes the effective use of scarce resources, and (8) simplifies the understanding of health care procedures for consumers, payers, and providers.     

Evidence-based medicine and the diverse cultures of healing

The term "unconventional medicine" refers to a remarkably heterogeneous group of theories and practices (homeopathy, herbal medicine, acupuncture, etc.) different from those peculiar to the dominant health system of a particular society. An unifying characteristic of these practices is that they have not been scientifically tested and that unconventional practitioners largely deny the need for such testing. However, established research procedures are to be considered adequate to address the majority of questions related to unconventional therapies and promising unconventional therapies should be subjected to the same level of scientific scrutiny that is required for drug therapies used within the official medicine. While many questions about the risk/benefit ratio of unconventional therapies remain unanswered, millions of people are spending millions of dollars each year in several developed countries, thus, to define strategies aimed at the careful evaluation of these practices is needed.     

Critical thinking among environmental health undergraduates and implications for the profession

During a study conducted in 2000-2002, the critical-thinking dispositions of undergraduate environmental health students at Illinois State University were found to have significant shortcomings. The critical-thinking-disposition scores were comparable to those of other undergraduates throughout the United States and Canada; nevertheless, these findings have significant implications for environmental health academic programs and the profession. Environmental health professionals commonly confront "ill-structured" problems, for which critical thiking is an essential skill. In addition, the challenges faced by the profession in terms of recognition, funding, and public support require a high level of critical thinking. This paper provides a number of recommendations for academic programs and professionals.