Letter to the Editor

The New York Times
Sunday, July 12, 2009

To the Editor:
Re “The Cap Doesn’t Fit,” by Michelle Mello and Amitabh Chandra:
There is certainly nothing wrong with bringing evidence-based medicine into health care practice. But allowing clinical practice guidelines to become the sole legal standard for deciding negligence is a terrible idea.
First, there are already more than a thousand such guidelines in existence. Not only are some contradictory, but also patient safety could greatly suffer from a “one size fits all” approach, because patients often present widely varying and complicated conditions. Furthermore, conflicts of interest and specialty bias are problems in the development of these guidelines.
The few states that experimented in the 1990s with using guidelines as medical standards, like Florida, failed to garner support among physicians.
Joanne Doroshow
Executive Director
Center for Justice and Democracy

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