Knowing What Works in Medicine

As the nation attempts to rehabilitate its health-care system, Dartmouth Medical School Professor John Wennberg and his Center for the Evaluative Clinical Sciences are helping with the diagnosis. With pioneering research into how physicians decide which medical treatment to offer patients, Wennberg and his colleagues have helped make the nation aware that few medical decisions are made on purely scientific grounds; indeed, that know-how about what works in medical treatment is far more illusory than most people have acknowledged. Trying to reduce guess-work, Wennberg recently established a master of science program in evaluative clinical sciences.

Wennberg's group is also formulating some cures for the system. The researchers are creating tools including interactive Videodisks that educate patients about treatment options and enable them to participate directly in decisions about their care.

The outcomes movement is no less than a "revolution" in health care, according to Arnold Relman, former editor of the New England Journal of Medicine. It is timely, too. Wennberg was a participant in the Clinton task-force on national healthcare; the evaluative approach to treatment is a dominant feature of the reform package being debated in Congress.

Wennberg shows how little docs know.