Here's what Susan Horn, one of our board members, an one of the world's experts on the science of improving outcomes in healthcare has to say about the crushing limiting randomized clinical trials have had on the quality of care for veterans with traumatic brain injury. It has implications not only for what is happening through the VA hospital system but for those who would use RiskMap as a one size fits all conduit for determining who gets access to medicines:
" The 1998 NIH consensus statement (about treating traumatic brain injury) acknowledged that individually tailored treatments provided within the context of acute rehabilitation create difficulties for efficacy studies. “This personalized approach leads to great difficulty in the scientific evaluation of effectiveness, because there is significant heterogeneity among persons with TBI and their comprehensive treatment programsâ€. The current level of evidence limits our ability to make firm decisions about the best therapy interventions, intensities, durations, or staffing characteristics for inpatient TBI rehabilitation. Also, randomized clinical trials severely limit the number of interventions that can be tested at any one time. Randomized trials attempt to examine an intervention in isolation from other interventions in order to detect the unique contribution to recovery of one or at best a few variables."
" The 1998 NIH consensus statement (about treating traumatic brain injury) acknowledged that individually tailored treatments provided within the context of acute rehabilitation create difficulties for efficacy studies. “This personalized approach leads to great difficulty in the scientific evaluation of effectiveness, because there is significant heterogeneity among persons with TBI and their comprehensive treatment programsâ€. The current level of evidence limits our ability to make firm decisions about the best therapy interventions, intensities, durations, or staffing characteristics for inpatient TBI rehabilitation. Also, randomized clinical trials severely limit the number of interventions that can be tested at any one time. Randomized trials attempt to examine an intervention in isolation from other interventions in order to detect the unique contribution to recovery of one or at best a few variables."
