http://www.nap.edu/catalog/12038.html. It speaks to the need for a transparent and believable process which is used to assess what delivers value to patients and how to package that information where it is accessible and understandable to health care providers and to patients and their families. It is a complex problem which will require collation, synthesis, and interpretation of vast amounts of information.
It brought to mind how the landscape of the health care delivery world has changed. That might seem like I am stating the obvious but I believe that the changes which are most fundamental one the ones that are least appreciated. When Jesus was dining with the sinners and tax collectors, he was asked by the Pharisees why he would engage in such behavior. His response was"
“It is not the healthy who need a doctor, but the sick. I have not come to call the righteous, but sinners.” (Mark 2:17)
http://www.amazon.com/Demon-Under-Microscope-Battlefield-Hospitals/dp/1400082137) completely changed not only how physicians practiced, but fundamentally changed what the goals of our jobs would end up being.
There are still many physicians who deal with life or death situations. However, increasingly our services are delivered to patients who are no longer sick in the same sense as those viewed as ill in previous generations. Perhaps even more fundamental is the change in the time line for the assessment of success or failure of interventions. We no longer exclusively attempt to focus on acutely saving lives. Measurement of outcomes in acute care settings is still demanding and can have pitfalls, but it is inherently easier than measuring more difficult to define outcomes which may occur years in the future. In my opinion, the IOM paper was written because of the need to know what works in the realm outside of acute life or death scenarios. We need to be able to figure out which interventions are best for patients when we look out months, years, or decades. This is exceptionally hard and in certain circumstances perhaps not even possible no matter what technology we deploy.
Any sufficiently advanced technology is indistinguishable from magic. Arthur C. Clarke, "Profiles of The Future", 1961There is no question that we are still are amazingly good at dealing with acute care situations where we can deploy technology which has the semblance of magic. It is questionable whether accomplishments in this realm should translate into confidence in medicine's ability to intervene and make meanigful impact in a more distant time frame.