The most basic information we need is about the effectiveness of measures to cure or prevent illness. In particular, we need to know whether a specific treatment works. Is it effective in curing the illness? We also need to know how a treatment performs comparatively. Looking at different medical treatments for the same condition, which treatment produces the desired output for the least input?
Florence Nightingale recognised the importance of this more than a century ago and she bemoaned the lack of effective information available then:
"I have applied everywhere for information, but in scarcely an instance have I been able to obtain hospital records fit for any purpose of comparison".
Collecting evidence
Information about the effectiveness of different medical treatments can still be difficult to obtain. It was not until the 1960s that epidemiology started to produce effective data on a wide range of causes of ill health (such as smoking) and treatments. Increasing numbers of randomised controlled trials (RCTs) have been undertaken over the last 50 years and have shown that many treatments thought to be beneficial were in fact ineffective and some were positively harmful. For instance, it has been shown that there is no medical gain in admitting patients with acute coronary heart disease to hospitals with coronary care units. Once they have had initial treatment for their heart attack, subsequent treatment can be delivered equally effectively at home.
Without such effectiveness information it is impossible to evaluate the efficiency of health care provision. However, this problem can be overcome. Information about treatments can be obtained. All we need is more RCTs. But information about health care outcomes needs to consider quality of life as well as length of life and this is much more problematic.
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