Asthma Disease Management-Evidence-Based Medicine Must Be Dynamic

It seems reasonable for physicians and clinical pharmacists to protest, at least quietly, evidence-based medicine (EBM) for its potential to become cookbook medicine. At another level, EBM cannot be cookbook medicine because unlike recipes for cooking, the evidence in EBM is constantly changing. Perhaps, therein lies the critical distinction and the absolute need to view EBM as dynamic and continually changing as new evidence becomes available, is challenged, and survives scrutiny. In this issue of JMCP, Heaton et al. challenge the value of leukotriene modifiers (LM) in disease management of asthma. Based upon the 3 clinical outcomes of emergency room visits, hospitalizations for asthma, and the use of oral prednisone (�steroid burst�) to indicate exacerbation of asthma, these authors concluded that LM use was not more effective than nonuse. Worse than no improvement in these 3 clinical outcomes, LM users appeared to have more ER visits, a higher rate of hospitalization, and a higher rate of use of oral prednisone bursts. Heaton et al. calculated that LM use added $1.63 per patient per month (PPPM) in costs (in 2002 dollars) for these 3 clinical outcomes compared with LM nonusers diagnosed with asthma.