Ronald L. Diedrich
Director and Chief Administrative Law Judge
Office of Administrative Hearings
State of California
560 J Street STE 300
Sacramento CA 95814

Dear Dr. Stuart and Ms. Strite,

Thank you for the presentation you made on November 29, 2004 to the California Office of Administrative Hearings' administrative law judges on evidence-based medicine. It was very well received. The information was provided in a concise and readily understandable manner. The judges now have a new and valuable tool to assist them in appraising the medical evidence that is submitted in the hearings over which they preside.

I can highly recommend the instruction you make available through the Delfini Group. I believe that your presentation on evidence-based medicine would also be of great interest and use to other groups, such as state agencies that license health care professionals, both government and private attorneys who practice in the area of health care, and those individuals who testify as medical experts.

Remember the millions of dollars involved in the legal battles surrounding bone marrow transplant and high dose chemotherapy for advanced breast cancer? The evidence for doing the procedure was never there. So how did this get to be a community standard?

Fact:
Nearly 80 percent of all physicians tested, fail our simple evidence-based medicine test. And we grade the test generously.

• Medical journals publish many useless or misleading studies – even those journals considered the very best?

• Most doctors lack skills to evaluate the quality of a medical study? Consequently, much that is done in medicine causes harm to patients.

• The Institute of Medicine, Medicare, the Veterans Administration, RAND and the Dartmouth Center for Evaluative Clinical Science all estimate that up to a half of all medical care is inappropriate? (Some think it’s even higher.)

• Scientist and evidence-based medicine leader, Dr. David Eddy, did ground-breaking work that exposes the lack of expertise in the “medical experts”? Aren’t these the very people you and your opponents think you can rely on?

How might what we know benefit you?

If your or your opponents’ case is based on published medical literature — even from the most prestigious medical journals – there is a very good chance the studies they are using have significant threats to validity.

Many of the 10,000 articles entered into the National Library of Medicine each week have “fatal flaws” which make them invalid. In other words, the results and conclusions in many of the published articles are so flawed, that a reader cannot reliably draw conclusions about the effects of the intervention on outcomes.

• We believe that a working knowledge of evidence-based medicine could help you.
• Wouldn’t you like to know easy-to-learn methods for evaluating the quality of medical science?
• Wouldn’t you like to learn of some of the highest regarded sources for finding quality medical information – and wouldn’t you like to know tips on how to find information quickly and easily?
• Wouldn’t you like ideas for how you can better test the expertise of experts?
  

Wouldn't you like to know...

Fact:
This does not negate the value of expert testimony, but puts a new type of expertise into the hands of attorneys – the power of knowing what the best available medical evidence says.

• If your opponents are basing cases on invalid medical science.

• If the medical evidence you are using has significant threats to validity.

• If your expert witnesses are basing opinions and conclusions on flawed medical evidence.

We are dedicated trainers in evidence-based medicine and clinical quality improvement methods. We are routinely hired by pharmaceutical companies and some of the best and largest medical care systems in the country to help them improve the medical care they provide. We are considered highly accomplished teachers, routinely receiving exceptionally high marks and many testimonials for our work. We focus on skill-building, confidence-building and practicality in our workshops.

Michael E. Stuart MD
Prior to starting Delfini, Dr. Michael Stuart – who has been praised as the “father of evidence-based medicine” at the prestigious Group Health Cooperative, nationally recognized for its high quality care – operationalized evidence-based medicine during his nearly 30 year tenure there. Work under his leadership has received the highest praise from some of the most distinguished leaders in medicine. Evidence-based treatment guidelines created under his direction have been licensed by such places as the US Navy and the Health Ministry of New Zealand.

Sheri Ann Strite
Sheri Strite is proof-positive that people with no formal training in health care can learn the principles of evidence-based medicine. An associate director in Family and Preventive Medicine at the prestigious UCSD Department of Family and Preventive Medicine in the School of Medicine, Sheri was invited to serve with the faculty as a result of her work in evidence-based medicine teaching. She has partnered with Dr. Stuart to create highly simplified, learnable methods and tools to help others evaluate medical studies – work which has received high praise around the country.