U.S. Department of Health and Human Services Agency for Healthcare Research and Quality
Evidence Report/Technology Assessment, Number 17 March, 2001
“It is estimated that over 45 million people in the United States have acne vulgaris…” “Coupled with loss of productivity and unemployment, the direct cost of acne may exceed $1 billion per year in the United States.”
Findings: * “The literature is extremely heterogeneous, severely limiting the number of meaningful conclusions…” * “Evidence for subpopulations is either not available or reported in such varied manner as to prevent meaningful integration.” * “Evidence for quality-of-life outcomes and cost is not available.” * “Of 250 comparisons, only 14 had evidence of level A.” (Level A = moderate to strong evidence of a clinically meaningful endpoint) * “The literature is not organized to differentiate responses to (different levels of) therapy.”
Comment: If we cannot evaluate the management of the most common medical disorders, how can we ever make decisions about the proper allocation of our resources? An integrated, information technology system that links together our entire health care system would move us much closer to a model that would more readily provide answers to these fundamental questions about health care and our health care resources. Yes, there is much more work to be done to refine the information technology tools that would enable this, but we are moving much closer to that reality. Some of the challenges are discussed in the publication, “Networking Health” published by the National Academy Press (
Attempts at integrating our fragmented health care system, as exemplified by the Healtheon model, have failed miserably, largely because of conflicting interests in the marketplace. The framework that would enable integration would be a universal system of publicly-administered health insurance. Through an integrated information technology system for health care, we could help to provide a basis for making rational decisions on where our health care dollars would be wisely spent, and avoid wasting them on ineffective services. We will never achieve high quality until we develop a health care structure that drives quality.