4-1). Second, the biological and social sciences often have employed different types of research designs, with resulting differences in the types of empirical evidence produced. Because M/SU health care involves both medical and psychosocial issues and professions that have their historical origins in either the biological or social sciences, reviews are conducted by entities with different origins and research traditions and sometimes produce different types of empirical evidence and judgments about their meaning. Table 4-1 lists some of the leading organizations or initiatives that conduct evidence reviews of M/SU health care services and make determinations with regard to effective practices.

The commitment of these and other organizations to promoting the delivery of evidence-based care is to be applauded. “Reinvention” has been identified as a key ingredient in ensuring acceptance of new concepts and necessary change (Greenhalgh et al., 2004). At the same time, however, variations in review and rating methodologies can result in different practice guidelines for treating the same condition and a lack of consensus on what guidelines are best (Manderscheid et al., 2001). The lack of coordination and consensus across the multiple existing review efforts also contributes to significant confusion about what constitutes “evidence-based” health care for mental and substance-use conditions (Ganju, 2004). These variations and sometimes duplication in the topics reviewed create challenges to the promotion of evidence-based care. Moreover, the lack of coordination among these initiatives means there are fewer resources available for other quality improvement activities.

There is also a contrast between the evidence review infrastructure for psychotherapies and that for drug safety and efficacy, as well for how new treatments and therapies are deployed. The U.S. Food and Drug Administration (FDA) oversees the development, delivery, and dissemination of safe and effective medication therapies by subjecting new medications to a safety review before they are released into the marketplace for use by consumers. FDA review mechanisms also assess the strength of the evidence for the effectiveness of certain drugs prior to their release. Medications cannot be distributed or advertised to the public unless they have been approved by the FDA. However, no such safety and efficacy reviews are required for psychotherapies. As a consequence, those seeking psychotherapy cannot always be confident that the treatment they are receiving has met any standards for safe and effective care. In one extreme example, this situation resulted in the death of a 10-year-old child who was subjected to “rebirthing therapy” (Associated Press, 2005), a practice subsequently discredited (Lilienfeld et al., 2003). Moreover, while many new therapies in general health care, such as surgical procedures not involving a new medical device, can be used without an FDA-type review, individual patients for whom such therapies are used generally receive information about the evidence for



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