[Evidence based medicine: theoretical bases and current misuse for cost cutting in the public health sector]

Founded on evidence based medicine (EBM), medical decisions should involve the best possible external scientific evidence as well as the expertise of the individual physician, while taking into consideration the subjective perspective of the patient. The Institute for Quality and Cost Effectiveness (Institut für Qualität und Wirtschaftlichkeit, IQWIG), which is financed through membership contributions to the statutory health insurance, deviates drastically in its evaluations for innovative medications from this concept. All publications on a medication are reduced to only a few "relevant" studies so that the statistics from the resulting meta-analysis are invalid. The resulting method dependent lack of statistical significance is considered by IQWIG authors to show the non-superiority of the test products, which are then speculatively discredited in terms of their safety. The "recommendations" of the IQWIG are accepted uncritically by the cost carriers. The aim of this article is to evaluate IQWIG-EBM in comparison with international standards on the basis of published IQWIG reports on metabolically active medications. The example of the reports on statins, short-term insulin analogues and inhaled insulin shows a methodology which suggests the misuse of study results and can best be characterized by the term "evidently biased medicine."