Earlier quoted context omitted.
> US doctors must follow national guidelines laid out by a scientific body No thanks. My daughter is alive today thanks to a therapy that would not be sanctioned by 'standards bodies'. I'm good. Thank goodness her doctor was a professional that was able to make professional judgements. If you want to reduce doctoring to looking up values in a dictionary, I suggest you try that with you and yours first, before forcing…
Do you mind sharing some details, without naming names? I'm curious to know more about the specific issue.
The treatment for clots during pregnancy is a daily injection called enoxaparin, which is rather expensive ($400/wk for 40 weeks), so insurance certainly does not want to pay.
Well, long story short, after seven pregnancy losses, she did the injections, and had a pretty textbook pregnancy. Of course, after we had the baby, all the 'evidence-based' doctors changed their tune and now insist that enoxaparin is a necessity if she wants to get pregnant again. Not just for the baby either, but for her health (since blood clots can lead to pretty sudden death for mothers).
So, yeah, basically her OBs advice, which was based entirely on intuition and five decades of actual clinical practice, saved both the lives of my daughter and in some ways my wife (again, she may have been at risk of clots during previous pregnancies).
Ultimately, medicine is not just about knowing what's in a book. These days, most medical knowledge is available for free online. When we went to UCSF, Stanford, and the Mayo Clinic, the 'care' we received included having the various conditions that can harm second-trimester fetuses listed for us and then we were explained why my wife did not have them. Of course, all these conditions we already knew about because of reading comprehension. I would not classify the information we got there as 'professional', because it was really a simple matter of looking up data in an index. On the other hand, her OBs care was actual professional care. We pay our doctors to give their opinion on our care based not just on what the books say but also based on what they have learned. An insistence on 'evidence-based' care reduces the ability for doctors to actually treat patients, and will -- inevitably, even if it takes some decades -- lead to a lack of evidence as new generations of doctors become less trusting of their intuition and more reliant on external validation.
EDIT: to be clear, it's not just a lack of evidence this treatment works. Several large-scale studies have been done in the United States and Europe (esp Britain) to see whether this therapy works at all. In Britain, where the NHS was considering this as a treatment for recurrent loss in the absence of diagnosis, the studies showed that the treatment was not effective, hence the NHS wouldn't cover it. Her OB knew of these studies and insisted they work, and also pointed out that studies done in other countries (like countries in the Middle East and Southeast Asia, where the demographics more closely fit those of my wife) did show an improvement. However, those studies weren't taken into account to help British mothers by their own national system. Thus, if my wife were British (or even in her parent's country of Canada), her treatment would not have been covered, but, because American insurance mostly pays for what the doctor prescribes, ours was paid for.