Palliative care, evidence, and ALS: The baby and the bathwater

In 2009, the American Academy of Neurology (AAN) effectively dropped palliative care from its evidence-based amyotrophic lateral sclerosis (ALS) recommendations because measurable benefit from palliative care services in ALS had not been proven.1 From one perspective, humanism and common sense were thus sacrificed at the altar of measurement; the baby was discarded with the bathwater. From another, palliative care had simply not proved its worth. Since that time, neurologic palliative care has burgeoned in both research and clinical practice but remains excluded from the ALS guidelines.

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