Comparative Effectiveness is really about the moneyApril 7, 2009

Comparative effectiveness is what medicine has been doing since its modern inception some 2,500+ years ago.  In the last century, the health care industry has spent billions researching drugs and devices for efficacy.  Medical and surgical societies have endless symposiums on new methodologies of treatment and comparisons of those with older more well known modalities.  So what is this really all about.  Dr Kevin Pho, in his op-ed piece in USA Today clearly starts off showing that he is apparently lost in the therapeutic woods.  To say that doctors “rarely” know the best treatments is not only disingenuous and misleading, but also truly incorrect.  The vast majority of physicians and sugeons have a great deal of knowledge from various sources as well as accumulated experience upon which to draw to determine the best treatments for their patients.  It is true, that some complex diseases do not have clear cut, single therapy solutions.  That is only because we are yet to find them.  Look at the history of polio treatment in the 20th century.  Prior to the late 1950’s there was essentially a polio treatment industry with devices, therapies, rehabilitation programs and the like being offered and promotoed globally.  Enter polio vaccine and the rest is history (along with iron lungs etc).  Research for better treatments yields better treatments.  The medical establishment is remarkably quick to adopt new therapies when they in fact work.  To be sure, there are cases where delays have occurred, but for the most part, a new, successful treatment cannot be kept at bay for long.

So what is all this really about?  Money.  When baby boomers needed new schools and universities in the 1950’s, 1960’s and 1970’s they were built.  Local, state and federal dollars were expended. But now that this generation is “coming of age” in an era when they will need more health care, extended care, rehabilitation, nursing care, after care and hospice care we suddenly have a health care crisis on what treatments are really effective.  Make no mistake, forces are at work to ration care, limit options for seniors and reduce expenditures.  After all the cheapest care is no care and the best financial outcome for any health care payer (be in private or the government) is the beneficiaries death – a final event which terminates all costs to the “system”.  Sound cynical? Perhaps, but dealings with both the health insurance industry and federal payers has led this site to believe the worst.  Indeed, some very responsible voices have raised these vary concerns (see references below).  In the end, comparing treatments is nothing new.  It is hard to believe than any federal bureaucracy with the hidden agenda of controlling costs will do a better job than the tens of thousands of dedicated individuals who work in the overall health care system daily.   I would place more faith in their cumulative wisdom than any federal initiative . . . obi jo

Unbiased research for doctors is good medicine

Because doctors rarely are sure which treatments work best, they often prescribe the most aggressive therapy, or the newest drug or medical device, which likely will also be the most expensive.
The Obama administration is hoping the $1.1 billion for “comparative effectiveness research” in the recently approved economic stimulus package will help provide doctors data to make more informed decisions. Studies that compare drugs, medical devices and procedures should help determine what treatments benefit patients the most while cutting costs.

Unbiased research for doctors is good medicine -  read @ http://blogs.usatoday.com/oped/2009/03/unbiased-resear.html

Cato paper: Comparative-effectiveness research is crucial – Cato Institute; Washington – reads @ http://blogs.usatoday.com/oped/2009/04/cato-paper-comparative-effectiveness-rese

Cost-Effectiveness Information: Yes, It’s Important, but Keep It Separate, Please! -  read @ http://www.annals.org/cgi/content/full/148/12/967

U.S. to Launch Comparative Effectiveness Research with Stimulus -  read @ http://aidemocracy.wordpress.com/2009/02/16/us-to-launch-comparative-effectivene

The Other $700 Billion Question Can behavioral economics bail out the problems with healthcare spending? – read @ http://gmj.gallup.com/content/111778/Other-700-Billion-Question.aspx

U.S. to Compare Medical Treatments – read @ http://www.nytimes.com/2009/02/16/health/policy/16health.html

A Better Way to Generate and Use Comparative-Effectiveness Research – read @ http://www.cato.org/pub_display.php?pub_id=9940

Medical Research Provision Provokes Fiery Debate: Will Care Be Rationed? – read @ http://bulletin.aarp.org/yourhealth/policy/articles/medical_research_provision.h