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-research-is-crucial.html
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-effectiveness-research-with-stimulus/
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.html
The other side of the comparative effectiveness story is also about money–pharmaceutical and medical device companies have so much in stake in their drugs and treatments that doctors can several things happen: (1) industry clinical trials rarely involve head-to-head studies with competing drugs on the market, just bouts with placebo, and (2) industry marketing always accentuate the virtues of their products, without any counterparty to boldly articulate the dangers and risks. In my latest blog posting at nuts for healthcare (nutsforhealthcare.com), I discuss the implications of the Allhat hypertension study commissioned in 1994 which did very little to alter physician prescribing habits. So the real thrust behind comparative effectiveness studies is funding the studies that industry would never do, but also being able to impactfully communicate them so that it actually shapes the practice of medicine.
Jeffrey,
Thanks for the thoughtful comments. Couple of quick ideas. It is true that industry trials do not often (but they sometimes DO) go up against competitors. However, that is an FDA issue, not really an industry one. It also relates to initial claims regarding drug research and the consent of the patent holder to allow their drug to participate in a new study. Industry marketing is getting great scrutiny. It is governed by a great deal of regulation. The question is whether direct to consumer marketing should occur. While there are good arguments on all sides, it is hard to see how in an era of open information via the internet, it would be possible to censor a company from at least discussing it’s research and new product developments. Much more to discuss here, but your comment about comparative effectiveness is only partially correct. Will address that more in a later post. Thanks again for the comment. Keep them coming and please list us on your site, we will do the same.