Searching for what works best in medicine
The Obama administration is intrigued by what’s called comparative effectiveness research. That’s the evaluation of different treatments for the same medical condition. Some want to use the research to decide what’s worth paying for. For others, linking comparative effectiveness with cost effectiveness is controversial.
This summer President Obama told Americans they need to become more discriminating consumers of health care.
Obama: If there’s a blue pill and a red pill, and the blue pill is half the price of the red pill, and works just as well, why not pay half-price?
Some say the president is trying to rein in health costs by nudging doctors toward better treatment decisions. Others say the government is trying to shove doctors out of the way. Analyst David Nash says that second interpretation is all wrong.
Nash: Comparative effectiveness research does not get between you and your doctor. If anything, it gives your doctor solid evidence to help her make a better decision as to what ails you and what we can do about it.
Nash leads health policy studies at Thomas Jefferson University. He says the evidence on what works best should be better known.
Nash: When the doctor takes out his pen and is about to write the order or the prescription that’s when we need comparative effectiveness research outcomes, right at that precious moment when we are about to spend money in anticipation of a particular test and result.
Earlier this year, the federal stimulus package set aside more than a billion dollars to pay for comparison research. Analyst Ellen Marie Whelan says government-sponsored research is a check against companies that author their own studies and have a commercial stake in the results.
Whelan: We’ve all seen on TV a brand new drug comes on the market, the pharmaceutical company has lots of money and they’re saying: Here’s the drug you’re supposed to use when you are having trouble falling asleep.
Whelan works for the Center for American Progress.
Whelan: We do need to get this information more easily into the hands of the folks who are providing the healthcare for us.
Kerri Houston Toloczko is an analyst with Conservatives for Patients Rights.
Toloczko: I have a problem with competitive effectiveness when it is run by the government as the tool that the government will, does, and will be planning on using to ration care, to withhold care to basically make medical decisions.
Toloczko says comparison research lays the groundwork for nationalized health care.
Toloczko: Comparative effectiveness research has been used in every single-payer, socialized medicine scheme in the entire world to make the determination of who will get care and what kind of care they will get.
The health reform proposals in Congress do not tie comparison research to what the government is willing to pay for, but Toloczko says that’s the next step.
Toloczko: It might say: OK, if you have kidney cancer, Drug A works really well for 70 percent of the people. Oh, and the other 30 percent do really well on Drug B, but it’s more expensive. From now on, if we are a government system worried about costs because we are now paying the bill, we are only going to give you Drug A, too bad for the people in the Drug B category.
Conservatives say their opposition to government-sponsored comparison research is a stand against single-payer health care; Policy expert David Nash says that linkage is working.
Nash: The political deal that has been struck is that no aspect of CER, if we can use that abbreviation, will be used to determine payment policy. That’s sort of silly because what CER can help us to do, is to rationalize, not ration, but rationalize, meaning explain the appropriate use of resources in the health care system.
Nash says the government is already trying to use comparison research. For example, in May, the Medicare program said it will not pay for a cancer screening test sometimes called “virtual colonoscopy.” Regulators want more proof that the procedure works for older patients.
To some, this is a wise nudge toward the best available treatment. For others, it’s evidence that the government is moving to limit medical options for Americans.