Proposed legislation to measure the effectiveness of treatment for diseases and certain injuries is drawing criticism from conservative circles. The following article provides opinion on why standard treatment and protocols may be too costly. The need for increased clinical trials and evidence based medicine could lead to best practices and a decline in health care costs.
Boston Globe – Globe Editorial
In a stimulus package of $787 billion, it is a mere $1.1 billion item that is facing particular vitriol from conservative ideologues. The money would fund a ramped-up effort to compare the effectiveness of different treatments for injuries and diseases. As inoffensive as this sounds, critics of any government role in healthcare see it as the slippery slope to rationing or Washington-mandated protocols for treatment.
One can imagine reruns of the Harry and Louise ads used by insurers to such good effect against the Clinton health plan in 1993. Except this time Harry and Louise would work for the pharmaceutical companies and medical-device makers. Both industries worry that studies on effectiveness will find that some of their prize – and most profitable – products are no better, or even worse, than cheaper alternatives.
Currently, new drugs can gain approval of the US Food and Drug Administration just by proving they are safe and better than sugar-pill placebos. They need not be better than existing – and often less expensive – drugs. Comparative effectiveness studies could help patients and doctors make better-informed decisions about care.
To allay concerns that clinical studies often include too few women or minority-group patients, the stimulus law calls for including those groups in studies. A report filed with the legislation also says the money should not be used to “mandate coverage, reimbursement or other policies for any public or private payer.” But the law itself is not as clear-cut on uses of the research. AdvaMed, the trade association for medical-device makers, says it supports the program but worries about it leading to cost comparisons, which it views as a way to ration care.
If this research can provide credible evidence of the superiority of one treatment over another, professional organizations, hospitals, and insurers will have to take notice. And if that leads to broad adoption of best practices, patients will get better faster – and healthcare costs will decline. Push will come to shove if, in the face of solid research, physicians persist in recommending drugs, devices, or surgeries that get low marks. Insurers, including Medicare, could then require doctors to explain their decisions.
This isn’t rationing – it’s rational. Research of this kind and the stimulus package’s $19 billion for electronic medical records are two ways to curb costs in the $2.2 trillion healthcare industry. Without such measures, the public is unlikely to support President Obama’s plan to provide nearly universal insurance. Both initiatives offer the promise of improved – and less expensive – healthcare for all.
