Is stimulus health IT money a trojan horse?

The Weekly Standard, a popular haunt among conservatives, is out with a column calling the stimulus bill's move to subsidize health IT and support comparative effectiveness a "Trojan Horse" aimed at controlling Americans' health care decisions.

The Weekly Standard, a popular haunt among conservatives, is out with a column calling the stimulus bill's move to subsidize health IT and support comparative effectiveness a "Trojan Horse" aimed at controlling Americans' health care decisions.

The author is Dr. Tevi Troy (right), a former Bush Administration official and author of Intellectuals and the American Presidency, which urges Presidential candidates to align themselves with highly visible academics.

Were one to take that advice, given the evidence in this article, one would give Dr. Troy a wide berth.

Troy's main argument against health IT is that doctors should pay for it because they gain the benefits. This runs counter to what doctors have told me, and the best evidence is most doctors have not bought Electronic Medical Record (EMR) systems.

Troy also argues that something better may come along, thus it's wrong to buy now. He offers the example of choosing "between VHS and Betamax, at a time when we see blu-ray on the horizon." This is always the argument against buying technology, and would lead you to prefer a pen-and-paper to a Pentium.

There are some arguments to be made against including EMRs in the stimulus. The industry lacks standards, even interoperability. Those should be a prerequisite to major investments in this technology, either by government or the marketplace. But this is something that most believe can and will be fixed, with funding as the carrot.

Troy saves his sharpest attack for the idea of "comparative effectiveness," the use of data to determine the best course of treatment and deliver this information to doctors at the point of care. The Proventys system described in today's earlier item can be described as a comparative effectiveness system for cancer patients.

Comparative effectiveness, however, is not a liberal plot to control medical practice. It is a trend within medicine aimed at bringing the benefits of data to the care of patients. Knowing what works, and doing that instead of whatever you decide after scratching your backside, is simple common sense.

This column will doubtless resonate among the ideologically intense and the Ned Ludd marching and chowder society. Troy has a great future in politics and hopefully he has many losing election campaigns in his future. Personally, I much prefer to see him writing things like this than making decisions for me and my family, which he was doing until a few weeks ago.

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