Making comparative effectiveness partisan is malpractice

Making comparative effectiveness partisan is malpractice

Summary: America is not debating a single-payer system. America is not debating the creation of a "health technology" bureaucracy that will tell patients what medicines they can't have and what procedures they can't buy. Comparative effectiveness is a tool that tells doctors what is most likely to work, based on hard data, knowledge they can override if they are willing to defend their decision.

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If we know, through data, that one medical approach works better than another, does following science make you a Communist?

That's what the idiots at the Heritage Foundation are trying to push.

Following on the nonsense offered by "Doctor" Trevi Troy last week, the conservative "think tank" is out with a "backgrounder" from registered British nurse Helen Evans (now a Ph.D and political consultant) aimed at making people think the latest trend in medicine is straight out of Das Kapital.

It is true that comparative effectiveness leads to choices. Governments, in determining national health budgets, may use those choices to favor one treatment over another. It's also true that Europeans live just as long as we do while paying 50-67% of what we pay for health care.

But no, writes Evans. Oogalaboogalaboogala:

As is clear from the British experience and other international examples, a comparative effectiveness strategy that relies on central planning and coercion would not only be counterproductive in the long run--because it would undermine the incentives for medical innovation--but would also lead to the imposition of cost constraints that would worsen patients' medical conditions and damage the quality of their lives.

Notice what Nurse Evans has done. First, she created a straw man concerning the American health debate, then she knocked it down with some scary Euro-stories which, frankly, the citizens of that continent long ago rubbished.

America is not debating a single-payer system. America is not debating the creation of a "health technology" bureaucracy that will tell patients what medicines they can't have and what procedures they can't buy.

Comparative effectiveness (CE) is a tool that tells doctors what is most likely to work, based on hard data, knowledge they can override if they are willing to defend their decision. What CE thinks works changes as the data changes.

Rationing of care is not some Euro-bogeyman, it's what is happening right now, in America, as insurance companies deny claims, patients are denied coverage, and life spans go down despite skyrocketing costs.

Rationing is real. We can either do it rationally or irrationally. The current market system for rationing care is simple -- if you can't pay you die. The European system is more complex, and has its own problems.

All comparative effectiveness means in the U.S. is that doctors will be given the latest data with which to make choices, as will insurers. What happens next is up to them.

If the choice is between guaranteed care with data helping us make decisions, or insurers arbitrarily telling us to drop dead, I'll take the side of science, and leave both Marx and Ludd moldering in their graves.

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12 comments
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  • A Couple Comments

    "Comparative effectiveness (CE) is a tool that tells doctors what is most likely to work, based on hard data, knowledge they can override if they are willing to defend their decision. What CE thinks works changes as the data changes."

    If you doctor isn't currenty suggesting the most likely solution to your issue, you need a new doctor, not a new tool to tell him what he should already be doing.

    "It?s also true that Europeans live just as long as we do while paying 50-67% of what we pay for health care."

    Does that include the significantly higher taxes they pay?

    BTW, I'm sure the "idiots" at Heritage know quite a bit more then you could ever hope to know about this and many other topics. Name calling NEVER helps your arguement.
    smann5
    • Most doctors lack data

      As I've been writing here for months, doctors
      lack the quantitative data they need to make
      accurate diagnoses. The whole comparative
      effectiveness movement is driven by doctors
      trying to access that data, to warehouse it, and
      to pull out conclusions based on it, just as,
      say, Google does.

      Politics had nothing to do with it until the Far
      Right decided to side with Ludd.

      I have nothing but contempt for such tricks, and
      nothing but contempt for Luddism. Same with
      Communism, by the way.

      Increasingly, same with Conservativism, when it
      sides with either one of the first two.

      I have a basic problem with -isms in general, in
      that such labeling tends to stifle debate rather
      than enhance it.
      DanaBlankenhorn
    • Here are some facts

      OK, here we go. I am an American living in Europe.

      Depending on the country, the health care services are different.

      In the UK, I go to a clinic geographically close to my home, choose an
      available doctor in the clinic. Every time I go, i disburse nothing. I
      receive reasonable health care in offices I always consider to be
      unkempt because of the paperwork the Brits require. If I need a
      prescription, I get the generic equivalent and pay about $10,
      regardless of the real price of the drugs, higher or lower. All of the
      cost is paid and that is for anyone in the UK. There are no forms to
      fill out, no cards to show. The UK takes ?1200 (I think) out of my
      paycheck over the year to cover my health care. If I need
      hospitalisation, I will not have a semi-private room and if it is elective
      surgery or non-emergency surgery, it may not be done for up to 6
      months. Some heart patients are sent to Calais in France for
      treatment of non-emergency heart health care and it is covered by the
      UK.

      In France, where I pay those supposedly high taxes, my company pays
      two health care costs: One is a tax that is 5% of my income (up to
      150k Euros per year) for medical insurance that pays 65% of all the
      costs, -1 Euro for each doctor visit. My company or I pay a mutual
      insurance to cover the remaing 35% if I so choose. Drugs are covered
      at the same rate. If I have a chronic or fatal disease, 100% of the
      costs are covered by the 5% tax on my income for the rest of my life
      whether or not I work. I have a card that I give to the doctor with a
      smart chip on it and pay him 22 Euros for a visit (to a generalist).
      Specialists cost around 60 - 100 Euros. Of that 22 Euros, it is all
      redepositied into my bank account automatically except 1 Euros,
      which is essentially my cost to see the doctor in France.

      The cost of the mutual insurance runs from 30 - 60 Euros per month,
      depending on the coverage I want. There are no deductables. I am
      covered around the world, if I am hospitalised in another country
      outside Europe, the state reimburses 65% of the charges I paid.

      Basic dental service is covered in both countries, dental health care for
      children up to 18 years old is covered at 100% by both countries.

      French doctors use drugs less for many maladies but France is second
      only to the USA for anti-depression and anxiety drugs.

      In the US, you don't pay taxes for your medical insurance but I doubt a
      family of 4 could be insured at 100% of all costs for only about 6% of
      the primary earners salary.

      France is considered to have the best health care system in the world
      because of the low infant mortality rate and the longevity rate. It also
      has the highest birthrate amongst European countries.

      http://www.photius.com/rankings/healthranks.html

      The United States is ranked 37th!!!!!

      We Americans need to stop thinking that we are some super-humans
      of the world because we are a super-power. With all our
      technological expertise, we could keep health care costs quite low but
      profit margins and personalized services for the few keep the cost
      high for the many.

      I personally think the French model is the best because it forces the
      private and the public sectors to find common solutions for the
      patient and the doctor, not for just the shareholders.
      mlindl
      • Thanks for that

        I don't know what model would be best in the
        U.S., I just know the current model does not
        work anymore.

        Thanks for that long, detailed, informative
        comment.
        DanaBlankenhorn
  • We've had comparative effectiveness for a long time

    They've been called clinical studies for new drugs,
    studies that doctors or universities carry out to get
    published and the accumulation of experience.

    The last one, accumulation of experience, is a
    term I pulled out of the air, but it still exists. A
    great example is a "failed drug" called Hytrin. The
    background to this one is called BPH - or enlarged
    prostate. A young guy emptying their bladder can
    write their name in the snow. An old guy with
    BPH can also write their name in the snow - in
    Morse Code.

    When these older guys were being pulled off
    Hytrin because it didn't meet expectations for
    hypertension they became vocal because Hytrin
    was very effective in reducing the problems of
    BPH. This accumulation of experience coming
    from the older guys led to studies and lots of old
    guys getting Hytrin for BPH. It also motivated
    other companies to work on the problems of BPH.

    I think it's also important to recognize that
    Doctors don't know everything. I've had extended
    discussions with three very bright doctors on the
    treatment of obstructive sleep apneas. The odd
    think about these discussions was the fact that I
    was the one presenting the information. After 10
    years of treatment and exposure from the internet
    I had more understanding than these docs - and
    all 3 had OSA and were being treated with the
    cheapest option available from the insurance
    company. Not one of the three, however, could
    tell me when they should have their next sleep
    study.

    "a comparative effectiveness strategy that relies on
    central planning and coercion" is not medically
    oriented comparative effectiveness - it is simply
    central planning and coercion. Doesn't matter if
    we're talking medical treatment for Americans or
    the country's air traffic control system.

    "would not only be counterproductive in the long
    run?because it would undermine the incentives for
    medical innovation?but would also lead to the
    imposition of cost constraints that would worsen
    patients? medical conditions and damage the
    quality of their lives."

    Let's look at innovation: total hips were developed
    in the UK. Australia (with a fraction of our
    population) were leaders in micro-surgery as well
    as laparoscopic surgery. Treatment for sleep
    apnea (cpap) was developed by Dr. Colin Sullivan
    in Sydney while on the other side of that island
    two Docs in Perth discovered that bacteria can
    cause ulcers. That one got them the Nobel Prize.

    Taxes? Add in the state income tax that a lot of
    people in this country pay before making a
    comparison. Then add in the cost of medical
    insurance - for the average family that would be
    about $12,000. Wouldn't brag about how cheap it
    is to live in the US when you start looking at the
    hidden numbers here.
    Ken_z
    • Thanks for your great set of comments

      I really appreciate the thoughtfulness of your
      comment.

      Given my age and your comments about Hytrin, let
      me close with this.

      -.. .- -. .-

      http://ciphers.navalspooks-
      ctsandcrabs.us/theme_images/morse%20code%20alpha
      bet.jpg
      DanaBlankenhorn
      • .-.. --- .-..

        If you've broken the mid 40s barrier be sure to keep tract
        of your PSA - looking for changes. One of the emerging
        trends is the increase in prostate Dx in guys in their mid
        to late 40s.
        Ken_z
  • RE: Making comparative effectiveness partisan is malpractice

    I read this expecting to be informed. I wasn't. Still unsure what it's all about, I'm in little doubt about your character and prejudices.

    This isn't professional journalism. You've only lent credibility to the object of your scorn. Leave name-calling to school-yard tyrants, and you'll likely discourage fewer from lending your own positions more thoughtful consideration.

    And, by the way, you might be surprised to learn how many 'conservatives' wholeheartedly support 'science', and vice versa.
    Gaius_Maximus
    • Sorry you feel that way.

      I don't mind specific criticisms. Got any?
      DanaBlankenhorn
  • RE: Making comparative effectiveness partisan is malpractice

    "Comparative effectiveness (CE) is a tool that tells doctors what is most likely to work, based on hard data, knowledge they can override if they are willing to defend their decision"

    While this logic works in a vacuum, let's not pretend that this will not be tied to reimbursement and copay (or whatever payment system is used to pass costs to the patient). This leaves us with a system not all that different than what we have currently: comply or pay.
    PharmD
    • No doubt

      CE is being heavily pushed by insurance
      companies as a way to maintain quality at an
      affordable price.

      So attacking it as a slippery slope toward
      government control is, at best, disingenuous.
      "Doctor" Evans is well-known as a political
      conservative, and she made a political hit,
      working with a right-wing think tank here while
      she usually works with one in England.

      I agree with you that we should not be naive.
      But I question whether, in the end, there is any
      choice. If you want coverage at an affordable
      price, you have to create some limits. And the
      best limits are those which accord with best
      practices, with sound science, and with hard
      data.

      That should be true regardless of who pays.
      DanaBlankenhorn
  • RE: Making comparative effectiveness partisan is malpractice

    First off Dana,

    WHAT KIND OF SECOND RATE JOURNALIST ARE YOU TO START OFF NAME CALLING???

    THIS GIVES ONE GREAT INSIGHT INTO THE LACK OF INTELLIGENCE AND CLASS YOU DISPLAY!!!!

    ANY PROFESSIONAL WOULD DISCREDIT WHAT YOU HAVE TO SAY BEFORE YOU EVEN TALK ABOUT THE ISSUE......

    Now to my respone on you're opinion .....

    Yeah I want a database telling my doctor what to do with me when I am sick!!!!!!!!!!!!!!!

    ANYONE ELSE WANT A COMPUTER TELLING THEIR DOCTOR WHAT TO DO?????

    THIS COULD NOT POSSIBLY TAKE INTO ACCOUNT THE INDIVIDUAL AND THEIR UNIQUE SITUATION... BUT HEY WHAT IS AN INDIVIDUAL???? NO SUCH THING IN A LIBERAL TEXTBOOK WORLD!!!

    DID THEY FORGET TO TELL YOU THAT AT COLUMBIA OR WHEREVER YOU WENT TO COLLEGE DANA???

    JUST LIKE MARXISM, SOCIALISM AND COMMMUNISM THEMSLEF THIS STYLE OF HEALTHCARE DOES NOT FIGURE IN THE HUMAN ELEMENT, THE SPIRIT, AND SOUL..... BUT I FORGOT DC LOST IT's SOUL A LONG TIME AGO!!!APPERANTLY THE BODY SNATCHERS TOOK YOU TOO.... LOL

    NEXT UP DANA what you forget to mention is HOW EUROPE AND CANADA BENIFIT FROM THE DRUG RESEARCH HERE....

    THEY WOULD NOT ENJOY MUCH OF THE HEALTH CARE PARTICULARLY IN THE DRUG SECTOR IF OUR SYSTEM DID NOT EXIST AS IT IS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

    In this sense they live off us like parasites as we do the research we EAT THE COST AND THEY REAP THE BENIFITS!!!!!!

    WHAT HAPPENS WHEN THE US IS NOT THERE?????? IF OUR SYSTEM BECOMES LIKE THEIRS????????

    HEY DANA MOVE TO EUROPE IF IT'S SO GREAT AND DO ME A FAVOR TAKE MIKE MOORE AND YOURE INSULTS WITH YA SWEET THANG.....

    BIG AL
    electroman76