The political problem for evidence based medicine
If insurers or government are to say no to any type of care, that decision must be based on facts. Debates must move toward the evidence and away from emotion.
A new study in Health Affairs gives serious pause to all reformers, because it shows patients still do not buy the premise.
"There is a fundamental disconnect between the central tenets of evidence based health care and the knowledge, values, and beliefs held by many consumers," write Kristin Carman of the American Institutes of Research and her colleagues.
If consumers, and voters, don't buy the premise of evidence, they will be easily swayed by industry front groups like the so-called Center for Medicine in the Public Interest, a drug industry front headed by PR man Peter Pitts (above, from CMPI).
Part of his job is pushing Nexavar, a Bayer cancer drug which has had scant evidence of effectiveness.
Last week Pitts again attacked Britain's decision to follow the evidence and not have NHS pay for Nexavar, saying they "needlessly condemned scores of their cancer-stricken countrymen to an early death by denying them access."
It's a compelling, emotional argument, especially for those suffering liver cancer. It also contradicts scientific evidence. For reform to have a chance someone, and some process, must have the power to say no, when a controversial treatment demands payment from a common pool.
When people trust PR men more than scientists we have a problem. It is a problem partly of science's own making, because science is not very good at PR.
Scientists tend to layer what they say in jargon, making it hard for laymen to understand the ideas behind what they say. An example is the Center for Health Value Innovation, which urges companies use preventive care to keep costs down.
There is increased evidence this works, that companies which are pro-active in managing employee health not only save money but gain employee loyalty. The approach is an outgrowth of evidence based medicine. It is based on science.
But even good science needs to be sold. It needs to be made the popular thing to do. Until it is reform will struggle.