Health Care Comparatively

, Daniel Allen, Leave a comment

When President Obama’s economic stimulus bill was signed into law, it included $1.1 billion for “comparative-effectiveness research,” a modest amount in comparison to the total cost of the package, but a massive allocation of resources by any other measure. In an article that appeared on National Review, Michael F. Cannon of the Cato Institute argued that this money “has nothing to do with economic growth an

d everything to do with letting government control your medical decisions.”

Comparative-effectiveness research is intended to determine which medical practices produce the best results and which either do not help, or actually harm the patient. According to Shannon Brownlee of the National Institutes of Health, “medicine is filled with uncertainty.” She noted that the Institute of Medicine estimates that only around “50 percent of what physicians do is backed up by valid evidence.”

This means that patients are receiving treatment, and paying for that treatment, believing that their doctor is administering a proven method. Only half of the time is the physician sure that he is practicing proven medicine. Policy analysis released by The Cato Institute reports, “Evidence suggests that Americans spend $700 billion annually on medical care that provides no value.”

The need, therefore, for comparative-effectiveness research is desperate. “Patients, providers and purchasers typically lack the necessary information to distinguish between high- and low-value services,” Michael Cannon explained. He considers the need for this research to be “tremendous,” and believes “this work could benefit the economy—but not if it’s done the way the Democrats propose.”

Shannon Brownlee summarized the reasons Democrats have turned to the government to provide for comparative-effectiveness research. She said, “The federal government is, in fact, really the only place to look for this kind of research. It’s a public good and the marketplace has not, and probably cannot, provide it.”

“There is another reason to look to public institutions for this kind of research, and this is the problem of bias. The other reason we need federal research is because many of the clinical studies that are being funded by the drug industry represent very poor science. They are biased by design, by conduct, by analysis and how they are written up. And many, if not most, physicians are unable to tell the difference between a good study and a bad study.”

Cannon argued in response, that one reason to oppose government funding of comparative-effectiveness research is because it “would lead to government rationing of medical care—indeed, that’s the whole idea.” Further, taxpayer dollars would be wasted systematically, as “the government is not well-positioned to reduce wasteful spending.”

Cannon continued, “If history is any guide, the more likely outcome is that the [comparative-effectiveness research] agency would be completely ineffective: political pressure from the industry will prevent the agency from conducting useful research and prevent purchasers from using such research to eliminate low-value care.”

To summarize the debate, he narrowed it down to a basic left vs. right argument. “We have on one side the left saying that the purpose of comparative-effectiveness research is not to ration care, when clearly it is. The right is saying that federally funded comparative-effectiveness research will lead to the rationing of medical care, and it won’t.”

What is the solution? Cannon concludes in his report entitled “A Better Way to Generate and Use Comparative-Effectiveness Research,” that “a better way to generate comparative-effectiveness research would be for Congress to eliminate government activities that suppress private production. Congress should let workers and Medicare enrollees control the money that purchases their health care.” The more control the government has over which methods are used and how much they cost, the less choice the individual has to determine the treatment of his or her own body.

Daniel Allen is an intern at the American Journalism Center, a training program run by Accuracy in Media and Accuracy in Academia.