As featured on p. 218 of "Bloggers on the Bus," under the name "a MyDD blogger."

Tuesday, May 12, 2009

Anti-Effectiveness Conservatives

Here we go again with conservatives trying to deep-six comparative effectiveness research in medical treatments, throwing up all kinds of horror stories about "Federal Health Boards" that would dictate to people what they can and cannot receive from their doctor. First of all, if we had to pay for the time and effort to manage 300 million individual health care treatment outcomes, we would need more money than exists in the entire world. Second of all, it's completely bogus, as Ezra Klein explains wearily.

The apparent fear here is that the evidence from comparative effectiveness will be, well, used to make treatment decisions. But that can't be quite right. We use evidence all the time. Your insurer won't pay for a leg amputation when your symptom is a headache. Medicare doesn't cover a wheelchair if you're diagnosed with acute constipation. No one whines about that.

The fear, rather, is that the existence of more evidence will somehow qualitative change the way government uses evidence. The government will decree, in other words, that their testing shows back surgery ineffective, and back surgery is now illegal. Put slightly differently:

Step 1: Comparative effectiveness review.
Step 2: ????
Step 3: Authoritarian medical system

It's sort of what would happen if you applied The Road to Serfdom to the comparative effectiveness debate.

The industry's fear is quite different: This is the profit objection. Right now, most research on, say, drug effectiveness is funded by the pharmaceutical industry. That presents obvious advantages for them and problems for us. The concern here is that if they cease controlling the flow of evidence, then new studies will show that certain treatments don't work. For instance: Claritin goes off patent. Generic versions emerge. They're very cheap. Claritin's manufacturer changes the chemical composition slightly and comes up with Clarinex. They apply for a new patent. They sell it at a heavy mark-up. But it probably doesn't work much better. If there's credible evidence out there showing that it doesn't work much better, that's the end of that business strategy.

Business interests are using the ideological objection to scare people into advocating against comparative effectiveness research, so they can maintain their profit motive. I would imagine that the drug industry could care less if we were in a single payer health care system, as long as they got their drug monopolies and increased their profits. They only use the ideological objection to their own ends.

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