U.S. to Compare Medical Treatments
Dr. Elliott S. Fisher of Dartmouth Medical School said the federal effort would help researchers try to answer questions like these:
Is it better to treat severe neck pain with surgery or a combination of physical therapy, exercise and medications? What is the best combination of “talk therapy” and prescription drugs to treat mild depression?
How do drugs and “watchful waiting” compare with surgery as a treatment for leg pain that results from blockage of the arteries in the lower legs? Is it better to treat chronic heart failure by medications alone or by drugs and home monitoring of a patient’s blood pressure and weight?
For nearly a decade, economists and health policy experts have been debating the merits of research that directly tackles such questions. Britain, France and other countries have bodies that assess health technologies and compare the effectiveness, and sometimes the cost, of different treatments.
Now, I understand the arguments that this project really did not fit the implied definition of the stimulus bill. You could easily call this a Christmas tree ornament. That concern has legitimacy.
I would argue that this funding is long overdue. If we are to practice the highest quality medicine, we need the highest quality data. We must ask the difficult questions.
Not everyone believes as I do.
Representative Charles Boustany Jr., a Louisiana Republican who is a heart surgeon, said he worried that “federal bureaucrats will misuse this research to ration care, to deny life-saving treatments to seniors and disabled people.”
The House Appropriations Committee inadvertently stoked such concerns in a report accompanying its version of the economic recovery bill. It said that research comparing different treatments could “yield significant payoffs” because less effective, more expensive treatments “will no longer be prescribed.”
Medicine will always have debates on treatment and diagnosis. Humans are too complex to have research give precise answers. As a physician, I believe that I need the most data possible to make intelligent and financially prudent decisions. We cannot get such data unless we have a centralized process. Industry will never do such studies. No foundations have supported such expensive research.
The real problem with CER is that it declares winners and losers. Those who might be losers are already screaming.
