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Issues :: Comparative Effectiveness Issues

In Medicine, the Power of No
David Leonhardt
New York Times, 04/06/10

How can we learn to say no? The federal government is now starting to build the institutions that will try to reduce the soaring growth of health care costs. There will be a group to compare the effectiveness of different treatments, a so-called Medicare innovation center and a Medicare oversight board that can set payment rates. But all these groups will face the same basic problem. Deep down, Americans tend to believe that more care is better care. We recoil from efforts to restrict care...This try-anything-and-everything instinct is ingrained in our culture, and it has some big benefits. But it also has big downsides, including the side effects and risks that come with unnecessary treatment. Consider that a recent study found that 15,000 people were projected to die eventually from the radiation they received from CT scans given in just a single year — and that there was “significant overuse” of such scans. Read more...

'Comparative Effectiveness' Research Is Always Behind the Curve
Dr. Leonard A. Zwelling
Wall Street Journal, 03/16/10

President Obama's stimulus package included more than $1 billion for comparative effectiveness research (CER) on medical treatments. The bill claims the research is meant to identify "what works best for which patient under what circumstances." But if Mr. Obama's health-care plan becomes law, CER could be used by the government to make rationing and reimbursement decisions. And as an oncologist and molecular pharmacologist, I don't think CER can keep pace with advances in medicine. Read more...

The Impact of Comparative Effectiveness Research on Health and Health Care Spending 
 Tomas J. Philipson and Anirban Basu
American Enterprise Institute/National Bureau of Economic Research, 03/02/10

Public subsidization of technology assessments in general, and Comparative Effectiveness Research (CER) in particular, has received considerable attention as a tool to simultaneously improve patient health and lower the cost of health care. However, little conceptual and empirical understanding exists concerning the quantitative impact of public technology assessments such as CER. This paper analyses the impact of CER on health and medical care spending interpreting CER to shift the demand for some treatments at the expense of others. Read more...

A Simple Health-Care Fix Fizzles Out
Keith J. Winstein
Wall Street Journal, 02/11/10

It sounds like such a simple concept: Study different medical treatments and figure out which delivers the best results at the cheapest cost, giving patients the most effective care. Even before Congress took up the now-stalled health-care overhaul, it appropriated $1.1 billion to fund these studies. Both the Senate and the House included it in their versions of the bill. President Barack Obama backed it. Yet, an examination of one of the best-known examples of a comparative-effectiveness analysis shows how complicated such a seemingly straightforward idea can get. The study, known as "Courage" and published in the New England Journal of Medicine in 2007, shook the world of cardiology. It found that the most common heart surgery—a $15,000 procedure that unclogs arteries using a small scaffold or stent—usually yields no additional benefit when used with a cocktail of generic drugs in patients suffering from chronic chest pain. Read more...

Medicine Isn't Perfect, But Obamacare Is Less Perfect
Dr. David Gratzer, Manhattan Institute
The Washington Examiner, 11/25/09

The controversy over breast cancer screening shows the political and practical limitations of this one-size-fits-all approach: Medical organizations have difficulty in setting and agreeing upon clinical guidelines, and patients are apt to resent mandates from bureaucrats. Leaving health verdicts in the hands of centralized authorities is a sure way to keep making mistakes in a field where re-examination and reversal are an unavoidable reality. Read more...

Tempest In A C-Cup
Sally Satel, American Enterprise Institute
Forbes.com, 11/25/09

The mammography recommendation lands smack in the middle of a roiling health care debate. Bad timing: It makes the guideline look like a cynical move intended to save costs at the expense of lives. The recommendation also foreshadows fears of rationing, a queasy prospect indeed. In some circles, it fuels long-standing suspicions about the medical patriarchy. Read more...

Liberals and Mammography
The Wall Street Journal, 11/24/09

The flap over breast cancer screening has provided a fascinating insight into the political future of ObamaCare. Specifically, the political left supports such medical rationing even as it disavows that any such thing is happening.  Read more...

A Breast Cancer Preview 
The Wall Street Journal, 11/19/09  

A government panel's decision to toss out long-time guidelines for breast cancer screening is causing an uproar, and well it should. This episode is an all-too-instructive preview of the coming political decisions about cost-control and medical treatment that are at the heart of ObamaCare.  Read more...

Calm in a Cancer Storm
Kathleen Parker  
The Washington Post, 11/18/09  

Calm. That's not a word one hears much these days, but calm is what some are urging in the wake of a new federal report on breast cancer screening. Released Monday, the paper has caused a stir with its recommendation that women in their 40s don't need annual mammograms and that self-exams no longer should be part of a doctor's instructions to female patients. Instead, the report suggests, women ages 40 to 49 who are not in a high-risk group should wait until 50 to begin mammograms and then have them every other year. Read more...

Breast Cancer Follies
Robert M. Goldberg, Center for Medicine in the Public Interest
The American Spectator, 11/18/09

Think Congress is regretting having allocated over a billion dollars to let the government generate studies to tell us what medical tests and procedures should be covered under Obamacare? In the wake of the U.S. Preventive Services Task Force recommendation to tell women in their forties to take a hike on mammograms, and to suggest that other screening technologies aren't worth the money, I bet it won't be long before that budget and the agency that has it and also controls the information the Task Force uses to make such wise decisions, the Agency for Healthcare Research and Quality, are the subjects of congressional hearings.  Read more...