A Test of Bad Health
By PETER PITTS
IF Congress overrides President Bushâ€™s veto of the State Childrenâ€™s Health Insurance Program, a little-known provision of the original House bill could be revived.
As written, the provision would allocate $300 million to create a Center for Comparative Effectiveness that would test whether newer, more expensive drugs work better than their older and cheaper counterparts. Medicare would use the centerâ€™s findings to help decide which drugs to cover. If the center found that a newer, pricier pill was no more effective than the older, cheaper version, Medicare would probably refuse to pay for it.
This sounds reasonable. But it will most likely result in Medicare covering fewer breakthrough medicines, which would, in turn, force doctors to prescribe only the drugs that Medicare will pay for â€” not the ones that are best for the patient.
Why? Drugs must be tested on large, representative populations that must be monitored for years. Because conducting these studies is so tricky, their findings are regularly overturned or modified by further research. In fact, some are so off the mark that doctors ignore them.
But if Medicare starts using flawed studies like these to determine its list of covered drugs, doctors will have to give them respect they probably donâ€™t deserve. Thereâ€™s also an inherent conflict of interest when the government conducts comparative-effectiveness studies and then uses those studies to determine which pills are worth buying. The more drugs the government classifies as â€œwasteful,â€ the more money it saves.
Look what happened in Britain. In 2001, contrary to expert findings by licensing authorities around the world, the British comparative-effectiveness agency cited â€œinsufficient evidenceâ€ for recommending the use of Gleevec in both early- and late-phase chronic leukemia patients.
In 2002, the United States approved Gleevec for another purpose: to treat a rare stomach cancer. It wasnâ€™t until 21 months later that Britain approved the use of Gleevec for victims of the disease.
What aside from cost concerns could explain such restrictions? And what could stop something like this from happening here? The centerâ€™s supporters say it will be financed through an independent â€œtrust fund.â€ But this wonâ€™t solve the problem. The center would still be part of the government â€” and still get in the way of medical innovation.