What starts out as an interesting article about the role physicians and patients play in healthcare reform also turns up a troubling issue: GroupThink.
“Ultimately, for any reform to work, patients will have to change their behavior. Of course, everyone should continue to demand the best possible care. But we will have to accept that “best” doesn’t always mean the newest drug or the latest treatment. The looming question is whether patients are ready to embrace the realities of reform.”
Good point.
She then goes on to discuss various doctor/patient issues relative to healthcare reform, specifically comparative effectiveness. Ms. Parker-Pope writes:
“At the heart of reform is a plan to cut costs, in part by trying to discern which treatments really work. President Obama’s economic stimulus plan includes $1.1 billion for studies that will ask basic questions about the comparative effectiveness of expensive procedures versus less expensive ones. For instance, with certain kinds of injuries, does surgery work better than physical therapy? Are costly new drugs any more effective than their generic predecessors?”
Good questions.
And then she falls into the trap of how comparative effectiveness is “proven.” She writes:
“But when it comes to comparative effectiveness, the track record of the American public and their doctors is not encouraging. Even when such comparisons are available, we tend to ignore them. In 2002, for example, one of the largest government-financed clinical trials ever found that generic pills for high blood pressure worked better than newer drugs that were up to 20 times as expensive. But most hypertension patients still use costlier drugs marketed by pharmaceutical companies.”
Oops.
She refers to the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) study. And what she says is says isn’t so cut-and-dried. In fact, it's wrong and misleading.
Here’s what Michael Weber, MD -- one of the original ALLHAT investigators (and Chairman of the Center for Medicine in the Public Interest) recently said:
“Using ALLHAT as an example of an “evidence gap” could be misleading, for the issue is not the information produced by ALLHAT, but rather how it’s interpreted and used.
Most experts, myself included, have concluded that diuretics are highly useful drugs in treating hypertension, and may even be underutilized. But there is no convincing evidence that they are superior to other drug classes.
Admittedly, diuretics are cheap to acquire, though not necessarily cheap to use. Because they cause unwanted changes in such factors as potassium, glucose (which can lead to diabetes) and uric acid (which can lead to gout), the additional costs of extra laboratory tests, follow-up doctor visits and corrective therapies must be reckoned in.
In fact, the British National Health Service, which is guided in drug selections by its highly cost-sensitive National Institute of Clinical Excellence, favors amlodipine (one of the diuretic’s competitors in ALLHAT) as the usual starting therapy for hypertension. This recommendation is based on the ASCOT study that found that a beta-blocker/diuretic combination (a favored treatment in ALLHAT) was significantly less effective than a combination of newer drugs in reducing fatal and non-fatal cardiovascular events and strokes.
Another powerful study, ACCOMPLISH, was recently presented at the scientific sessions of the American College of Cardiology and is expected to be published before year’s end. This much discussed trial has also indicated that diuretics -- valuable as they are -- may not be as effective in prolonging life and preventing heart attacks as other choices.
So the claim of an evidence gap is not based on a disregard of evidence, but in fact demonstrates that the opposite is true. Clinicians apparently are aware of the full spectrum of evidence, not just selected portions promoted by a government agency. From the perspective of patients with hypertension, this surely is good news.”
Reporters need to be careful about the claims they make – just like drug companies.
Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.
