Steve Pearlstein is a Pulitizer Prize winning columnist for the Washington Post who writes winningly and smartly about economics and health care. He believes that Treasury can rebuild the banks and that the stimulus package can create jobs and by extension the whole shebang will rebuild the economy. Whatever. He also believes that "there is no reason we cannot set up reasonable procedures, overseen by independent health professionals, to protect patients who can demonstrate a special need for a treatment that is not normally cost-effective."
Hmm, I guess the doctor-patient relationship doesn't quite cut it for Mr. Pearlstein. Or put another way, if Mr. Pearlstein's doctor had access to 21st century tools that made medicine predictiive and prospective -- which is increasingly possible -- he would still opt for cookbook decisions rendered by researchers who are largely selected from HMO sponsored research institutions using research methods that by definition exclude the variations in treatment effect and response that his doctor can detect...or could detect if those said researchers would ever get around to evaluating the value of those 21st century tools...
Pearlstein asserts that critics of comparative effectiveness don't have "any shred of evidence that the professionals who do this research are incompetent or have any but the best intentions in trying to figure out what treatments are the most effective for patients. There is no reason to believe that once this clinical research is completed, it cannot be used in a disciplined, scientific way by physicians, economists and medical ethicists to determine whether there are drugs, tests, surgical procedures or devices that simply don't deliver enough benefit to justify their cost."
He is quick to claim that England is special and doesn't count. What about Canada, or Australia or Germany? How about Netherlands or Italy or Israel? Is there any entity that uses comparative effectiveness that does not restrict access to new technologies based on what it is worth to the institution without regard to the consumer? What about the VA which restricts access to new drugs? Or the Medicaid formularies that restrict access to cancer medicines and drugs for mental illness based on the comparative effectiveness research churned out by the Drug Effectiveness Research Project which is paid for by the Agency for Health Care Research and Quality and is conducted by HMO supported institutes? Forget about intentions. In healthcare, it's the outcomes that matter. It's not belief, it's evidence. And the best evidence is biological and mechanistic, not probability.
Pearlstein then introduces a straw man when he writies:
"But ours is an economy that is sinking under the weight of a health-care system that costs twice as much as any in the world while delivering poorer health outcomes. The cost of health care has crippled entire industries, disadvantaged our companies in international competition and brought millions of families into bankruptcy. Worst of all, in denying vital medical services to the 40 million Americans without health insurance, we engage in the most immoral kind of medical rationing imaginable -- rationing by the ability to pay. "
The reasons for our rate and intensity of health care spending has little do with medical device and drug expenditures, the smallest part of the health care budget. It is multifactorial. And the assertion that our outcomes are poorer is wrong in any event. In any event, health systems that ration have done little to control the rate of health expenditures. They merely shift spending into other categories. Ultimatley the solution to health care problems, including spending, is innovation, which comparative effectiveness is used to kill.
Pearlstein tries to slime those who criticize comparative effectiveness as political arsonists supported by drug and medical devicemakers. So be it. If those fires had been quenched decades ago where would society be. And where will it go if Pearlstein fails to fully understand the consequences of the approach being proposed the comparative effectivenesss zealots.
See his article here.
Hmm, I guess the doctor-patient relationship doesn't quite cut it for Mr. Pearlstein. Or put another way, if Mr. Pearlstein's doctor had access to 21st century tools that made medicine predictiive and prospective -- which is increasingly possible -- he would still opt for cookbook decisions rendered by researchers who are largely selected from HMO sponsored research institutions using research methods that by definition exclude the variations in treatment effect and response that his doctor can detect...or could detect if those said researchers would ever get around to evaluating the value of those 21st century tools...
Pearlstein asserts that critics of comparative effectiveness don't have "any shred of evidence that the professionals who do this research are incompetent or have any but the best intentions in trying to figure out what treatments are the most effective for patients. There is no reason to believe that once this clinical research is completed, it cannot be used in a disciplined, scientific way by physicians, economists and medical ethicists to determine whether there are drugs, tests, surgical procedures or devices that simply don't deliver enough benefit to justify their cost."
He is quick to claim that England is special and doesn't count. What about Canada, or Australia or Germany? How about Netherlands or Italy or Israel? Is there any entity that uses comparative effectiveness that does not restrict access to new technologies based on what it is worth to the institution without regard to the consumer? What about the VA which restricts access to new drugs? Or the Medicaid formularies that restrict access to cancer medicines and drugs for mental illness based on the comparative effectiveness research churned out by the Drug Effectiveness Research Project which is paid for by the Agency for Health Care Research and Quality and is conducted by HMO supported institutes? Forget about intentions. In healthcare, it's the outcomes that matter. It's not belief, it's evidence. And the best evidence is biological and mechanistic, not probability.
Pearlstein then introduces a straw man when he writies:
"But ours is an economy that is sinking under the weight of a health-care system that costs twice as much as any in the world while delivering poorer health outcomes. The cost of health care has crippled entire industries, disadvantaged our companies in international competition and brought millions of families into bankruptcy. Worst of all, in denying vital medical services to the 40 million Americans without health insurance, we engage in the most immoral kind of medical rationing imaginable -- rationing by the ability to pay. "
The reasons for our rate and intensity of health care spending has little do with medical device and drug expenditures, the smallest part of the health care budget. It is multifactorial. And the assertion that our outcomes are poorer is wrong in any event. In any event, health systems that ration have done little to control the rate of health expenditures. They merely shift spending into other categories. Ultimatley the solution to health care problems, including spending, is innovation, which comparative effectiveness is used to kill.
Pearlstein tries to slime those who criticize comparative effectiveness as political arsonists supported by drug and medical devicemakers. So be it. If those fires had been quenched decades ago where would society be. And where will it go if Pearlstein fails to fully understand the consequences of the approach being proposed the comparative effectivenesss zealots.
See his article here.
