Does Peter Orzag have a new gold standard for comparative effectiveness: comparing established treatments like antidepressants to placebos and finding placebos just as effective....
http://www.cbo.gov/doc.cfm?index=9887
Let's take a step back.
In his powerpoint presentation Orszag has a slide stating:
"As we seek to improve the efficiency of the health sector, let’s learn some lessons from economics."
He shows some slides that automatic enrollment in 401Ks leads to higher participation in 401k plans than when it's voluntary. As if that's an earth shattering discovery.
Then a slide purporting to show that the placebo effect is almost as strong as antidepressants, angina pectoris treatment, knee surgery and exercise.
Then a slide showing that once a day dosing and frequent doctor-patient interventions increase compliance with medication regimens
What are we to derive from this?
I think Orszag is trying to underscore the importance of psychological and behavioral differences in determining responses to treatment, not that placebos are better.
That is, individual responses have to be taken into account to maximize value and improve outcomes. Establishing who is risk averse and why is part of this process. So too is genetic response to medicine. All are important.
That is, measuring the personal is critical to comparative effectiveness. Finding ways to promote patient-centered care is crucial. More to the point, perhaps Orszag is seeking to drive comparative effectiveness towards value-based medicine based on personalized health care information which in turn is generated by a critical path for comparative effectiveness.
Thank you Dr. Orszag.
http://www.cbo.gov/doc.cfm?index=9887
Let's take a step back.
In his powerpoint presentation Orszag has a slide stating:
"As we seek to improve the efficiency of the health sector, let’s learn some lessons from economics."
He shows some slides that automatic enrollment in 401Ks leads to higher participation in 401k plans than when it's voluntary. As if that's an earth shattering discovery.
Then a slide purporting to show that the placebo effect is almost as strong as antidepressants, angina pectoris treatment, knee surgery and exercise.
Then a slide showing that once a day dosing and frequent doctor-patient interventions increase compliance with medication regimens
What are we to derive from this?
I think Orszag is trying to underscore the importance of psychological and behavioral differences in determining responses to treatment, not that placebos are better.
That is, individual responses have to be taken into account to maximize value and improve outcomes. Establishing who is risk averse and why is part of this process. So too is genetic response to medicine. All are important.
That is, measuring the personal is critical to comparative effectiveness. Finding ways to promote patient-centered care is crucial. More to the point, perhaps Orszag is seeking to drive comparative effectiveness towards value-based medicine based on personalized health care information which in turn is generated by a critical path for comparative effectiveness.
Thank you Dr. Orszag.
