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On the Hidden Dangers of Comparative Effectiveness

Posted on 10 April 2011 by Editor

Originally posted 2009-06-18 21:15:49. Republished by Blog Post Promoter

As part of the stimulus spending package approved by the government earlier this year, funding in the amount of $1.1 billion was included to sponsor research into comparing the relative effectiveness of one form of medical treatment to another. Such research, as the program’s sponsors and supporters argued, would over time reduce the net cost of medical services by determining which medical procedures offer the lowest cost treatment to address common ailments. Armed with such information, it was further argued, doctors and medical professionals would apply this additional economic data in their decision to prescribe specific medicines and treatments.

On the surface this would seem to make good common sense in that it would provide some stabilizing relief to the increasing costs to the government of operating the country’s medicaid, medicare and veteran benefit systems. However, some of the less known aspects of the research bring out a number of troubling issues. Among these is the inclusion of studies which add the dimension of patient characteristics (such as age, gender, lifestyle) into the formula of overall effectiveness. As a result, effectiveness is defined in terms of a cost-benefit ratio as applied to a specific type of individual. For example, a comparative value is placed on the benefit of curing an illness in an 80 year-old versus 20 year-old man.  When faced with limited resources the results of the research would then be intended to provide guidance as to how those limited resources should be applied and when to apply available cures relative to the cost and benefit that such cures would provide. In the case cited, the 80 year-old man has little chance of receiving priority consideration.

While such policy is widely accepted in many European countries, I dare say to any American pondering such gross delegation of power over life and death decisions this has to be deeply concerning. There are numerous specific opportunities to bring new efficiency and reduce the resulting costs associated with providing healthcare. National electronic medical records, individual (not employer) management of healthcare insurance subscription, tax incentives to support wellness and health awareness are all excellent examples.

The recipe is to make individuals more responsible for the management of their health and medical matters. Delegating this to a disinterested third part, especially a government bureaucracy is tantamount to relinquishing one’s freedom.

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Quotation of the Day:

“Liberty means responsibility. That is why most men dread it.”
George Bernard Shaw (1856 – 1950)
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