Health Care

How to Manufacture a Stupid Controversy

by Tim Foley

categories: Comparative Effectiveness Research, Enemies Of Reform

Published February 10, 2009 @ 03:19PM PT

Apparently, it's as easy as it ever was.  First, potentially threaten the profits of multi-million and -billion dollar manufacturers of pharmaceuticals and medical device companies.  They, in turn, spring their lobbyists on Washington and meet with Republicans who are already looking for a reason to denounce the stimulus package.  They in turn, unleash Rush and the noise machine.  Pretty soon, one of the smartest elements in the plan - comparative effectiveness research on what works and doesn't in medicine - is being demagogued as a threat to all liberty.  And all because we want to know if the wonderful toys those guys sell us actually do anything to make us healthier.

Man, those guys really like their profits.

Deep breath, folks.  We're talking about accumulating data on how effective the treatments paid for by Medicare actually are.  The stimulus benefits are pretty clear - as Jonathan Cohn puts it, "You have to hire researchers, plus support staff, to collect and analyze data; you have to purchase equipment and build infrastructure for their operations. All of that creates jobs."  The principle is also pretty clear - as my dad used to instruct me, you "measure twice, cut once" (nor surgical pun intended.)  When it comes to measuring whether the treatments we undergo make us healthier or not, we're not even measuring once.  The single biggest source of information on new drugs, less newer drugs and medical devices are the studies that are sponsored by the makers of those drugs and devices.

That's not research.  That's advertising.

However, a study by a neutral party like the National Institute of Health (intended recipient of most of the $1.1 billion for the study) will be testing the science more than the marketing sizzle.  We know there's a problem here, with a Dartmouth College study approximating at least $700 billion is spent each year on treatments that don't lead to better health.  But we don't know the specifics until we analyze the data.  If I was a responsible steward of taxpayer's money, I'd want to know what we're spending money on that doesn't work.  If I was someone like, oh, I don't, Sen. Ben Nelson, and I was making an argument that we had to make sure the stimulus package wasn't too big for the sake of fiscal responsibility, I'd also want to know if we were losing the equivalent of an entire stimulus package every year on care that doesn't make you better... and in some cases, makes you worse... and in all cases, makes the federal budget worse.

Nope.  My dreams of consistency on fiscal responsibility are dashed.  Sen. Ben Nelson led the charge in cutting that provision - a cut that drug and medical device companies are taking credit for.  Now, we're hearing all the old bogeymen in the noise machine dedicated to keeping the research out of the bill:  how this is the first in many steps leading to "rationing of care" (like me learning how many calories are in a Big Mac is the first in many steps of me forbidding everyone in my family from eating Big Macs... wait, that doesn't follow, does it?  Because even I still eat Big Macs -- just not as often); that doctors may stop prescribing "necessary" care (despite "necessary" being the exact quality the research is supposed to study).  What's next - "this is socialized research?"  There is not a doctor or patient on the planet who benefits from being denied data on the treatments they prescribe and undergo.  Who's afraid of the Big, Bad Data on Health Outcomes?  'Tis not the freedom of man that's threatened by reality - only the profits of those who have something to hide.

Let us not forget that medicine is real science.  You learn in science by collecting data and using it to test your assumptions and hypotheses.    There's hope that we've moved past the knee jerk hatred of science and expertise fostered by the previous 8 years, but clearly old habits die hard.

(Photo credit: alexeo10 on Flickr.)