Would Comparative Effectiveness Reduce Patients’ Options?
This month, lawmakers such as Senator Kent Conrad (D-ND) and Senator Edward Kennedy (D-MA) have introduced a flurry of healthcare-reform bills that provide for comparative-effectiveness (CE) research. Supporters of CE research say that it could cut unnecessary costs by identifying the treatments that produce the best results. Federal and state governments’ share of the national healthcare bill could consequently be lighter, yet critics fear that promoting CE research could give the government too much power over treatment.
In a press statement, Senator Jon Kyl (R-AZ) said that the economic stimulus bill, which allocated $1.1 billion for CE research, could allow the government to micromanage medicine and use CE research to ration healthcare. He introduced the Preserving Access to Targeted, Individualized, and Effective New Treatments and Services Act of 2009, which would bar the federal government from denying insurance coverage of a treatment based on its cost.
House Democrats introduced a discussion draft on Friday that could allay fears of healthcare rationing. The draft would establish a Center for Comparative Effectiveness Research and also an independent Comparative Effectiveness Research Commission, which would oversee the Center.
The Commission would include representatives of consumers, physicians, insurance companies, clinical researchers, and payers. The draft states that the Center would have to “develop rigorous scientific methodologies for conducting comparative effectiveness studies” and that “all aspects of the prioritization of research, conduct of the research, and development of conclusions based on the research shall be transparent to all stakeholders.”
I think the Democrats’ discussion draft would ensure that CE research wouldn’t let the government “dictate treatment,” in Senator Kyl’s words. Sharing the results of CE research would likely improve the quality of healthcare and make consumers’ and patients’ lives easier. To my mind, CE research would provide benefits too great to be dismissed. The discussion draft shows how it could preserve doctors’ and patients’ rights to exercise their own discretion.
Comparative-effectiveness criteria will lead to a one-size-fits-all approach in any government scheme.
You have symptoms A, B, and Q, plus signs B, N, and Z. In addition, you are Z years old: therefore you will receive Treatment L.
Individualizing treatment will be considered “too expensive” as a cost-cutting tool. The American public will never accept such mechanical health care.
Hi, Jack. Thanks for your comment. The idea that comparative-effectiveness research (CER) will lead to medical decisions that ignore differences between individual patients is commonly held. The government seems to have a procedure in place to take such concerns into consideration.
The Federal Coordinating Council for Comparative Effectiveness Research was created to help federal agencies coordinate CER. The Council held three listening sessions to obtain public comment before it makes its report and recommendations to Congress on June 30, 2009.
In the course of the listening sessions, attendees made the following comments:
“CER must account for the individual nature of patient characteristics, including their specific preferences and personal values.”
“CER must develop the ability to account for both the important individual differences in physiology and risk faced by patients making decisions about their care and for individual patient preferences.”
See http://www.hhs.gov/recovery/programs/cer/summary_june10.html
for other comments.
I believe that these comments will be included in the Council’s report and will guide the way CER is conducted.
Erik