Tag Archives: effectiveness

Stimulus initiative stirs up controversy

In the Los Angeles Times, Noam N. Levey reviews the controversy that broke out when President Obama included money in the stimulus plan to study what medical treatments are most “cost effective.”



As Levey writes, “Many healthcare authorities and policymakers have agreed for years that a better system for tracking how well drugs, medical devices and surgical procedures work could improve the care Americans receive and ultimately save billions of dollars.”

The fight over what Levey calls “a relatively obscure proposal” foreshadows arguments that health care reform advocates can expect to face as Obama moves forward with plans to overhaul the health care system.

“The comparative-effectiveness issue was supposed to help lay the groundwork for the broader reform effort. But it became a lightning rod for conservative commentators who labeled it a step toward socialized medicine, a line of attack that has doomed every health overhaul effort since World War II.”

Stimulus funds study of effectiveness of treatments

Robert Pear reports in The New York Times that $1.1 billion of the $787 billion federal economic stimulus package will fund research into the relative effectiveness of drugs and other forms of medical treatment.

A council of federal employees will advise President Obama and Congress on the funding of studies that proponents hope will help bring down the soaring cost of health care. Advocates say the research will be used for reference purposes, and not to mandate certain treatments.

“The money will be immediately available to the Health and Human Services Department but can be spent over several years. Some money will be used for systematic reviews of published scientific studies, and some will be used for clinical trials making head-to-head comparisons of different treatments.”

Newer technology not always more effective

Joe Rojas-Burke reported in The Oregonian on what he called “a widespread problem in the health care system: the tendency to embrace new technology without waiting for proof that it’s better than older, cheaper, time-tested solutions.”

Some examples from Rojas-Burke’s report:

  • A Duke University study found that men who received robot-assisted prostate surgery experienced about the same rate of harmful side effects as those who went under a traditional surgeon’s knife and that, furthermore, the men who received robotic surgery felt three to four times as much post-surgery regret as those who chose the traditional option, probably due to heightened expectations.
  • Two Finnish researches reported in the British Medical Journal that falling, not osteoporosis, was the greatest risk factor for bone breaks among the elderly, casting doubt on the effectiveness of scanning bone density and prescribing drugs. “By one estimate, more than 80 percent of low-impact fractures occur in those who don’t have osteoporosis, which means that bone-density tests can’t reliably predict which patients are likely to break bones,” Rojas-Burke reports.
  • He cites the use of electronic fetal heart monitoring, computer-aided mammography devices, blockbuster drugs such as Vioxx, Zelnorm and Avandia as other cases in which newer may not be better.

The Columbia Journalism Review‘s Trudy Lieberman blogged that Rojas-Burke’s findings are particularly important when considered alongside the government’s proposed stimulus package, the Senate version of which “includes $1 billion for research on the comparative effectiveness of medical treatments.”

Lieberman, president of AHCJ’s board of directors, said the proposed “bill has already sparked concern that some patients may not get expensive treatments that they or their doctors want,” and recounted the cautionary tale of the National Center for Health Care and Technology, created in 1978 with a similar purpose. Lieberman said the center met an early demise during the Reagan administration thanks to the efforts of the American Medical Association and the Health Industry Manufacturers’ Association, which “argued that the Center was redundant because doctors were the ones best equipped to evaluate new technology.”