Stanley Feld M.D.,FACP,MACE
Medicare and Medicaid (run by the states) are both on the brink of bankrupting the country. The present path is unsustainable.
It would be prudent to repair both programs by innovations that would render these societal entitlements sustainable. In order to fix the system the government should focus on solving the causes of the largest costs to the healthcare system (go where the money is).
The money is in preventing the onset of chronic diseases and its complications. Eighty percent of the healthcare dollars are spent on treating the complications of chronic diseases.
The complexity of President Obama’s “economic stimulus bill” for healthcare is going to lead to increased government spending and increased control over physicians’ medical judgment. It will be a deterrent to innovative research and thinking.
“Congress will provide 1.1 billion dollars for clinical research to the federal government to compare the effectiveness of different treatments (drugs, medical devices, surgery and other ways of treating specific conditions) for the same illness.”
A new government body will supervise head to head clinical studies. The clinical studies will test the difference between medication, procedures and other treatments for specific diseases. The government will then decide on the best treatment for each disease.
The stimulus package creates another bureaucracy that could add a level of inflexibility to the delivery of effective medical care. The government’s goal is noble. It wants to increase uniformity of care at the lowest cost of care. This could lead to rationing of healthcare and elimination of patient choice.
It is obvious to me that it will not stimulate new innovative medical science. It could also drive physicians away from treating patients in government programs.
President Obama should be investing in research that promotes the development of more effective medical and surgical treatments for various diseases. They should not be comparing old treatments to decide on which are better. Physicians should be allowed to exercise medical judgment. Physicians should be given incentives to choose the most cost efficient therapy and not restrict their intellectual property. Presently incentives promote the least cost efficient therapy.
Government regulated and supported research has already judged the therapeutic safety of medication and procedures in a limited and artificial way. President Obama’s healthcare team should learn from the experience in other countries before wasting this money.
“Britain, France and other countries have bodies that assess health technologies and compare the effectiveness, and sometimes the cost, of different treatments.”
“Comparative effectiveness is a useful tool in the tool kit, but it’s not the answer to anything,” Andrew Witty, the CEO of GlaxoSmithKline said in an interview. “Other countries have fallen in love with the concept, then spent years figuring out how on earth to make it work to save money.”
Mr. Witty is the CEO of a stakeholder company that is threatened by President Obama’s initiative. His comments can easily be dismissed by clinical researchers because the comment threatens their vested interest. However it is a common sense comment.
Federal government officials can see this as a way to control costs. However not one has looked at its practical effect in countries that have used this approach. It certainly would restrict access to care.
For many years, the government has regulated drugs and devices and supported biomedical research, but the goal was usually to establish if a particular treatment was safe and effective, not if it was better than the alternatives.
The money for healthcare research should focus on medical and financial outcomes in real time in the real world. Most clinical research studies are short term (1 year to 3 years) with limited follow-up evaluations and no long term financial outcome comparisons. Some clinical research studies are poorly designed and the conclusions can be detrimental to good medical care.
A non surgical approach can be as effective as a surgical approach short term. Long term the patient might need a surgical approach. This is what a physician’s clinical judgment is about. The data that will be captured by this new agency using comparison clinical research protocols is limited and can yield poor conclusions.
An example of a disastrous clinical trial is the Women’s Health Initiative. Both the protocol and the statistical analysis were defective. I believe that the defects in the study will lead to more female morbidity and great healthcare cost in the future.
I believe the “clinical research” is going to result in confusion, senseless debates and inaccurate conclusions.
The government will find the incidence of chronic disease has because obesity and environmental pollution has increased.
The complications of chronic disease absorb 80% of the healthcare dollars. These are the areas government ought to be spending money to inspire innovative thinking.
The $1.1 billion dollars can go a long way toward controlling chronic disease.
The cost of head to head comparisons makes this endeavor a meaningless waste of money. I was hoping the new administration would have the curiosity and common sense to repair the healthcare system correctly.