What you don’t know can hurt you

WHAT YOU DON’T KNOW CAN HURT YOU…. The Wall Street Journal reported today, “The drug and medical-device industries are mobilizing to gut a provision in the stimulus bill that would spend $1.1 billion on research comparing medical treatments, portraying it as the first step to government rationing.”

Now, you may read this and wonder what’s so bad about research comparing the efficacy of medical treatments. Paul Krugman, who called the push to gut the provision “truly vile” and “really unbelievable,” added, “Because freedom is all about laying out vast sums on medical treatments without knowing whether they’re actually doing any good.”

But let’s go a little further, because the $1.1 billion for comparative medical research has been an issue for a while. In fact, just last week, the Senate “centrists” specifically targeted this provision for elimination.

As Harold Pollack explained very well a few days ago, this issue should be a no-brainer.

Comparative medical research is a high priority by any conceivable measure. Candidate Obama and Candidate McCain both advocated major investments here to improve the quality and cost-effectiveness of care, and they were right. An astonishing proportion of American medical care has never been rigorously evaluated, or outright fails to meet reasonable thresholds of quality and cost-effectiveness.

As Ezekiel Emanuel put it in his book Healthcare, Guaranteed: “The United States spends over $2 trillion on healthcare, about $200 billion on prescription drugs, and nearly $100 billion on medical research and development, but only a paltry $1 billion to evaluate the comparative costs and effectiveness of medical interventions and their influence on health outcomes.”

The two most responsible funding agencies for this research — the National Institutes of Health and Agency for Healthcare Research and Quality — are now getting many more high-quality proposals than they are able to fund. Their peer-review process is rigorous and highly competitive, sometimes excessively so. Many of my junior colleagues are suffering professional setbacks because they cannot find funding for excellent research that would have been supported five or ten years ago. Incidentally, both the loudest and the most dangerously silent opponents of comparative medical research have been surgical subspecialties, medical device manufacturers, and pharmaceutical companies afraid that their ox might be gored.

That the drug and medical-device industries hope to “gut the provision” is crazy.

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