Interesting article on the likely success of implementing a “Evidence Based” medicine system in the US.
IMO it will not happen until the entire system is on the verge of collapse and the only way I see that happening is for enough people not to have coverage be it as a result of cost, unemployment or some other reason that it motivates providers, insurers and legistlators and regulators to do something. I think that this sort of situation is some way off.
I’m thinking groups like AARP may become sworn enemies of Obama and the dems if the approach is not careful and the press well crafted. OTOH it puts pubs in alignment with big pharma, a group I think is sticking it to America and Americans in a big way. No short term winners here.
I have the tendency to disagree.
I think it all depends on how it’s presented.
We have MANY issues here.
First as stated "I make my living off of “unnecessary procedures”. I don’t think most doctors want to make their living that way but in most cases are forced to because of fear of lawsuit. This is not even a question of rationing but a question of CYA. Simple litigation restructuring makes a huge difference here.
Second I think most Americans are getting to the point of realizing that you can’t have cradle to grave 100% all the time coverage for all conditions. Most rational thinking Americans understand it makes NO sense to spend 100K to keep a cancer patient alive for another week, in many cases with a far lower “Quality of life”. In many cases the “End of life” experience could be made much better by improving the patients “Quality of life” but at a much lower cost.
I do 100% agree with the media influence and how they will seek out every instance of “Oh poor nana won’t see here grandsons graduation…” In the mean time her having that life experience could be costing literally hundreds of others access to care that would improve their lives for years. That being said the media can, and has, been used as a tool for both sides and can be done here as well. That’s part of the game in this country and a good leader will know that.
I did pull these two issues from the article which really illistrate to me why I shy away from high levels of giovernment involvment.
$1.1 billion found its way into the stimulus piñata for “comparative effectiveness” research.
NICE, with its 270-member staff and $50M budget, not only reviews whether treatments work, but explicitly analyzes cost-effectiveness (leading some drug manufacturers to cut their prices to achieve better C-E ratios and chances of NICE approval).
I realize that NICE is not doing the research, but it’s this kind of “Overbloated” budgets that will kill any cost effectiveness.
Obvioulsy NICE has a really good start here all ready, Correct? We really don’t need to recreate the wheel and could probably pull 90% of the data we need from the same data NICE is already basing it’s decisions on. We more than likely don’t need a whole lot of “Additional research” to form a committee and get started. Yet we have thrown more than 22x NICE’s annual budget at the problem.
Yes, it’s moves like this that make me say “Nope, don’t want the government running the show on this one either”
~Matt
I’m thinking groups like AARP may become sworn enemies of Obama and the dems if the approach is not careful and the press well crafted.
Yep, well crafted press is the answer.
On one side you will have “Seniors” being denied care and being “Left to die”. On the other you have to show the “Better quality of life” and the ability to enjoy those “Last days”. You do this by comparing well run “Hospice” type care with pain management and the grand kids running around to a drugged out, half comatose, chemo patient that’s constantly ill and can’t bear to be in the company of anyone.
It’s really will be a PR battle with Drug companies, Trial lawyers, Insurance companies on one side and the American People on the other.
~Matt
I do 100% agree with the media influence and how they will seek out every instance of “Oh poor nana won’t see here grandsons graduation…” In the mean time her having that life experience could be costing literally hundreds of others access to care that would improve their lives for years. That being said the media can, and has, been used as a tool for both sides and can be done here as well. That’s part of the game in this country and a good leader will know that.
You can not imply that…the converse is reationing and only us socialists ration care based on a limited resource…
As to NICE and its budget, I do not think $50m for 270 staff and the fact that it is in court defending its judgements 50 weeks / years is excessive.
As to the comparative research bit, that probably does need to be done, its an expensive gig evaluating different procedures, my issue would be less than it needs to be done (because it does) but more the fact that there is little to no means of ensuring compliance with evidence based practice…and if you cant get them to comply, why bother doing the research?
You can not imply that…the converse is reationing and only us socialists ration care based on a limited resource…
I’ve read this a couple times and am not sure what your saying.
As to NICE and its budget, I do not think $50m for 270 staff and the fact that it is in court defending its judgements 50 weeks / years is excessive.
No that was not my point at all. I think 50M a year is quite reasonable, I think 1.1B for research for something that we haven’t even started to figure out how to implement is unreasonable, particularly when we have a “Blueprint” to follow in NICE already.
My point is what cost the UK 50 million for NICE, will like end up costing the American taxpayer 500m or Billion.
**As to the comparative research bit, that probably does need to be done, its an expensive gig evaluating different procedures, my issue would be less than it needs to be done (because it does) but more the fact that there is little to no means of ensuring compliance with evidence based practice…and if you cant get them to comply, why bother doing the research? **
My point is that a good deal of the research has already been done. In fact has to have been unless NICE is basing their decisions on non existing data which would be worthless.
I’m guessing we will have to spend some money on research as new procedures, drugs etc comes out, but again I’m guessing 90% must already be covered and if it’s not what is NICE basing it’s decisions on?
Also I would think that most companies would and do most of this research themselves. They have to show that their drug or procedure is somehow better than the existing ones in order to sell their product. Every commercial I hear on TV spouts out how much better it is than their “competitor”.
For the most part as long as the panel insist that you prove the “Worthiness” of your product then the government shouldn’t have to spend dime one on research.
~Matt
I was being tounge in cheek, the point being that it is usually unacceptable to say that any form of rationing is or would be acceptable in the US system…
As to your second point, the Comparative Effectivness Research will evaluate different products / treatments / meds for the same condition and determine which is best.
NICE does not do this. Manufacturers do not do this. Manufacturers just test to see how effective their own product is. Nice simply determines whether it provides good value and quality of life outcomes.
I think there is mileage in the CER but lets face it, until you simply determine that there might be 10 ways to treat a problem but only 5 provide some value for money and good outcomes, worrying about which one is best is a bit academic.
I was being tounge in cheek, the point being that it is usually unacceptable to say that any form of rationing is or would be acceptable in the US system.
Yes there will be many “Knee jerk” reactions to that here. Too many people actually think they should be able to have whatever they want. It’s kind of ingrained in our culture at this point.
As to your second point, what I can not figure out is what they are researching…medical device manufacturers, pharma and others all get their products approved through testing.
This testing in part contributes to NICE’s evaluation.
That was kind of my point as well. We already have “FDA” and pretty much everything has to have FDA approval. In most cases I would assume this would include “Effectiveness” studies as you can’t have a drug claiming “this makes your blood pressure go down 100%” if it doesn’t do anything at all…although we do that with vitamins 
I suspect what is happening is that they are going to start again rather than take any guidance from NICE but again where the money is going one can only speculate
And if they do they are just wasting tax payer dollars. The only way that could even be partially justified is by saying that all of the studies that were previously done, I’m guessing many coming from all over the world, were done improperly, which is a load of BS.
NICE has by and large taken a converse view and said so long as the procedure is cost effective and provides go outcomes they will approve it. So NICE think there are many ways to skin a particular cat.
As it should be. Physicians need to be able to make proper decisions as well. If we have 10 procedures to deal with one condition and they all have similar ROI’s but also all have some different level of benefits depending on the situation, the doctor should decided which is best. OTOH unless the doctor can make a REALLY strong case that a procedure that is less cost effective is the only choice, that choice should not be an option.
~Matt