Tag Archives: comparative effectiveness

Why Can’t Medicine Make Up Its Mind?

The Problem:

[It] seems like an endless series of contradictory health findings. First they tell us a medication is safe, then they say it’s not. First they say women should get screened for mammograms at 40, then not. And so on to what vitamins we should take, what foods we should eat, and even how many glasses of water we should drink.

Thomas Goetz’s take:

As frustrating as these shifts can be in isolation, taken together they reflect an effective system. Every revision and new recommendation is an attempt to put forward the best available information.

My take:

This is all the more reason not to lock people into cookbook guides that rely on 5-year-old data.

(Hint: Like comparative effectiveness is likely to do.)

Comparative Effectiveness Research, Change Your Memories, and the Supersized Meal at the Last Supper

Is it possible to permanently change your memories? Maybe.

How much was consumed at the Last Supper? The food in famous paintings of the meal has grown by biblical proportions over the last millennium.

Canadian man faces either bankruptcy or death. After he went to the Mayo Clinic for surgery, the Alberta Cancer Board refused to pay for doses of the anti-tumor drug Avastin. (Hat tip to Linda Gorman.)

How Comparative Effectiveness Works in Britain

A new report from the Rarer Cancers Forum suggests that 16,000 people in the United Kingdom have been denied cancer drugs by Great Britain’s government-controlled National Health Service (NHS). Key findings:

  • Although progress has been made in gaining access to treatment, with 8,750 more patients being given vital treatment, 16,000 have still been denied access to treatments that they may need.
  • The National Institute for Health and Clinical Excellence (NICE) needs to improve drug assessment time periods — with the Institute taking 21 months to appraise new cancer drugs, rather than the 6 months promised by ministers.

Additional findings:

  • 36 percent of patients cannot find their Primary Care Trusts (PCT’s) cancer procedures and policies on PCT Websites.
  • 49 percent of patients were unclear about how quickly they would hear a decision on a request for treatment.

All in a Day’s Work

The House Ways and Means Committee, marking up the Health bill:

  • Rejected 25-15 an amendment from Rep. Paul Ryan (R-Wis.) that would have eliminated the public plan option;
  • Rejected 22-19 amendment from Rep. Charles Boustany (R-La.) that would have prevented providers from being forced to participate in the public plan;
  • Rejected 21-18 an amendment from Rep. Dean Heller (R-Nev.) that would have required members of Congress and their dependents to enroll in the public plan option;
  • Rejected 21-19 an amendment from Rep. Peter Roskam (R-Ill.) that would have based payment rates on the private market, rather than on Medicare;
  • Rejected 26-15 an amendment by Rep. Wally Herger (R-Calif.) that would have prevented comparative effectiveness research from being used to deny care based on cost.

Cookbook Medicine Coming Soon

A committee convened by the Institute of Medicine just released a list of its 100 top priorities for the new Comparative Effectiveness Research board. The move is ultimately designed to replace physician discretion with protocols that have been vetted through a research board. Committee co-chair Harold C. Sox said… “Health care decisions too often are a matter of guesswork because we lack good evidence to inform them.”

Let Private Compete with Public Insurance

Supporters of the public option, a government run health insurance plan to compete with private insurers, say that it will make everyone better off by forcing private firms to provide health insurance for less. But if that is the case, why not allow already existing public plan options to compete with the private sector?

Give people in Medicare, state Medicaid plans, the Veterans Administration, and state SCHIP plans the choice of staying in the government run program or taking an equivalent voucher for the purchase of private health insurance and private medical care, perhaps with a health savings account option for any leftover funds. Continue reading Let Private Compete with Public Insurance

Comparative Effectiveness Abroad

We have previously warned about this here, here and here. This is Virginia Postrel. Full article is worth reading.

  • Private infusion clinics have been springing up all over Canada, offering cancer drugs to patients who either can pay themselves or have private health insurance, usually through an employer, that will cover the cost.
  • In the U.K., some regional authorities threatened to exclude patients from all NHS coverage if they pay private providers for pricey cancer drugs.
  • Until July 2007, New Zealand wouldn’t fund the anticancer drug Herceptin for early-stage breast cancer…. To pay for treatments, women who could do so have mortgaged their homes, dipped into their retirement savings and held fundraisers among their neighbors. Many have cut their treatments short to save money.