The following op-ed was published on March 26th, 2009 in the USA Today.
As a primary care doctor, I am frequently faced with decisions where the choice is not always clear. Do the latest, more expensive drugs work better than the less costly, older medications? Will ordering an MRI help me treat a patient’s lower back pain? Often, the answer to these questions is, “I’m not sure.”
Because doctors rarely are sure which treatments work best, they often prescribe the most aggressive therapy, or the newest drug or medical device, which likely will also be the most expensive.
The Obama administration is hoping the $1.1 billion for “comparative effectiveness research” in the recently approved economic stimulus package will help provide doctors data to make more informed decisions. Studies that compare drugs, medical devices and procedures should help determine what treatments benefit patients the most while cutting costs.
Cost savings foreseen
The Congressional Budget Office says that $700 billion can be saved annually by identifying the treatments that do provide the best results for patients. That is a substantial sum when you consider that health care spending totaled $2.2 trillion in 2007, and is rising at an alarming rate.
The American College of Physicians says such research “has the potential to reduce unwarranted variations in treatment among providers, increase patient accuracy in expected treatment outcomes, and provide patients with greater comfort in the treatment choice made.”
In the past when Hillary Clinton championed such studies, drug companies, medical device makers and think tanks such as the libertarian Cato Institute have expressed concerns that health care rationing and denial of certain treatments or drugs would follow. But AARP’s outgoing chief executive, Bill Novelli, has argued that these critics are using “scare tactics” because “they fear it will cut the profits they make on ineffective drugs and equipment.”
Unanswered questions
Currently, comparison research is largely conceptual, and questions remain as to who will conduct the studies, what to make of data presently available, and how new research will be applied. A 15-member panel was created to make those decisions. The new panel might use the U.S. Preventive Services Task Force as a model. Made up of primary-care clinicians, the task force is an independent, government-sponsored body that provides preventive care recommendations based on rigorous assessments of the available evidence on issues such as cancer screening and heart disease prevention. Although the task force is universally recognized as the “gold standard” in preventive service research, doctors are not bound by its recommendations.
To be sure, such studies have a number of limitations. Women and minorities are not appropriately represented in most studies. The Obama administration says its measure specifies that minorities, women and the disabled be included in future research. Also, large-scale clinical trials take years to complete, and the issue being researched could change, or become irrelevant, during the course of the study.
Finally, doctors must be willing to incorporate this new research in their daily practice. With new drugs and technologies being introduced regularly, doctors face an increasing array of diagnostic and treatment choices. We need to realize that the latest isn’t always the best, and by using data from comparative effectiveness research, physicians can provide the best care for their patients.
