Rationing Away Bad Medicine
By Chris Martin on February 16, 2009 at 6:43 PM in Current Affairs
Let’s imagine the following scenario. You are trying to put together a puzzle that has the identity of a killer, but you have no idea what that killer looks like. OK, with enough work you can fit the puzzle together to figure out what the killer looks like. But imagine you didn’t have all the pieces in front of you, they are scattered in locations around the country. Unfortunately, though you know the possible locations where the puzzle pieces may be, you have no idea which of those locations actually contain the pieces you need.
This is what its like for many clinical researchers trying to evaluate the effectiveness of various medical treatments (certain drugs, for example). Scattered throughout the country, in hospitals and doctor’s offices, are patients undergoing various treatments with varying levels of success.
If you are trying to evaluate the effectiveness of an individual treatment, you’d have to go to each and every hospital and doctors office to obtain the information you need. You may spend most of your time at locations where the treatment you are interested in is not being prescribed.
How many people want their doctors to be privy to as much information regarding your condition as possible? How many want doctors and clinical researchers to spend years instead of weeks to learn about potentially life saving or career threatening treatments?
If you are against helping doctors better treat and cure their patients, then you should be against the health care informational technology (HCIT) provisions in the bill. If you want to save lives and help doctors make better, more informed decisions than you should be for the HCIT provisions in the bill.
Seeing some of the criticisms of the HCIT provisions coming from congresspeople and so-called “think tank” people makes me wonder if they are just that ignorant of how doctors do their job or if they are being deliberately disingenuous. Doctors rely on having information on the latest treatment options, they don’t pull it out of their . . . hats. Would anyone trust a doctor who knowingly prescribes treatments that everyone knows won’t work? What about a doctor who knowingly refuses to ignore information that could help save their patients’ lives. The HCIT provisions in the bill will provide doctors with the information they need to help their patients. Period.
One criticism I hear is that HCIT hasn’t been debated and that is merely a partisan issue. Well, that is not true at all. One of the first classes I took in graduate school was a class on medical informatics and can say that this is not a new field at all. For decades, informatics researchers have been trying to perfect the use of computational power in helping doctors make better, more informed decisions. Over those decades, researchers have gotten better and better at it. The benefits of electronic medical records has been so thoroughly debated that it is hardly a partisan issue amongst the more critical thinkers. Even former Republican House Speaker Newt Gingrich has been talking about this for years, even setting up his own organization. Lest there be some who still question the partisan nature of the HCIT provisions, this comes from a press release by Newt’s organization:
The proposed stimulus package generally addresses these issues in a positive way. Innovative organizations across the country are already driving and delivering evidence-based medicine that delivers better, safer care for patients.In the Senate proposal, the Federal Coordinating Council for Comparative Clinical Effectiveness Research (CER), a board which will advise Congress and the President on strategies regarding the infrastructure needs for comparative effectiveness research within the federal government will be established. While this board will help coordinate among the federal agencies, The Center believes the private sector must be represented to ensure an informed and innovative initiative.
With the right balance from the public and private sectors, this body could learn from the best of the private sector and recommend ways for other institutions to ultimately adopt best practices.
While fears are justified that this kind of research could indeed be a slippery slope to ultimately rationing care, that argument is not currently justifiable in the specific language of the bill.
That is from the former Republican partisan House Speaker’s own organization. (My highlight.) Given that, it is hard to justify this being purely partisan motivated and efforts by politicians and pundits (including think tankers) to make it so is dishonest.
Another criticism is that this does not belong in a stimulus bill. Well, if creating jobs is bad, then it shouldn’t be. But if creating jobs is what you think should belong in a stimulus bill, than the HCIT provisions should be in there. As some have pointed out, these provisions could lead to around two hundred thousand jobs. Further, in a couple years time it is possible that many ineffective treatments will be thrown out of the process to make way for stuff that actually works. This puts money in the hands of patients to buy products to help stimulate the economy.
I normally avoid strong statements either way in my posts here, but when even Newt Gingrich’s organization says that some of the loudest criticisms are unjustified, well I feel that it is justifiable for me to also say that the majority of the criticisms on the HCIT provisions are unjustified.
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