Ironically after I spent last week sitting in with the Dartmouth crowd, on Friday the IOM (despite having a lack of Dartmouth folks on this committee!) came out with a recommendation for a New National Program To Evaluate Effectiveness of Health Care Products and Services and End Confusion About Which Work Best. In other words an American NICE. (Here’s the more digestible Retuers article).
All major Democratic proposals suggest such a thing, and it’s even something that I and Karen Ignagni can agree about.
"Patients deserve to know not only what medical treatments work, but which treatments work best," Karen Ignagni, president of America’s Health Insurance Plans, said in a statement. "With new treatments and technologies introduced each day, providers need a dependable and trusted source of information that provides useful guidance on treatment options available."
However, there might just be the teeniest bit of opposition out there even with AHIP’s enthusiasm (and the cynics would say because of it)….so don’t expect any one agency to have controls over exactly what care gets paid any time soon.
In cancer medicine, patients suffer through doses of expensive and potentially toxic treatments that are possibly well in excess of what they need. It would seem that pharmaceutical companies are attracted to studies looking at the maximum tolerated dose of any treatments. It is suggested by some that we make the search for minimum effective doses of these treatments one of the key goals of cancer research.
An increasing number of drug studies are developed through collaborations between academic medical centers and drug companies. In fact, pharmaceutical-industry investment in research exceeds the entire operating budget of the NIH. It is important to understand the influence that industry involvement may have on the nature and direction of cancer research. Studies backed by pharmaceutical companies were significantly more likely to report positive results.
Over the past couple of years, if you watched TV with any regularity, it would have been difficult to miss the direct to consumer advertising that touted the benefits of some drugs over others, especially for patients undergoing treatment for cancer. Even to the point that buses covered with “shrink wrapped” advertising being strategically placed outside major cancer centers for patients and their families to see (EPO anyone?).
Drugmakers are going directly to the consumer at a time when their products are indeed at the margins of evidence-based medicine. On one hand, pharmaceuticals advertise extensively and the advertising is manipulative in the extreme. On the other hand, even NCI-designated cancer centers do this sort of direct to consumer, hard sell advertising. And in cancer medicine, the media advertising is no more misleading than the one-on-one communication which often goes on between a chemotherapy candidate and an oncologist.
More must be spent on analyzing drug data, and the need for larger and more detailed studies to figure out why there is an association between pharmaceutical involvement and positive results.
So much of our health care system today is backed by pharmaceutical companies. I worked in a pharmaceutical company for a few months and doctors were booked almost 6 months out for lunch appointments with pharmaceutical companies. It’s revolting and definitely needs change.
The idea of a “NICE” type organization is one of the few health policy ideas that could garner support from elements of both parties. However, the issue is how this organization possibly gets funded, who oversees it, and what kind of regulatory authority (if any) it gets.
Funding though is the real big issue since you are talking about $250-$300M annually and this would be nearly 3x the amount of the current Congressional funding for AHRQ. Would this new organization cannibalize AHRQ funding or other funding for healthcare research purposes? More importantly, where is this huge new infusion of money going to come from considering that Medicare physician payments face a huge shortfall and Congress seems unwilling to cut back on Medicare Advantage plans?
My bet – If this is going to happen though, it will happen right after the next president is inaugurated and only if a Democrat is in the White House. If the next president waits, this idea will probably be relegated to the list of various health care reforms.
AHRQ – or whoever – will need some SERIOUS political cover to do this kind of work. Last time AHRQ brought to light the fact that spinal fusion and other invasive procedures were being overused in US, the forces for “healthcare transformation” (i.e. Newt Gingrich and Co) nearly had the agency disbanded on behalf of their benefactors (i.e. spinal surgeons).
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