CER Kills?

According to the Pacific Research Institute recently, because of “Comparative Effectiveness Research” (CER) “under conservative assumptions, R&D investment in new and improved pharmaceuticals and devices and equipment would be reduced by about $10 billion per year over the period 2014 through 2025, or about 10-12 percent. This reduction in the advance of medical technology would impose an expected loss of about 5 million life-years annually, with a conservative economic value of $500 billion, an amount substantially greater than the entire U.S. market for pharmaceuticals and devices and equipment.” [Study available here.]

I haven’t read the study. I don’t need to, since it is so obviously true, if we just make certain assumptions, such as:

  • Every dime spent on R&D for drugs and devices is wisely spent, on advances that will save and improve lives.
  • Every dime spent on finding out whether those drugs and devices actually work as advertised, and don’t actually kill people, and do it better or cheaper than other drugs and devices, is a dime wasted. CER just slows down legitimate, helpful research.
  • Experience does not show us any examples of wasteful or unnecessary drugs or devices. Those multiple peer-reviewed research papers showing that we waste hundreds of billions of dollars every year on useless complex back surgeries, the 22% of  implanted defibrillators that are unnecessary, tens of millions of unnecessary scans, coronary stents put in people with stable heart disease and no heart pain, the heartburn surgeries that work no better than over-the-counter drugs—those studies are all false, wrong, some kind of mumbo-jumbo that we can safely ignore.

If we just make those few simple assumptions, the study has a valid point. If we don’t accept those assumptions, we have to wonder about the mental state, motivations, and personal finances of someone who would cook up such an obvious bit of flim-flam.

Joe is a healthcare speaker, writer, and consultant, working with clients ranging from the WHO, the Global Business Network, and the U.K. NHS, to the majority of state hospital associations. Joe writes at imaginewhatif.

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7 replies »

  1. One other minor assumption:

    That Pacific Research Institute is an objective, substantive, credible, and unbiased research and public policy organization.

  2. So if I understand this author correctly, his premise is that all pharmaceuticals and devices are good and all attempts to determine if they are actually good, is bad.

    People actually listen to this guy?

  3. ‘Pacific Research Institute’ – The hillbilly, poor libertarian bumpkin cousin of Cato or AEI?

  4. The author’s closing assertion (returning to where he began, verbatim):

    ‘…a “bottom up” approach of experimentation by many millions of practitioners and patients would be a more fruitful vehicle for the acquisition of information about the comparative effectiveness of alternative clinical approaches.’

    The final sentence in the paper. Permit me to ask: the aggregate “study designs” and scientifically administrative coordination of all these ad hoc, silo’ed n=1 experiments will be accomplished precisely how and by whom?

    Simply “Let a Million Clinical Thomas Edisons Bloom”?

  5. OK, I’ve been closely through the entire “study” with yellow highlighter and red pen for underlining and margin notes. It could have been done as a short Powerpoint deck of the usual [1] “ell ’em what you’re gonna tell ’em, [2] tell ’em, [3] and finish by telling them what you told them” format.

    In sum:

    – Government BAD;
    -unfettered for-profit markets GOOD.

    Y’see we can’t trust “the government” to produce unbiased scientific CER findings owing to their imperative to cut costs — inexorably at the expense of patients’ interests and market “innovation” and profits. BUT (implicitly), no such conflict of interest biases exist in the free market.

    That’s really the essence of this paper, extensive footnotes, neat-o ECON algebra, and Blinding Glimpses of the Obvious undergrad 101 psych and biz school theory assertions (“incentives,” “ROI,” “opportunity cost,” “efficiency,” etc).

    Gotta love the repetitive hedging phrase “to the extent that…” too.

    This kind of stuff is that of the “Concern Troll.”

  6. Joe–OK you’re banned from going after PRI when they write industry sponsored drivel like this. Pick on someone your own size (intellectually)

  7. Go, Joe!

    I get an “assist” on this one (see my current blog post update).

    Moreover, I HAVE read the entire study (which is akin to “Creation Science” — i.e., start with a conclusion and work back, retaining only evidence and speculation that support your conclusion), and will be commenting further.

    BTW, link to the PRI study is bad.