Monday, February 16, 2009

Big Goverment Wants to Get Between You and Your Doctor: An Old Scare Tactic is Abroad in the Land

Somebody apparently feels that there's a real chance that the present administration might pass substantial health reform.

That would seem to be the implications of a couple of recent news items. The items show that conservative opponents of health reform (including, in this case, the champions of Big Pharma) have opened up a dusty old coffin to release the zombie that was highly effective at scaring the townsfolk in the past, and they obviously hope the ol' guy will do the trick one more time. The scary zombie is the threat that Big Government Wants to Get Between You and Your Physician.

Back off a bit for the big picture: As documented in HOOKED and on this blog, more than 80 percent of today's clinical trials of pharmaceuticals are company-sponsored. That means there are precious few head-to-head trials comparing rival drugs to see which is better. No company as a rule will take the risk that its own product will come in second. So most policy experts have said we will never control health costs in the US sufficiently to make care affordable for all who need it until we set up some sort of neutral agency to perform these needed head-to-head trials. Add to the lack of those trials the observation, well documented by Shannon Brownlee in her book Overtreated, that as much as a third of the US health care budget is spent on "treatment" that is actually useless from the patient's viewpoint. There's a lot of room to trim those costs without coming anywhere close to harming patients' vital interests. The sensible doc, far from seeing well-conducted efficacy trials as an interference with prescribing, desperately wants that scientific information as a tool to better serve patients.

Now, President Obama has done two things that are highly scandalous according to most Republicans. First, he says that in a time of threatened economic depression, federal spending might be needed to get the economy back on track and create new jobs. Next, he had the nerve to suggest that since we are going to spend Federal dollars to create new jobs, we might as well create those jobs doing something that we really need in the future. Since he's for health care reform, and knows that down the road sensible reform will require an agency to conduct serious efficacy trials of what works and what doesn't, he suggested putting some money into the stimulus package to fund that sort of health research.

This got the Republicans all upset, according to Dr. Doug Bremner's "Before You Take That Pill" blog:

Clearly, say the Republicans, a dastardly plot to put Big Government between you and your doctor. Meanwhile, over on the Columbia Journalism Review blog, Trudy Lieberman caught CNN doing a bit of Republican lobbying under the guise of news reporting:

She noted that Betsy McCaughey was quoted issuing dark predictions that under the new Obama health plan, the Feds would be issuing marching orders to your doctor, telling her what treatments to use. Asked what specific portions of the bill gave the Feds that authority, no one could say, but they concluded that because the language was vague, anything could happen. CNN conveniently left out the fact that McCaughey, a former New York lieutenant governor, had in past days attacked the Clinton plan with two articles in the New Republic [corrected 2/18: earlier text erroneously said the New Yorker--Sorry!] which were so full of factual errors that the magazine later had to retract them and apologize.

So-- be prepared to hear from a number of quarters in future months that big government wants to order your doctor how to treat you. When you hear that, you'll know that the apologists for the big drug companies, the big insurance companies, and all those who make a killing off the present inefficiencies in our so-called health system are on the prowl.


Roy M. Poses MD said...

For some background on the conflicts of interest affecting some of those so opposed to comparative effectiveness research, including Betsy McCaughey, see this post on Health Care Renewal:

Howard Brody said...

I especially commend Dr. Poses' comment (above) to your attention--his blog posting does a very nice job of summarizing the pros and cons of comparative effectiveness research.

Unknown said...

I believe Betsy McCaughey's (then Betsy McCaughey-Ross) infamous articles attacking the Clinton plan in '93 were published in The New Republic, not the New Yorker.