What Works Best?

It's amazing how little physicians know about what works best when it comes to treating their patients. They know plenty about what works because the drug industry's salespersons give it to them. "This drug is effective in reducing your risk of heart disease." "This chemotherapy regimen will definitely increase your chances of living for five years with this cancer."

But perhaps there is something else the physician can prescribe or suggest you do (like improving your diet or increasing exercise or taking a different pill) that would do more to reduce your risk of a heart attack or increase your chances of surviving? Does your physician know how well the two options compare?

In testimony before the House Ways and Means subcommittee on health earlier this week, the former Republican head of the Center for Medicare and Medicaid Services, Gail Wilensky, who is now publisher of the health economics journal Health Affairs, discussed the need to reform Medicare's physician payment system if the nation is going to hold down costs and improve outcomes. Any alternative system should align the incentives for physicians to give the best and most cost-effective care, she wrote.

To that end, she renewed her call for creation of a new agency to conduct comparative effectiveness studies, which would require a large increase in government funding. Her testimony was posted today on the magazine's blog. Here's the relevant section:

As important as it is to realign incentives, it is also important to provide both payers and providers with better information on the relative clinical effectiveness of alternative medical procedures and technologies. A number of other countries have been involved with the concept of comparative clinical effectiveness, but generally only for new pharmaceuticals and medical devices. Similar information needs to be available for medical procedures as well, since that’s where most of the money is spent.

Even if incentives are appropriately aligned, we can hardly expect to “spend smarter” if clinicians and payers (and patients) don’t know “what works when, for whom, under what circumstances.” Getting such information will require a significant investment and take several years to develop. But in a sector that is now spending $2 trillion, it is hard to explain why that type of investment would not be appropriate.

The bottom line: “We need to know more and pay for it better.”

Sen. Hillary Clinton (D-NY), the frontrunner for the Democratic presidential nomination, has championed legislation in the Senate that would create an arm of the government capable of conducting comparative effectiveness trials. Her bill promotes better and more cost-effective health care for the American people much better than the bills now moving through the Senate's Health Education Labor and Pensions committee.

For instance, chairman Ted Kennedy (D-Mass.) is pushing a drug safety bill that has drawn fire from most drug safety advocates and is considered woefully inadequate by Food and Drug Administration whistleblowers. As I reported earlier this week, Kennedy is also pushing a bill that would protect the biotechnology industry from generic competition.

Clinton sits on the HELP committee. It will be holding a mark-up hearing on March 28 to consider Kennedy's drug safety reform bill. One way for the frontrunning presidential candidate to show she is serious about health care reform is to offer an amendment to Kennedy's bill that would create an agency that could not only conduct comparative effectiveness trials, but also conduct the post-marketing drug safety trials that the FDA orders but the drug companies never seems to get around to doing.

Posted by gooznews at March 9, 2007 02:46 PM