Big Brother Is Watching Your Doctor

One of the biggest fears the American people have about the new health overhaul law is that government will control decisions involving their health care, usurping the doctor-patient relationship.

They have reason to be afraid. A report is in which details the blast of $1.1 billion in early spending on “comparative effectiveness research” (CER) by the Obama administration, and it shows the government already is setting up the systems to direct doctors to practice Washington-approved medicine.

The American Recovery and Reinvestment Act of 2009 (aka the “stimulus”) appropriated $1.1 billion to fund CER studies “comparing different interventions and strategies to prevent, diagnose, treat, and monitor health conditions.”  All of the funds had to be obligated by September 30, 2010, and a report by the Government Accountability Office provides a detailed list of where the money went.

The evidence clearly shows the comparative effectiveness research money is being used to build a “scientific” case for government rationing of health care.  Here are a few examples:

–One of the biggest grants went to Ogilvy Public Relations, which got $50 million to “educate” the American people about the value of this research.  Another grant for $35 million went to pay government officials to visit doctors’ offices to tell them which treatments the Department of Health and Human Services recommends.

These government officials are expected to counter the work of detailers employed by pharmaceutical companies who inform doctors about the new medicines they are offering. The government detailers “will help doctors make the right decisions for their patients” and promote “appropriate prescribing habits…including the cost-effective use of drugs.”

The government recommendations will be based upon the findings of government studies, such as a largely-discredited 2003 ALLHAT study into the best treatments for high blood pressure.  The government concluded in the study that cheap diuretics work best to lower blood pressure and prevent stroke.  Of course, the study has been discredited as scientists have concluded that the best treatment for hypertension cannot be centrally determined but that each patient’s individual physiology must be considered.

Nonetheless, government agents are visiting doctors’ offices to tell them the government thinks that cheap, older drugs are best, leading to the one-size-fits-none medicine that Americans fear.  Big brother is watching your doctor.

–The stimulus money also provided $530,000 for studies into “resource allocation” for children with autism to measure their “quality adjusted life years.”  QALY is a measurement widely used in government-run health systems in other countries to help officials determine whether a new treatment should be funded, i.e., whether a treatment is “worth it” in terms of added years of life. This means the government, not doctors and patients, will be making those decisions.  In other countries, QALYs have become a rationing tool.

U.S. researchers are being encouraged to work closely with government officials at the rationing board in England (the National Institute for Health and Clinical Excellence or NICE), which has many years of experience with QALY measurements in determining whether or not the government will pay for certain treatments.  U.S. agencies will use the new QALY findings to set its research priorities.

–The stimulus funding also spent $340,000 to “inform public policy” about whether patients with dementia should be given feeding tubes on the hypothesis that feeding tube insertion does not significantly improve survival but does increase health costs. The study clearly is directed with determining whether denying feeding tubes to elderly patients with “cognitive impairment” can reduce government spending.

–Nearly $500,000 went to fund a series of PBS documentaries to focus on how biotechnology and bioethics are impacting American families’ decisions, including “unprecedented choices that can influence how they have and raise children, how they live as adults, and their end-of-life decisions.”  The Hastings Center, which is partnering with PBS on the series, produces studies on bioethics, including Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying.

The list could go on.  And it will. That’s because a new agency, the Patient-Centered Outcomes Research Institute (PCORI), will continue to hand out government funding for CER research.  A new tax on health insurance went into effect on Jan. 1, 2012, to fund PCORI.  It is clear that the first $1.1 billion of government funding on health research has been devoted to spending taxpayer dollars to produce the studies that will enable centralized government control over health care decisions.

A full one-fifth of PCORI’s $500 million annual budget automatically goes to HHS to support more government detailing work and “disseminate” government recommended treatment information to doctors.

The tentacles reach right into a doctor’s office.  Government-funded “detailers” come to his office and say they are making recommendations about the best treatment, even when the doctor knows that treatment may not work for some or even most of his patients.  And the government detailers are to end each visit with a “specific practice change recommendation.”  Will doctors be willing to go against the recommendation when it is clear that government is watching?

This is particularly alarming because we are entering an era of personalized medicine where treatments and even medicines are being tailored to the individual genetic makeup of a patient.  Doctors can know before a chemotherapy drug is administered, for example, whether it is likely to be effective in shrinking or even killing a patient’s cancer.

These tailored medicines have little or no place in a one-size-fits-all world with mega government studies trying to determine which treatments work for the majority of people.  The outliers who would respond exceptionally well to a particular drug will find that their doctor is afraid to recommend it for fear of going outside the government guidelines.

Newer drugs, particularly the biologics that can be tailored to an individual’s particular genetic code, are unlikely to be on the government’s recommended lists.

This kind of rationing of care will be hard to detect and document as doctors simply don’t discuss, and may not even know about, a new drug or treatment that could save a patient’s life.  And when there is no market for these drugs, the companies that will produce them will find they simply cannot get the funding for future research and development of these new medicines.

Government CER sounds like a progressive solution, but it is actually a frightening move that puts government detailers between patients and doctors and favors one-size-fits-none cost cutting over continued medical progress.

Posted on Forbes.com, January 5, 2012.

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