Published in the Athens Banner-Herald June 6, 2009
A majority of Americans – 55 percent – told pollsters recently they would trust an independent board of scientists to evaluate competing medical treatments and to recommend which ones should be covered by insurers.
That may seem like good news for Congress, which just allocated $1.1 billion for research into the relative effectiveness of various medicines and medical devices. But the same poll, conducted in March by the Kaiser Family Foundation, National Public Radio and Harvard University, also reveals that only 41 percent of Americans would trust the scientists on the panel if they were "appointed by the federal government."
The problem is that the new board, the Federal Coordinating Council for Comparative Effectiveness Research, already has been appointed by the federal government, and it is composed entirely of government employees.
The funding for comparative-effectiveness research (CER) was passed quickly by Congress earlier this year in the stimulus bill with virtually no debate. Few voters even knew it was there.
CER could be extremely valuable for doctors and patients. With medical innovation advancing almost daily and medical treatments becoming more and more complex, many physicians need information to help them keep up on the latest developments in medical research.
CER studies could help doctors determine, based upon an analysis of many studies, whether a patient's neck pain, for instance, might be better treated by surgery or by a combination of pharmaceuticals and physical therapy. Armed with better information, physicians would be able to treat patients more efficiently and effectively.
And because this new board and funding for CER are already in place, federal officials now must ensure that the research is used to provide physicians with more information – not to restrict patient access to particular medicines, as many fear.
But if public insurance programs like Medicare and Medicaid begin using comparative-effectiveness research to deny patients access to new treatments because of cost, CER would have a disastrous impact on patient health.
Restrictions and rationing already are a reality in many countries that have similar agencies. For example, New Zealand's CER agency, Pharmac, took nearly five years to approve the use of the anti-cancer drug Herceptin even though the breakthrough drug was shown to increase the survival rate of certain early-stage breast cancer patients by up to 95 percent.
In July 2007, Pharmac finally approved Herceptin – but only for a nine-week regimen. There was scant evidence that nine weeks of treatment would be sufficient to save lives. In the interest of cost, Pharmac opted not to cover the drug for the full 12-month period that had been proved effective in a clinical study of more than 13,000 patients.
Britain's comparative-effectiveness agency is similarly parsimonious. It has denied approval for three kidney cancer drugs widely available in other countries. Their comparative-effectiveness agency, the National Institute for Health and Clinical Excellence, claims the medicines are too costly. Even worse, patients who buy the drugs on their own risk losing coverage for other medical care through the country's national health system. All the while, British cancer patients needlessly suffer and some die for lack of drugs that are available elsewhere and proved safe.
Americans are justifiably concerned that such scenarios could take root in the United States if the government manipulates comparative-effectiveness studies to dictate how doctors treat their patients.
Lawmakers must not repeat the mistakes of other countries by misusing CER to systematically deny patients access to top-flight medical treatments and ultimately diminish the incentive for researchers to develop new drugs in the future.
Grace-Marie Turner is president of the Galen Institute, a nonprofit research organization focusing on patient-centered solutions to health reform.