"One Cannot Measure What One Does Not Manage": Socialized Medicine, Unaffordable? (Part XIII-o)

Comparative Effectiveness

It was fairly easy in last week's post to justify looking hard at the costs of care. All I had to do was reference population studies that show wide, unexplainable variation in tests, procedures, the costs, its quality, or benefit (outcomes). The matter resurfaced in an article on comparative effectiveness in the NY Times, May 6, 2009:

"It was in the mid-1990s, when Dr. Deyo [see Hope or Hype: The Obsession with Medical Advances and the High Cost of False Promises] helped develop federal guidelines urging surgeons not to perform spinal fusions to treat acute pain. The reason was simple: There was little evidence that the fusions worked in many patients.

Spine specialists quickly attacked the report, calling it flawed. One medical device maker, Medtronic, sued unsuccessfully to block its release. Republican lawmakers tried to kill the agency that issued the report. It survived, but its funding was drastically cut, and it decided to stop issuing guidelines." And, now we back in the fray as the whole point of comparative effectiveness is resurrected."

Vital to any healthcare reform effort is getting the right care to the right patient at the right time and place, and the obverse—cutting down on inappropriate, unnecessary or unhelpful care or services.

Quoting from "New Effort Reopens a Medical Minefield," we need to "move medical practice beyond the limits of [contrived] trials, by looking at a broader range of evidence that includes the actual experience of patients undergoing treatment." 'Ironically, the motivation for comparative effectiveness is to see what works in practice, rather than overgeneralizing from a few unrepresentative studies.'"

Meier B. "New Effort Reopens a Medical Minefield." NY Times, May 6, 2009