How ‘Comparative Effectiveness’ Can Cost You Your Life

j0439593by Victor Morawski

The phrase “Comparative Effectiveness” is becoming increasingly in vogue among Obama health care advocates. So, it’s important to note that it actually amounts to little more than a euphemism for health care rationing.

Based on comparative effectiveness research, patients will inevitably be denied life-saving medicines, services or procedures because they are not deemed to produce substantial enough benefits to justify their costs. In short, the government will decide whether your life is worth saving depending upon whether its bureaucrats deem you a productive member of society.

And how will the bureaucrats make such life and death determinations? Probably the same way they decide whether they should take your property under eminent domain: it’s all a matter of tax revenues. Under eminent domain, the more you pay in taxes, the better the chances you have of keeping your property. Under comparative effectiveness, the more you pay, the longer you’ll be allowed to live.

There is simply no other way to look at it. And, of course, there can be no question that it will stack the cards against the elderly as a group that consumes the largest quantity of health services and pays the lowest taxes.

Effectiveness is all too often gauged using a standard like QALY [Quality Adjusted Life Years], which in the British NIH measures it in terms of the length and quality of life a patient can normally be expected to have following some specific medical intervention. Procedures or medicines that do not, for an elderly patient, prolong life enough or enhance its quality enough to justify their cost are thus judged to have insufficient effectiveness and may be denied.

It is common opinion that the most prominent example of an agency that conducts comparative effectiveness research and then uses it as the basis for decisions regarding the approval or disapproval of health services is Great Britain’s National Institute for Health and Clinical Excellence (NICE). The Senate Baucus Health Care Reform Bill has within it provision for just such an organization, which it calls the “Health Care Comparative Effectiveness Research Institute.”

The Senate expressed belief that, “to reduce health care spending, the results of comparative effectiveness analysis would ultimately have to change the behavior of doctors and patients—that is, to get them to use fewer…or less expensive services.”(30) Thus, they would pressure doctors financially to adjust their care decisions to bring them in line with the Institute’s findings and recommendations in ways that would ultimately lead to rationed care.

And what are we then to make of the fact that the latest version of the House Health Care Reform Bill, H.R. 3962, has within it a provision for setting up and funding a “Center for Comparative Effectiveness Research” — and yet also contains a clause which seems to render this government agency all but ineffective? For we are told in the bill that the Center’s “Research May Not Be Used to Deny or Ration Care.” And that kind of obvious duplicity only adds insult to injury.

After all, why have such a research body at all if its findings are not going to be used for the one purpose that justifies its creation: supplying the information on the basis of which prospective medical interventions are either approved or disapproved? Isn’t it, in fact, more reasonable to think that this clause will be dropped when it is reconciled with the Senate version? Or, that the bureaucrats who administer it will simply be told to ignore the clause altogether, as is so often the case when such legislative sleight of hand?

While the ‘Center’ in H.R. 3962 is now a toothless tiger, it is not hard to imagine its equivalent eventually becoming the full-fledged, powerful health care rationing body that Great Britain’s NICE now is. Eventually – inevitably – the healthcare monstrosity that Nancy Pelosi has just released on an unwitting American public will grow to full maturity. And it will then gobble up not only a vast chunk of the US economy, but an untold number of victims whose lives, based on the results of comparative effectiveness research, will simply be deemed not worth the cost of saving.

Victor Morawski, professor at Coppin State University, is a Liberty Features Syndicated writer.

Reprinted by permission of Americans for Limited Government.

4 Responses to “How ‘Comparative Effectiveness’ Can Cost You Your Life”

  1. The practice of medicine is all about probabilities. When I assess a patient's complaints I begin with a thorough history and follow with an appropriate exam. Based upon this information I begin to develop a “differential diagnosis” (possible diseases that might account for the problem at hand) and might order lab studies or x-rays, etc. to help narrow the possibilities. At some point I decide that I have enough information to make a reasonable diagnosis and begin treatment.

    There is almost always more than one treatment option and, based upon training and experience and, perhaps factors unique to that individual (such as drug allergies) I decide what option is MOST LIKELY to produce a desired outcome and set upon that course and monitor the results. I am prepared to consider another option in the event the first fails, as is sometimes the case.

    “Comparative effectiveness” assumes that there is only one best option for each diagnosis based upon statistical analysis of many similar cases. It also puts greater weight upon the cost of each option, so one course may be shown to be more effective but costs three times more than another that is only 50% as effective. It such a case, the latter option would be considered the better in ALL cases.

    Implementation of a policy that depends upon “comparative effectiveness” treats patients as a group, rather than as individuals. This is the way cattlemen treat their herds, and it is cost effective and efficient; but do Americans want to be treated as cattle?

    You and your physician are the persons in the best position to decide what is best for you. Every individual deserves medical care that considers his unique situation. Government panels cannot know what is best for an individual. “Comparative effectiveness” and its sister “evidence-based medicine” are efforts to apply herd medicine to human beings. It can only ration and deny care as it attempts to control costs, while, in fact, shifting the dollars from medical care to administrative bureaucracies.

  2. I find it interesting that you comment that there “is simply no other way to look at it.” As a clinician and a researcher, I can think of many other ways to look at this issue. Currently, when I want to prescribe a treatment to a patient, I have to go with what I know about the treatment based on the research, which is mostly on Caucasian Americans with only one diagnoses (they are actually screened out if they have anything else). Unfortunately, the majority of the people I treat are never included in the research I use to make treatment decisions. For example, let's say the majority of people I work with are middle-aged African Americans who commonly suffer from hypertension, diabetes, and depression. Most studies on treatment for any of these extremely common ailments only look at the effects of the treatment on the one disease. So, when I prescribe treatment for depression, I have no real means for knowing how that will effect their other diagnoses beyond observing the outcome. I am forced to treat these people with a trial by error methodology. And my colleagues in many different disciplines complain of the same problem. Comparative Effectiveness Research calls for research that looks on the outcomes of treatment in different populations and considers outside forces or diseases that may increase or decrease treatment effectiveness. I will actually be able to save my patients (and in some cases insurance companies) money by minimizing the number of treatments I have to prescribe. It will not limit me from prescribing them, just help me know what will work better. Imagine a world where we don't have to put people on medication solely to counteract the side effects of another medication because we know that when you have two illnesses, that drug doesn't work effectively. I see where the fear comes in, but this is not Britain and we do not have the same motivations. I want to give my patients the freedom to have a health care that gives them choices and information about how treatments will likely effect them. Now, I can't do that. I can tell them what happens in the studies, but that these people they studied were nothing like them. Comparative effectiveness research will give them the freedom to have a better idea of what the effects are of a treatment and make a choice. Unfortunately, right now, it's mostly a shot in the dark, which sounds much more limiting and powerless and not becoming of a nation that prides itself on giving it's citizens the freedom of choice. What do you do if there is no way to choose?

  3. The kind “comparative effectiveness” you discussed sounds reasonable.

    However, the “comparative effectiveness” that Dr. Emanual and other Utopians advocate has more to do with whether the almighty state is wasting their money on someone too old, too young, or too handicapped to be as “effective” to the glory of the state as someone else.

    We're not like the British, eh? How do you know that? Wishful thinking?

    It's this kind of “comparative effectiveness” that is un-American, inhumane and should scare the daylights off any non-Koolaid drinking American.

  4. The kind “comparative effectiveness” you discussed sounds reasonable.

    However, the “comparative effectiveness” that Dr. Emanual and other Utopians advocate has more to do with whether the almighty state is wasting their money on someone too old, too young, or too handicapped to be as “effective” to the glory of the state as someone else.

    We're not like the British, eh? How do you know that? Wishful thinking?

    It's this kind of “comparative effectiveness” that is un-American, inhumane and should scare the daylights off any non-Koolaid drinking American.