Rationing Wolves in Public Servants’ Clothing

Posted July 6, 2009 at 4:15pm

Congress may soon move to thwart America’s medical ingenuity. Health care “reform— may keep doctors from treating certain patients — especially seniors — with the most effective treatments.[IMGCAP(1)]It’s known as comparative effectiveness research. Doesn’t that sound positive? If CER merely compared similar medicines, devices and procedures, then disseminated the findings on what works best, no one would object. But this isn’t some benign exercise.Rather, CER has been euphemistically inserted into the health reform legislation moving on Capitol Hill. It could mandate that some life-or-death decisions be based primarily on cost and likely longevity. CER will quash innovation and drastically slow medical progress.The full scope of comparative effectiveness research is taking shape. And its shape looks like a monster.The “economic stimulus— bill passed earlier this year put $1.1 billion toward CER by creating the Federal Coordinating Council for Comparative Effectiveness Research. A new grant program will dole out taxpayer money.The National Institutes of Health has now called for CER grant applications for stimulus funds. One area is titled “Integrating Cost-Effectiveness Analysis into Clinical Research.— It intends to “guide future policies that support the allocation of health resources for the treatment of acute and chronic diseases across the lifespan.—“Allocation of health resources— translates into English as making spending decisions. The House committee report accompanying the stimulus bill indicated where policymakers driving CER are heading. Medicines, therapies and medical devices “that are found to be less effective and in some cases, more expensive, will no longer be prescribed.”The way it’s going, CER will ultimately dress health care rationing in political and bureaucratic clothing.The Democrat Senators on the Health, Education, Labor and Pensions Committee have defeated Republican amendments that would have ensured that CER does not allow rationing. Despite the assurances of Democrat Senators that CER findings would not be the basis for clinical judgments, the HELP Committee legislation should trouble anyone who values the doctor-patient relationship and the virtual monopoly U.S. health care holds over medical progress. America leads the world in medical innovation, and access to the latest innovations is more egalitarian in this country than elsewhere.The practice of medicine can’t be boxed in without serious consequences. For example, the bureaucracy that runs Medicare recently refused to pay for a less invasive, cheaper diagnostic procedure, the “virtual colonoscopy.—Virtual colonoscopies could be used to screen many more people at risk of the second leading cancer killer than traditional invasive and expensive colonoscopies. Colon cancer is cured in 93 percent of cases caught early. Thus, Medicare’s coverage decision represents a death sentence.CER could well end up empowering government bureaucrats with the power to pick one medical size to fit all. But in health care, similar therapies may not work the same for all patients. And doctors practice an art, not just a science.I know this firsthand. When our son was 7, he had a seizure. The doctor followed the treatment protocol of anti-seizure medicine. That stopped the seizures and, after five years, our son stopped taking the medicine.At 16, the seizures returned. Our pediatrician insisted on an MRI. The MRI revealed a tumor that was cancerous but caught early. Our son underwent surgery, radiation and chemotherapy, and he was cured. Now, 12 years later, he is completely cancer-free, happily married and living a full, normal life.Had the doctor been constrained by a comparative effectiveness rule and forced to prescribe anti-seizure medicine again, instead of ordering a revealing MRI, the cancer would have grown undetected for months or years, and our son likely would have died.If CER becomes more than identifying generally best practices and therapies and disseminating them for doctors’ consideration only, then it will reduce doctors to mere body mechanics and plumbers. Medicine will become a check-list trade, no longer a profession centered on individualized treatment and judgment.The British experience appears more and more to be the goal of liberal American lawmakers and the Obama administration. The misnamed National Institute for Health and Clinical Excellence, or NICE, rations British medical care based on cost.NICE has refused to make breakthrough medicines and therapies available through the British health service, even though they are clinically effective. For instance, NICE has rejected colon cancer, rheumatoid arthritis and Alzheimer’s medications that are routinely available to American patients. The not-so-nice agency is all stick, no carrot. Brits who go around the system and buy such medicines with their own money may lose coverage of health services through the government-run health system.Health reform legislation should not institutionalize U.S. health care rationing. Sadly, that is exactly what the majority leadership in the House and the Senate proposes, under the Orwellian name of comparative effectiveness. Colin Hanna is president of Let Freedom Ring.