This morning’s NYTimes carried an article about one of the elements of the US government’s stimulus plan that may have a big impact on health. Buried within the massive stimulus plan is $1.1 billion dollars for “researchers to compare drugs, medical devices, surgery, and other ways of treating specific conditions”.

This may not seem like a very radical new program, but it is. While the US government and private companies spend literally billions of dollars every year on research on the effectiveness of new drugs and other health technologies, very little is spent in the US on what is known as “comparative effectiveness research”.

The big difference between this type of research and the current system is rather than leaving each individual developer in charge of studying the effectiveness of its own product relative to some standard treatment protocol (frequently nothing or a placebo), now research will be funded that can compare a whole set of treatment options and comment on the relative effectiveness of each approach. Many countries, in particular the United Kingdom (e.g. the NICE agency), do a lot of this type of research. However, the current structure of the US health care system means that each individual developer will not commit to doing such research because the costs would likely exceed its own benefit and because there is great risk you find out (and so does everyone else) that your product is relatively less effective than you hoped.

I loved this quote from the article:

“…Republican lawmakers and conservative commentators complained that the legislation would allow the federal government to intrude in a person’s health care by enforcing clinical guidelines and treatment protocols.”

What horror! When did clinical guidelines and treatment protocols become such a bad thing? Just because it is nice to think that I should have some choice in my treatment mean that I know best? I would rather walk into the office of a doctor who has some plan of action on how to treat me instead of having to rely upon some uninformed trial and error process. I get that people are worried that taking costs into consideration may mean that some treatments may become less available, but bear in mind that this process takes into consideration the effectiveness, so if the most expensive treatments also work the best, than they would likely be cost effective. At least I would now know what trade-offs are being made. After all, real life is always about trade-offs, in particular in the current economic crisis.

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