Cutting off your nose to spite your face

Paul Krugman highlights the current thinking of many people on comparative-effectiveness research as written by Gov. Huckabee:

Tucked away in the $787 billion stimulus was the establishment of the Federal Coordinating Council for Comparative Effectiveness, which will become our version of Britain’s National Institute for Health and Clinical Excellence, the ironically and Orwellian-named NICE. NICE decides who lives and who dies based on age and the cost of treatment. So the stimulus didn’t just waste your money; it planted the seeds from which the poisonous tree of death panels will grow…

Who will get rationed? Well, the very old and the very young, obviously, the most helpless and vulnerable among us.

This is frustrating.

It baffles me why people are opposed to “comparative-effectiveness” research. “Comparative” means we want to, well, compare things. “Effectiveness” signals we are interested in how well things work. When we say “comparative-effectiveness” all we mean is that we want to compare how well things work.

Full stop. That’s it.

In essence, all research is “comparative-effectiveness”. Even when we compare a drug to placebo (or nothing), we are comparing the effectiveness of two alternatives. What’s confusing in all of this is that – right now – most funded research is against placebo. Hard as it is to believe, little is done to compare two therapies to each other. That’s why some want to explicitly do more of this.

Cost is nowhere in this. It’s not “cost-effectiveness” (which I also support). That’s somehting different.

The major rationale for this “comparative-effectiveness” is that we might find out that something works better than something else.  That’s all. I imagine most people would like to know that.  I don’t know why someone wouldn’t.

I admit, if we find out that something works better (through the “comparative-effectiveness” work), AND it also turns out it’s cheaper, I’d encourage its use. I think that when something is more effective AND costs less, it’s a no brainer that it’s a superior option. But that’s not the point of “comparative-effectiveness” nor of any of the legislation that supports it.

Moreover, if you just feel like “comparative-effectiveness” is the slippery slope to death panels, then I don’t understand how any research at all isn’t on the same slippery slope. After all, any research which shows a therapy doesn’t work could lead to its not being paid for. Any research could lead to rationing of things that don’t work. Should we abandon all research?

But it’s the last line of the excerpt above that’s the most bizzare to me. Personally, I would love to know if some expensive therapies are less effective than cheaper ones. We all know we need to slow spending, and if we need to spend less, this seems like a great way to trim the fat.

If we don’t, then we will run out of money and just have to spend less, period. We’ll have to ration.  What will get rationed? Medicare and Medicaid, obviously, or the very old and the very young, the most helpless and vulnerable among us.


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