Please Don’t Follow the Money

From the Institute of Medicine meeting on comparative effectiveness research:

Photo courtesy Flickr Creative Commons license

Photo courtesy Flickr Creative Commons license

It’s the end of a long day of short speeches from health care “stakeholders” – the Institute of Medicine wanted to find out what clinicians, patients, researchers, and others think the government should do with its $1.1 billion in stimulus money for comparative effectiveness research. One of the many stakeholders testifying at this meeting was Dr. Mohammad Akhter, executive director of the National Medical Association. He asked the panel to consider many of the same issues other speakers mentioned: what the purpose of the research should be, who would conduct the research, and what was the best way of implementing the results. But it was what he mentioned in passing that interested me the most – that his group has “trust issues” with government research funding.

Since the National Medical Association represents minority physicians, I was curious as to what he was talking about – did he mean the infamous Tuskegee experiment? Was he talking about the disparities in minority health outcomes and the lack of minority patients in clinical trials? I followed him out of the meeting to ask why.

No, it turned out to be something else entirely: His concern was whether the ulterior motive was cost savings. There are a lot of instances in which government efforts purport to be about improving patient care and then they turn out to be something else entirely, Dr. Akhter said. He gave peer review organizations as an example – they started out being concerned about professionalism “and then they became punitive. …We should know what the aim of all this is. Is it just about saving money?”

That sentiment was echoed over and over all day. “The health of the public should trump business interests,” said Dr. Ted Epperly, president of the American Academy of Family Physicians. “We should look at clinical effectiveness, not cost-effectiveness,” said Teresa Lee of AdvaMed, the trade organization for medical device manufacturers. “Cost effectiveness is an important priority, but comparative effectiveness research should be done in an impartial fashion,” said Dr. Jack Lewin, CEO of the American College of Cardiology.

But one person had a slightly different take: Carmella Bucchino of America’s Health Insurance Plans. “Our industry believes comparative information on cost is equally important….if one intervention is marginally better, we still want to know how much more we’re paying for that benefit.” –Joyce Frieden

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