Vol. 9 November 15, 2009 Health Care Reform, Comparative Effectiveness Research

“Rationing means making the most of your available resources. The most ‘rationed’ facility I have ever been in was the Albert Schweitzer Hospital when Dr. Schweitzer was running it. He insisted that the use 0f absolutely every medicine, every tool, and even every piece of paper be used maximally for the patients’ benefit.”
-B. Lachlan Farrow, MD, Assoc. Prof. of Medicine, Harvard Medical School

Number of annual U.S. deaths in people of ages 18-65 yrs. due to lack of health insurance: 18,000-45,000 (1)

Number of World Trade Center collapses that number of deaths is equal to:  6-15

Average cost of Avastin (an inhibitor of blood vessel growth) for one year: $50,000

Number of weeks it prolongs the life of patients with metastatic breast cancer: 0

Amount of improvement in quality of life in those same patients: 0

Significant reduction in progression of disease on Xray images: yes

  • Dr. Forrow’s illustration of his view of “rationing” care for those patients might be to give them the choice of Avastin or “free” home care services (including family support, transportation, etc.), nursing home and/or hospice care, all medications, and a $10,000 for a cruise of their choosing for the same cost! (2)

Per cent average increase of Mass Blue Cross premiums for small businesses in 2010: 15 – 18 (3)

Number of Congressmen using nearly the identical words as Genentech lobbyists promoting the need to keep research jobs in the U.S. as part of the health care reform bill:  42   (22 Republicans and 20 Democrats – at last, some bipartisanism in the health care reform debate) (4)

Amount of stimulus money earmarked for Comparative Effectiveness Research (CER) by Congress in February 2009: $700 million (spilt between NIH and the Agency for Healthcare Research and Quality)

  • CER is a new program aimed at analyzing groups of patients to compare the effectiveness of alternative strategies of drugs, devices, procedures, and diagnostic tests. This is a significant change. For instance, to get FDA approval for a new drug a pharmaceutical company just needs to show that it is better than no drug (placebo). CER raises the bar by asking for data that a new drug (or other therapy or test) is better than the ones already available.

Per cent of annual health care cost increase due to use of new technology: 50  (4)

Chances that CER will be targeted as “rationing” by opponents of health care reform: 100%  (has already occurred)

  • From the originator of the “death panel” label, Betsy McGaughey, former lieutenant governor of New York:  She connected the CER initiative with the electronic medical record initiative to warn that clinicians would get punished for failing to comply with rationing guidelines in treating individual patients ! (5)
  • Specific wording in the House bill on health care reform (HR3962) establishing a Center for CER (a step above a program under two different agencies) prohibits any CER Center authority over “mandated payments, coverage, or reimbursement policies” (6)

1. Institute of Medicine 2002
2.  Ethics of Health Care  Reform, B.L. Forrow, PriMed  Conference, Boston, November 2009
3. Boston Globe, Nov. 15, 2009
4. Congressional Budget Office (from Medical Ethics, Lahey Clinic, vol. 16:9 , Daniel Callahan)
5. NEJM, 360;19, May 7, 09,p.1929 (quoting Bloomberg.com)
6. http://www.newamerica.net/blog/new-health-dialogue

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