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Doctors must have final say on patient treatment, care

November 19, 2014

Washington, D.C., has a new health-care buzz phrase. “Comparative-effectiveness research” is the latest government-led effort to bring health-care costs under control.

Others, like reducing tobacco use, tackling obesity and connecting hospitals to the Internet, have yet to succeed in bringing down costs, but that doesn’t keep Washington from trying.

The goal of comparative-effectiveness research is to discover the most effective treatments for every disease, injury and mental condition.

Once identified, the idea is to direct doctors to use those treatments consistently rather than prescribe treatments based on drug advertisements or outdated training.

In theory, costs should come down as people are prescribed the right treatment from the get-go. We might even find that some expensive treatments aren’t effective and can be discontinued.

Comparative-effectiveness research already takes place all over America. Medical research is done constantly to compare the effectiveness of drugs and treatments individually and relative to each other.

Professional medical researchers, pharmaceutical developers and insurance companies all perform these studies.

With private researchers and companies already doing this work, what’s the need for the government to step in?

As government health-care costs rise in programs like Medicaid and Medicare, there’s a recognition that something must be done to bring costs down.

The goal of Washington-directed comparative-effectiveness research is to create the list of treatments doctors can offer to patients on Medicaid and Medicare. And therein lies the rub.

We all want to bring costs down, but this will let the government set the standards for your care instead of your doctor, who knows you best.

This won’t affect just patients on government health programs, it will affect us all.

Even if your care is not paid for by Medicare or Medicaid, your treatment could depend on what a committee of Washington bureaucrats decides is appropriate. Doctors could be paid based on how they treat all their patients, not just those on government plans.

Even if you are willing to pay for a treatment not on Washington’s approved list, your doctor might feel reluctant to give it to you.

Doctors might also hesitate to try new treatments based on their own insights.

Years ago, the standard treatment for stomach ulcers was a dangerous surgery, until an Australian doctor theorized that a bacterium, not stress, caused ulcers. He tried treating patients with antibiotics and cured them.

He was considered a medical heretic, but he persisted and, today, thousands are ulcer-free without surgery.

Had that doctor not been allowed to use antibiotics because of earlier comparative-effectiveness research, patients would still be suffering unnecessary ulcer surgeries.

Today, in addition to antibiotics, many find relief from chiropractors, acupuncture and massage therapy.

It is doubtful these alternative therapies would find a place on a government list of approved treatments based on comparative-effectiveness research.

Bringing down health-care costs is essential. But the protection of the personal doctor-patient relationship where patients get the care they need based on their own personal situation must be at the center of any reform.

Government-dictated comparative-effectiveness research would put patients in a bureaucratically induced treatment time warp, rather than allow us to live better, healthier lives at lower costs.

Byron Schlomach is an economist with the Goldwater Institute in Phoenix.



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