Most Americans, I submit, believe that our medical system is not only the world’s most expensive but also the world’s best. When we have a problem we want the latest and best test, medicine, and procedure. Would it surprise you to learn that the latest and most expensive test, medicine or procedure is often not the best?
It isn’t just an individual study here and there that’s flawed. Instead, the very framework of medical investigation may be off-kilter, leading time and again to findings that are at best unproved and at worst dangerously wrong. The result is a system that leads patients and physicians astray—spurring often costly regimens that won’t help and may even harm you.
Biased medical information is likely a major driver of excessive costs. Anyone following my blog posts and those of my online correspondents for the last year will know that the national debt and the national budget deficit are dominated by medical costs. Debt is at a crisis stage, and most of us have agreed that healthcare entitlement reform is crucial to a solution.
I had concluded that reform of the present system, the Obama administration’s Affordable Care Act not withstanding, is impractical and that the only viable solution was a single-payer socialized, government-controlled medical system. Now however I read in the July 2011 edition of Scientific American magazine another article by Begley that offers some hope of reforming costs under the present system. She provides as an example “the largest and most important investigation of treatments for high blood pressure ever conducted, with a monumental price tag to match.” Called ALLHAT, the study of over 42,000 patients concluded that,
If patients were prescribed diuretics for hypertension rather than the more expensive medications, the nation would save $3.1 Billion every decade in prescription drug cost alone — and hundreds of millions of dollars more by avoiding stroke treatment, coronary artery bypass surgery, and other consequences of high blood pressure.
Although it is very expensive to do a study like ALLHAT, it has now been discovered, Begley says, that a careful analysis of electronic medical records, of which there is now a very good data base of millions of patients, can accurately substitute for expensive long-term comparative studies in determining the efficacy of drugs and procedures. That methodology is called CER, for comparative effectiveness research.
As an example of a successful CER project, Begley cites a study of two competing drugs for treating age-related macular degeneration, Avastin (used off-label) and the latest and greatest, Lucentis. By carefully using standard statistical techniques to control for hidden biases in the selection of their population study the researchers were able to prove that the new drug was no better than Avastin. The savings? Lucentis costs $2,200 per dose and Avastin $50 per dose.
How much good can this do? The director of the Kaiser Permanente’s research center said,
As much as one third of our [medical] spending is for ineffective or unnecessary care . . . — around $900 Billion a year, in other words.
Begley’s article is not available to non-subscribers online, unfortunately. It does have two graphs that I would have liked to show, but they only confirm what is available elsewhere. They show that the U.S. spends roughly twice as much per patient than do the rest of the developed countries (OECD countries), (half again as much as the next-lowest), and that we are near the back of the pack for data on life expectancy. (The U.K. is at the median on life expectancy.)
Begley recognizes that there will be much skepticism in the U.S. over the use of CER analysis or any other methodologies to reduce costs. Scare tactics such as “death panels” may have already poisoned the well for any rational attempts at controlling costs, and what I call the Medical Industrial Complex is certain to continue its inexorable search for profits and growth. That after all is the nature of business. It is no accident that prescription drugs dominate the expensive ads accompanying the evening news, with its audience of more-educated viewers.
I am still convinced that the best solution to healthcare crisis is a single-payer government system delivering quality care, epitomized by the high standards of the National Institutes of Health, but a cost-cutting system based on CER methodology surely deserves attention in the meantime.