“Wonder of wonders, miracle of miracles!” That pretty much describes the media’s approach to coverage of new drugs and medical therapies. The Oregonian in Portland did not go in that direction this month when it ran a comprehensive and honest appraisal of new health technology. The story, by Joe Rojas-Burke, was so refreshing that we encourage other news outlets to use it as a model. The lede explained how a large independent study showed that computer-aided mammography did not significantly increase cancer detection rates. The process did boost the number of false positives, prompting a 20 percent increase in the rate of invasive biopsies. (Not to mention the cost of those procedures.)
The story then got right to the nut graph, which is worth repeating verbatim. It summarizes a major reason why U.S. health care is so expensive, and why reducing costs is an important reform objective—at least for some:
The finding is just one example of a widespread problem in the health care system; the tendency to embrace new technology without waiting for proof that it’s better than older, cheaper, time-tested solutions.
The Oregonian’s story described five medical interventions that support the nut graph’s thesis:
• Robotic surgery to minimize the side effects of cancer treatment
• Osteoporosis screening, leading to drug therapy—when falling is the real risk for broken bones among the elderly
• Fetal heart monitoring—which, studies show, is no better than an old-fashioned stethoscope when it comes to preventing brain damage from birth trauma.
• Blockbuster drugs, like the highly advertised Zelnorm, a drug for irritable bowel syndrome that was pulled from the market following questions about its safety and efficacy.
• Drugs to prevent diabetes, instead of lifestyle changes—which carry none of the drugs’ deadly side effects.
Stories like the The Oregonian’s are especially timely right now. The stimulus package moving through Congress will likely include billions for research on medical effectiveness. The Senate bill includes $1 billion for research on the comparative effectiveness of medical treatments, but that bill has already sparked concern that some patients may not get expensive treatments that they or their doctors want. The bill says:
By knowing what works best and presenting this information more broadly to patients and health care professionals, those items, procedures, and interventions that are most effective to prevent, control, and treat health conditions will be utilized, while those that are found to be less effective and, in some cases, more expensive, will no longer be prescribed.
Does this sound like a solution to the problem posed in The Oregonian’s nut graph?
The politics of medical effectiveness will be fierce, and the “firestorm” over the language in the legislation, as CongressDaily put it, is just the beginning. Dennis Cotter, who runs the Medical Technology and Practice Patterns Institute, a research firm that looks at all aspects of new and emerging health technologies, wrote to me not long ago sharing some important history about other government efforts to assess medical effectiveness. The history calls to mind the quote by American philosopher George Santayana: “those who cannot remember the past are condemned to repeat it.” Cotter’s history is worth passing on.
In 1978, the National Center for Health Care Technology, with a $4 million budget and a staff of twenty, was established as part of the Department of Health & Human Services to assess the value of old and new technologies and broadly disseminate its findings. The agency was short-lived, however; it died at the hand of Ronald Reagan’s Office of Management and Budget. “One should learn from the reasons for its demise,” Cotter told me. Cotter, who worked at the agency, said the AMA and a trade group, the Health Industry Manufacturers’ Association, argued that the Center was redundant because doctors were the ones best equipped to evaluate new technology. They also maintained that the Center was a cost control scheme.
Today, makers of diagnostic and imaging machines and other medical technology belong to a trade group called the Advanced Medical Technology Association, or AdvaMed. What its members do and don’t do could make a fine sequel to The Oregonian’s story.