The host interrupted here, and the conversation centered for a moment on a Wall Street Journal story from last week, about a study showing that, generally, stents offer no additional benefit when used with a cocktail of generic drugs for patients who have chronic chest pain. Johnson and Kilmeade chatted about the study, and Johnson had the last word, which couldn’t help but cast doubt on the comparative effectiveness movement:
If the new standard is save money, best practices—does President Clinton or you or I who needs it—get the stent under that new regimen of health care effectiveness?Fox missed the real point of the Journal’s very good piece: studies, like the one for heart stents, “that find an already-popular and a lucrative treatment can merely be unnecessary, but not harmful,” have rarely changed medical practice—unlike studies showing that a particular treatment, such as hormone replacement therapy, can actually be detrimental. Journal reporter Keith Winstein used heart stents as an entrée to show how a procedure that costs the U.S. $15 billion a year continues to be used because it satisfies stakeholder interests—cardiologists who get paid roughly $900 for doing the procedure; insurers who fear a crackdown on stenting would mean employers would take their business to other carriers that are more loosey-goosey about spending; patients who don’t care about the cost because someone else is paying, and may take their business elsewhere if a doctor doesn’t accede to their demands.
That’s why comparative effectiveness faces a tough battle for respectability. Fox missed another important point the Journal made. Comparative effectiveness provisions in the bills passed by the House and Senate allow researchers to disseminate their findings, but don’t require insurance companies or Medicare to base their coverage or payments on them. A few weeks ago I sat down with Jeffrey Lerner, who heads the ECRI Institute, and knows a thing or two about evaluating medical technology and the evidence. Lerner explained that the bills would establish an institute or a center to identify research priorities and conduct the studies, but the findings cannot be used as mandates, guidelines, recommendations for payment, or to deny coverage. Fox News: Take note!
Such prohibitions raise questions about how any of this research might translate into actual medical practice and benefit patients, and they show how the whole idea of comparing treatments got watered down in the legislative give and take. Lerner talked about another thorny issue: cost effectiveness, which looks at how well a particular treatment works for the amount of money there is to spend on it. “You don’t see any language about cost effectiveness,” said Lerner. “That was removed.” In other words, any notion of cost effectiveness vanished a year ago when the stimulus package made its way through Congress.
Few stories have delved into this devil lurking in the details. Kaiser News Service offered a summary of the issue, noting that a group, the Partnership to Improve Patient Care, headed by former congressman Tony Coelho, opposes using comparative effectiveness research for coverage decisions. That’s a group to keep an eye on should health reform start moving again. The Sacramento Bee brought the story home and talked about a local orthopedic surgeon who conducted his own study to find out if a certain procedure actually worked. It was an interesting journalistic approach.
There’s plenty here to explore to counteract the misleading reporting from the likes of Fox News.
Wow, an attack singling out Fox News coverage! How daring! How refreshing!
In the meantime, the mainstream broadcast media was joining the administration in an exceptional effort to promote his brand of health care 'reform' as soon as he took office. There were no tough questions asked. The Democratic narrative that the public is panting to have its health care even more directly controlled by politicians was accepted by rapt, adoring minds. The massive miscalculation by the Administration, and press complicity in it - which may cost it control of Congress in November, showing the Clinton lessons were not learned by slow-minded liberals - is not ruthlessly scrutinized at CJR. Instead, when in doubt, attack Fox News by holding it to much higher standards than other more liberal news outlets.
#1 Posted by Mark Richard, CJR on Tue 16 Feb 2010 at 12:27 PM
SOMEHOW each of is going to have to learn how our body works in relation to medications and surgical treatments and genetics plus good health care and environment. But seemingly that's too much of a mouthful for 2/3 of our population to take in. I can't use a generic form of a medication because stops the other kind that needs to work to keep me out of a sanitarium--at least from 1957 on. My 93 year old father just had stents put into his heart which has 5 valves not 4 like normal people. The 5th one kept him alive from Sterling , IL to Davenport, IA in an ambulance--about 60 miles one way. He returned to have his stents checked and they added from 2 to 5 with 3-4 medications mostly in the morning. His father lived until 4 weeks before his 97th birthday and had only medications and wine to take him through three heart attacks in the 60's and 70's. He died of prostate cancer--not heart trouble. We must check back over our family history, our health habits--good and bad--and the environment we live in. In many ways that can tell us and our doctors what is better for you as an individual. Also, if the doctor doesn't like being told what you have learned over the past years and either insists on you using something detrimental or useless to you--change doctors. I have had to change doctors because one insisted on my being tested for osteoporous--my age I HAD to have it as a female--but I don't. I do have osteominosis(old bones) but at 671/2 What else should I expect? Also, none of my grandmothers, aunts nor my mother had osteoporous. The first ones died at 75-80, my aunts all lived past 80 and my Mother lived until 88--despite her polio at 3 years old. All my relatives for 4 generations have lived in farmlands or small towns, so the air and water were much better for them than any big city. This "black sheep" does live in a big city--over 1 million people but no industries for air pollution and the land and water pollution (IBM, etc) is south so the likelihood is less though more dangerous than smalltown midwest America. Keep a good watch over your health and habits for eating, sleeping, exercise and medical necessities and you'll do well. Double check your family tree and it may be better than mine. If not, be prepared and ask questions and don't fear changing doctors or asking a second one. But haven't most of you heard this before???!!!
#2 Posted by Patricia Wilson, CJR on Tue 16 Feb 2010 at 07:26 PM
I would like to thank Fox News ,because of all the Half truths ,lies, and fear mongering it looks like the Dems. are finally going to get some balls and pass health care reform.
Except this time the bill will have a public option or expanded medicare, no more anti-trust monopolies,and the ability to import drugs from other countries.
They are going to do this with 51 votes .
The true winners are the American people and the people who are now on medicare as this will help save it .
The Dems. will be rewarded for this in Nov. because the people Know if they leave it for the Repubs. that nothing will happen but a few more tax breaks to the top 1%.And then more people losing their insurance and their homes in the middle class. Thanks Fox News, without you and the Tea baggers you sent to Mass. we would have been stuck with a much worse bill.
#3 Posted by Mikey, CJR on Fri 19 Feb 2010 at 01:00 PM