The following op-ed was published on March 26th, 2009 in the USA Today.
As a primary care doctor, I am frequently faced with decisions where the choice is not always clear. Do the latest, more expensive drugs work better than the less costly, older medications? Will ordering an MRI help me treat a patient’s lower back pain? Often, the answer to these questions is, “I’m not sure.”
Because doctors rarely are sure which treatments work best, they often prescribe the most aggressive therapy, or the newest drug or medical device, which likely will also be the most expensive.
The Obama administration is hoping the $1.1 billion for “comparative effectiveness research” in the recently approved economic stimulus package will help provide doctors data to make more informed decisions. Studies that compare drugs, medical devices and procedures should help determine what treatments benefit patients the most while cutting costs.
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Cost savings foreseen
The Congressional Budget Office says that $700 billion can be saved annually by identifying the treatments that do provide the best results for patients. That is a substantial sum when you consider that health care spending totaled $2.2 trillion in 2007, and is rising at an alarming rate.
The American College of Physicians says such research “has the potential to reduce unwarranted variations in treatment among providers, increase patient accuracy in expected treatment outcomes, and provide patients with greater comfort in the treatment choice made.”
In the past when Hillary Clinton championed such studies, drug companies, medical device makers and think tanks such as the libertarian Cato Institute have expressed concerns that health care rationing and denial of certain treatments or drugs would follow. But AARP’s outgoing chief executive, Bill Novelli, has argued that these critics are using “scare tactics” because “they fear it will cut the profits they make on ineffective drugs and equipment.”
Unanswered questions
Currently, comparison research is largely conceptual, and questions remain as to who will conduct the studies, what to make of data presently available, and how new research will be applied. A 15-member panel was created to make those decisions. The new panel might use the U.S. Preventive Services Task Force as a model. Made up of primary-care clinicians, the task force is an independent, government-sponsored body that provides preventive care recommendations based on rigorous assessments of the available evidence on issues such as cancer screening and heart disease prevention. Although the task force is universally recognized as the “gold standard” in preventive service research, doctors are not bound by its recommendations.
To be sure, such studies have a number of limitations. Women and minorities are not appropriately represented in most studies. The Obama administration says its measure specifies that minorities, women and the disabled be included in future research. Also, large-scale clinical trials take years to complete, and the issue being researched could change, or become irrelevant, during the course of the study.
Finally, doctors must be willing to incorporate this new research in their daily practice. With new drugs and technologies being introduced regularly, doctors face an increasing array of diagnostic and treatment choices. We need to realize that the latest isn’t always the best, and by using data from comparative effectiveness research, physicians can provide the best care for their patients.
Kevin Pho, MD, is a practicing, board-certified internal medicine physician and the founder and editor of KevinMD, which he built from scratch in 2004 to give clinicians and patients a place to be heard. Over two decades, it has become one of the most recognizable physician-led publications in health care, drawing more than 7 million annual page views and over 500,000 followers across social media. He still sees patients in primary care in Nashua, New Hampshire, the practice he says keeps the platform honest.
He is the host of The Podcast by KevinMD, a daily, 15-minute show that has surpassed 2,000 episodes and 2.6 million IAB-certified downloads, featuring physicians, patients, caregivers, founders, and health care leaders in conversation about what they actually see and do. He is also a national media commentator and the coauthor of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices.
An acclaimed keynote speaker, Kevin speaks nationwide to clinicians and non-clinicians on health care, digital media, physician leadership, and burnout. His signature keynote, “Connect and be heard: Make a difference in health care with social media,” traces his social media journey since 2004 and inspires audiences to strengthen the doctor-patient relationship, make their voices heard in health reform, and turn the tide against clinician burnout. He is the founder of Physician Speaking by KevinMD, a physician-run speakers bureau, and is available for speaking opportunities.
Kevin earned his medical degree from Boston University School of Medicine and completed his internal medicine residency at Boston University Medical Center. The New York Times called KevinMD “a highly-coveted publishing place for doctors and patients,” and Forbes called it a “must-read health blog.” He is an inductee of the Healthcare Internet Hall of Fame, a recipient of the American Medical Writers Association McGovern Award, and a New Hampshire Magazine Top Doctor.
