Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

A global view on effectiveness research

Christopher Johnson, MD
Policy
March 18, 2011
Share
Tweet
Share

We badly need effectiveness research — which medical treatments work and which ones don’t. After all, some reasonable estimates are that a third or so what we spend on medical treatments is for things that aren’t known to work, or worse, don’t work. Effectiveness research means comparing two competing therapies to see which works better; if both work the same, our preference should be for the less expensive one. We have very little of that now.

There is another way to think of effectiveness research, a more global one. This approach looks at the bottom line — does a treatment make people’s lives better and/or make them live longer? A key metric for this kind of research is the quality-adjusted life year, or QALY. The idea is simple: to what extent does the treatment add meaningful years of life to people? This notion has been around for decades. It’s particularly useful because it crosses all disease categories, simply comparing life outcomes.

The idea of the QALY, however, can create fears that it will somehow be used to judge lives, one against the other, regarding which has a higher “qualtiy.” Could QALY measurement be a stalking horse for rationing, of allocating heathcare resources to those some committee deems more deserving. The political traction that Sarah Palin’s nonexistent “death panels” received shows the depth of this distrust.

This fear is, in fact, embedded in the recent healthcare reform bill, the Affordable Care Act. The Act established an outcomes research center, called the Patient-Centered Outcomes Research Institute. But, as a recent editorial in the New Journal England of Medicine notes, the Act specifically forbids the use of QALY measurement “as a threshold.” It is not clear at all what that means, but, like the authors of the editorial, I think it reflects a fear that some lives will be judged more worthy than others, leading to unfair (or unethical) rationing of care.

But here’s the problem: QALY analysis is one of the most powerful tools of effectiveness research, and it’s absurd to pretend is should not or will not be used. From the article:

The antagonism toward cost-per-QALY comparisons also suggests a bit of magical thinking — the notion that the country can avoid the difficult trade-offs that cost-utility analysis helps to illuminate. It pretends that we can avert our eyes from such choices, and it kicks the can of cost-consciousness further down the road. It represents another example of our country’s avoidance of unpleasant truths about our resource constraints.

I suppose the fear-of-QALY clause made into the bill because the legislative sausage-making machine contains many pet items of the various legislators. But this particular one is absurd.

Christopher Johnson is a pediatric intensive care physician and author of Your Critically Ill Child: Life and Death Choices Parents Must Face, How to Talk to Your Child’s Doctor: A Handbook for Parents, and How Your Child Heals: An Inside Look At Common Childhood Ailments.  He blogs at his self-titled site, Christopher Johnson, MD.

Prev

Osteopathic medicine and the growth of D.O. graduates as physicians

March 18, 2011 Kevin 22
…
Next

Slowing health costs requires answering 3 simple questions

March 19, 2011 Kevin 15
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
Osteopathic medicine and the growth of D.O. graduates as physicians
Next Post >
Slowing health costs requires answering 3 simple questions

ADVERTISEMENT

More by Christopher Johnson, MD

  • The success of Australian firearms regulation: What it could mean for children

    Christopher Johnson, MD
  • Do protocols and pathways improve care?

    Christopher Johnson, MD
  • Why are so many community hospitals transferring children to larger facilities?

    Christopher Johnson, MD

More in Policy

  • The One Big Beautiful Bill and the fragile heart of rural health care

    Holland Haynie, MD
  • Why health care leaders fail at execution—and how to fix it

    Dave Cummings, RN
  • Healing the doctor-patient relationship by attacking administrative inefficiencies

    Allen Fredrickson
  • The hidden health risks in the One Big Beautiful Bill Act

    Trevor Lyford, MPH
  • The CDC’s restructuring: Where is the voice of health care in the room?

    Tarek Khrisat, MD
  • Choosing between care and country: a dual citizen’s Independence Day reflection

    Kathleen Muldoon, PhD
  • Most Popular

  • Past Week

    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Why the U.S. mental health care system is failing and how to fix it [PODCAST]

      The Podcast by KevinMD | Podcast
    • The unseen cost of detachment in radiology

      Dr. Yesu Raju | Physician
    • I thought success was a destination. Then I became a doctor.

      Ryan Nadelson, MD | Physician
    • Why psychotherapy works and why psychotherapy fails

      Peggy A. Rothbaum, PhD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • How oral health silently affects your heart, brain, and body

      Charles Reinertsen, DMD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Why the U.S. mental health care system is failing and how to fix it [PODCAST]

      The Podcast by KevinMD | Podcast
    • The unseen cost of detachment in radiology

      Dr. Yesu Raju | Physician
    • I thought success was a destination. Then I became a doctor.

      Ryan Nadelson, MD | Physician
    • Why psychotherapy works and why psychotherapy fails

      Peggy A. Rothbaum, PhD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • How oral health silently affects your heart, brain, and body

      Charles Reinertsen, DMD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

A global view on effectiveness research
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...