Tuesday, December 2, 2008

"Evidence" is for damn dirty socialists

via Ezra Klien

I don't find the story Ezra links to in the New York Times surprising anymore... just exasperating.
The surprising news made headlines in December 2002. Generic pills for high blood pressure, which had been in use since the 1950s and cost only pennies a day, worked better than newer drugs that were up to 20 times as expensive.

The findings, from one of the biggest clinical trials ever organized by the federal government, promised to save the nation billions of dollars in treating the tens of millions of Americans with hypertension — even if the conclusions did seem to threaten pharmaceutical giants like Pfizer that were making big money on blockbuster hypertension drugs.

Six years later, though, the use of the inexpensive pills, called diuretics, is far smaller than some of the trial’s organizers had hoped.
Read the whole article, but things like this are a good way to remind ourselves that just doing more studies of comparative effectiveness won't magically make things cheaper. Anywhere where money and policy meet, there is politics, and biomedical research is big money and big politics. This ends up muddying the waters and making it harder for doctors to really know what they right call is... thus they stick with what they've been doing. Fair enough... to some extent.

I know doctors want to maintain independence and be able to prescribe whatever they want, but if they're not going to keep up with the literature in regards to what they're prescribing... or they think they think they know best whatever the so-called "evidence" says... I'm thinking that responsibility needs to be, at least partially, taken out of their hands. Is it possible to avoid taking away the autonomy, but still tilt things, with reimbursements and whatnot, to get it so the most effective drugs are the first option? Maybe "capitation" like Ezra suggests is the way to change the incentives so that doctors make these changes on their own... but obviously you need to balance cost savings with health outcomes, and I'm not convinced that free market principles can really be harnessed to that end.

Maybe we just need to say F-it and make a pill dispensing version of the Robot Surgeons.