Healthcare Realpolitik

  • by: |
  • 03/30/2007
Some key take-aways from yesterday’s joint Center for Medicine in the Public Interest/Old Dominion University conference on Comparative Effectiveness:

• My opening question to the panel was whether or not comparative effectiveness (aka evidence-based medicine, aka healthcare technology assessment, aka rational use of medicine) was focusing on cost rather than care. Practice variation vs. patient variation.

•Carolyn Clancy (Director of AHRQ) remarked that we need to capture clinical data from off-label prescribing.

• Scott Gottlieb pointed out that the value of studying Avastin vs. Erbitux or Actos vs. Januvia is of no value – but that studying Avastin+ Erbitux and Actos + Januvia would yield important clinical information.

In short – if you don’t ask the right questions, you won’t necessarily get the wrong answers – but you won’t get the answers that will help improve patient care on the clinical level.

There was much conversation about the relative benefits of RCTs vs real life epidemiological data (like off-label prescribing outcomes). Look at it this way – consider each separate pieces of software designed for different purposes. Both are relevant to any discussion of comparative effectiveness – but only one “software” is used – RCTs (by DERP, Consumers Union, etc.). We need to design a software interface that will allow these two data sets to “talk” with each other.

The time for puritanical allegiance to RCTs is coming to an end.

Panelists were also brutally honest when it came to the question of cost-over-care, the new health care realpolitk, agreeing that when it comes to Washington, DC – cost containment will win out over patient care every time.

Unfortunately I agree – that’s the way it is right now. But that has to change. As John Bridges (Johns Hopkins Bloomberg School of Public Health) commented, “There is no health care without the patient.”

When it comes to changing the short term, politically-driven cost-over-care debate to a long term, patient-focused right-care-for-the-right-patient at-the-right-time paradigm, yesterday’s debate wasn’t the end, or even the beginning of the end but, hopefully, the end of the beginning.

And, when that day comes, it will indeed be health care's finest hour.

Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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