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In a sign of their undying loyalty to drug and device makers the Republicans have declared their opposition to a plan to add a billion dollars to the stimulus package to study the relative cost and effectiveness of different treatments for chronic conditions, a plan which President Obama is expected to sign tomorrow. I simply had to ROTFL when I read this quote in the NY Times this morning (“US To Compare Effectiveness of Treatments”):
Republican lawmakers and conservative commentators complained that the legislation would allow the federal government to intrude in a person’s health care by enforcing clinical guidelines and treatment protocols.
In other words, drug and device makers wouldn’t be allowed to use expensive treatments that don’t work! OMG!
The pharma and device maker cheerleaders don’t have any rational reason for their retarded statements so they get Rush Limbaugh to go on the air and blabber about how I don’t want the government to tell me what kind of healthcare I got and here is a caller who lived in Canada and blah blah blah blah…
The article used several examples of bogus treatments that have not been shown to be better than conservative treatments, like surgery for neck pain, or claudication (pain in legs from artery disease). In fact most of the examples involved bogus surgeries.
I hate surgeons!
As the article pointed out we now spend 16% of our gross domestic product (GDP) on healthcare, and that amount is expected to increase to 25% by 2025. The article quoted the CEO of Glaxo making a vieled reference to “other countries” who have tried to come up with rational guidelines to inform their clinical care. What he is referring to is the National Institute for Clinical Excellence (NICE) in England, where they actually evaluate what treatments do and do not work. I think the evaluations of treatments done by NICE are the best in the world. Needless to say, pharma doesn’t like it when someone does a rational evidence based assessment and comes to the conclusion that one of their drugs is useless, or no better than a cheaper generic.
Based on these guys logic, since it is a bad idea to find out if a treatment works or not we might as well go back to the treatments of choice of the middle ages, like blood letting.
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Doug,
Thanks for sharing what you did in this post.
Chronic illness has the lion’s share of health care spending, which is more unfortunate for those who are ill than us, of course.
The reasoning and logic are simply illuminating regarding the republican’s stance on such issues. I mean, why create an appropriate standard of care for the chronically ill? After all, that would improve the quality of care the chronically ill receive. And why actually determine what is in fact reasonable and necessary treatment protocols for the chronically ill?
I mean, that would help people. That’s a right wing political taboo.
By the way, Rush Limbaugh, from my home state, is nothing more than a narcisstic whore,
Dan Abshear
Thanks, Doug. My comments here:
http://pharmalittle.blogspot.com/2009/02/comparative-efficacy-hoopla.html
While I agree with you 90+% of the time, I have to disagree with your reasoning. I have no problem with funding evidence based medical trials. But to put the government in charge of establishing protocols, based on saving govt money and nothing else, is not the way to do it.
EX: let’s say a study shows 80% of people improve on a treatment, and 20% don’t. What do we do. Make it a standard of care, and force docs to treat 100% of people with a plan that helps 80%, and may hurt the other 20%.
Medical care is not cookbook, and if the govt gets control , our profession will be dragged down even further.
OBama is trying to incrementally take over control of physicians. Not a good sign for physicians, patient’s or our country.
OMG is right, Dr. B! What procedure was recently debunked — a knee surgery that was shown to be no better than placebo? At least with medication, there must be some peer-reviewed study. With these surgeries, some forcefully imperious surgeon develops it (along with a marketing model) and poof, it becomes standard.
And Rush Limbaugh, that paragon of mental health, as arbiter of healthcare policy.
As someone who suffers from chronic Lyme disease, unfortunately, I find myself in agreement with the Republicans on this one — particularly if this study actually says what the Republicans claim it will do — that is, “allow the federal government to intrude in a person’s health care by enforcing clinical guidelines and treatment protocols.”
Last year, the Connecticut Attorney General Richard Blumenthal undertook an antitrust investigation against the Infectious Diseases Society of America (IDSA) for their 2006 Lyme disease guidelines, which essentialy “disappeared” an entire class of ill patients — that being, chronic Lyme disease patients, a class to which I belong. If a guideline like this was enforced by the federal government, this would mean that I would have no access to the antibiotics that keep me from further clinical deterioration. There are many problems with the IDSA guidelines – mainly that they are biased, and the Chairman, Gary Wormser, MD, knowingly failed to disclose to IDSA that he has been consulting for the pharmaceutical company, Baxter, with regards to a future Lyme disease vaccine.
Then Dr. Wormser cherry-picked who would be on the guidelines committee, leaving off anyone who would dissent from his point of view about the disease. There were qualified, but dissenting physicians who were members of IDSA who wanted to be on the panel — but they were denied. Is Dr. Wormser’s point of view a business model of the disease that protects aspects of the consulting work he is doing for Baxter? Certainly, the guidelines do not reflect the real disease — not the disease that I have come to learn about in my own body over the last 13 years of this illness.
The IDSA guidelines are substantially different from the ILADS guidelines (the International Lyme and Associated Diseases Society, http://www.ilads.org) particularly in that ILADS recognizes the world medical literature on persistent infection, despite antibiotic treatment. However, the IDSA guidelines, under Dr. Wormser, have refused to recognize this literature. Yet, the guidelines are supposed to look at *all* of the literature — not just what supports your business model for your Lyme disease vaccine!
For Lyme disease patients such as myself, the guidelines process has been a nightmare. Keep in mind, there is no oversight. There is no one you can go to when a guidelines committee is biased and it effects your health.
What is even more peculiar about what has happened with IDSA, is that they also persuaded other medical societies (with the exception of ILADS) to “copy” their guidelines — so, as a patient, there is virtually no medical specialty for someone like myself to receive medical care from for my disabling illness, other than an ILADS member. What this means is that I have to drive 900 miles just to get antibiotics so that I can still think (the disease for me has had major neurological ramifications).
The 2006 guidelines make chronic Lyme disease patients pariahs within the medical community.
For those who scoff at the notion of chronic infection in Lyme disease, please know that after thirteen years, many of those days taking daily antibiotics — that when I go off, I continue to experience Jarisch-Herxheimer reactions when antibiotics are reintroduced. This is a sign that infection remains.
IDSA has had other “boo-boo’s” that effect people’s lives in a serious way. For example, they issued guidelines that neutropenic cancer patients should not receive prophylactic antibiotics. This was because there were no good studies showing it was necessary — although, gosh, if I was a neutropenic cancer patient, I would sure want some doc to cover me with antibiotics until my neutrophils came back up. But then a study came out demonstrating that antibiotics substantially decreased the mortality rate in this population! Well, duh!
I remember being at the IDSA convention when a physician, with contempt in his voice, announced the findings of this study and said very pointedly that the guidelines needed to be changed.
I am surprised, Doug, that you take the position you have taken knowing what you know about how corrupt the guidelines process has been shown to be — not just in Lyme disease, but in other areas. Guidelines committees are typically chock full of people with financial or other beneficial interests in a disease. There are publications on this.
While the study to compare effectiveness of treatment may sound like a good idea, in practice it doesn’t work. Guidelines need to be voluntary. IDSA and Dr. Wormser have tried to make their Lyme disease guidelines have the force of law, and they have pretty much succeeded, which is why Blumenthal brought the antitrust action against the organization.
Instead of listening to the concerns of Blumenthal and patient advocacy groups, IDSA fought the investigation, paying the law firm of Hogan & Hartson a half million dollars. They are still fighting. According to the agreement, a new panel has been chosen and it appears very biased. Some panelists have been known to make statements saying chronic infection does not exist — but the fact is, none of them see chronic Lyme disease patients in their offices, only acute Lyme. They are like two different diseases. While I hope we will prevail and that IDSA will be forced to issue fair guidelines that reflect the true scope of the medical literature, based on the composition of the committee, it suggests to me that Blumenthal’s efforts will fail.
So, oddly, on this one, I must vote with the Republicans!
Lynn Shepler MD JD
For anyone who is interested, here is the link to information regarding the antitrust investigation against IDSA.
http://www.ct.gov/AG/cwp/view.asp?A=2795&Q=414284
For further information on the Lyme debacle, I suggest readers check out the new documentary on the subject – “Under Our Skin,” by the producer Andy Abrahams Wilson of Open Eye Pictures, Sausalito, California. There is a trailer, and 13 clips from the film on YouTube.
http://www.youtube.com/watch?v=Qg7pWkTX2S8
In particular, take a look at the clip entitled, “The Perfect Storm,” that comments on the financial interests in the disease. Merrill Goozner appears in this clip.
ttp://www.youtube.com/watch?v=cwVj_IKP8mY&feature=channel
Lynn Shepler, MD JD
Doug, I wonder if you could prepare a protocol evaluating the effectiveness of trepanation on republicans.
I agree with Lynn S. that there’s great potential for abuse with this, BUT… there’s already abuse of the same sort by commercial insurers.
So it does not seem a totally valid argument against funding such research.
I agree that if we use the current American style guidelines committees it will become a disaster, but the English NICE system seems to work very well, I am not sure who is writing the NICE guidelines but they certainly don’t work for pharma as there are frequent pharma protests against them, e.g. their guidelines that dementia drugs are not worth the effort for early or advanced stage Alzheimer’s Disease, or that none of the “Z” drug (ambien, lunesta, etc) sleeping pills are better than another.
Didn’t know what trepanation is so had to look it up. Drilling a hole in the skull to let out evil spirits that cause mental diseases. I think we should try that one on Newt Gingrich.
http://en.wikipedia.org/wiki/Trepanation
Doug:
After reading your post with the responses it seems that the best alternative is to rid our system of all the special interests, corporate interests, and government political interests, and take them out of the decision making process of health care, and leave it with the individual patient and doctors.
No one knows a medical condition like the patient and the doctor. We must not let a govt body take away our healthcare rights!!
As a Democrat, I side with the Republicans on this one as well. While I support universal health care, this bill takes it too far. Doctors would first have to yield to the government to make decisions about whether it’s cost-effective to treat a patient for a serious condition. For example, if it is not cost-effective to treat someone with cancer, the government could deny that person’s claim. The healthcare inclusions in the bill pose serious risks to those with terminally diseases and the elderly should they rely on the government for healthcare.
The plan is mostly flawed.