Morons and Others with Vested Interest Lead Charge to Keep Logic Out of Medical Decision Making

When I was working my way through college as a nurse’s aid at the community hospital in my hometown of Olympia, WA, one of the things we used to do for backpain was put these little electrical stimulation devices called “TENS” units on people’s backs. Well about fifteen years ago some doctors published a study showing that TENS units (manufactured by Medtronics) were useless for back pain. And what was the response? Everyone glad to learn what does and does not work for back pain? Of course not. Since they couldn’t do anything to the doctors directly (you can read their story in the excellent book Hope or Hype: The Obsession with Medical Advances and the High Cost of False Medical Promises, by Richard Deyo MD and Donald Patrick PhD), Medtronics got their Republican buddies to cut the funding to the federal agency that funded their research.

Bravo!

Now the morons are back with a vengence, this time to fight against President Barack Obama’s plan to spend one billion dollars on research to evaluate the effectiveness of different medical treatments (comparative effectiveness research, or CER). God forbid that coronary artery bypass graft (CABG) surgery should be found to have no effect on long-term survival for 97% of patients with heart disease, or that prostate and breast cancer screening have no effect on mortality. Come to think of it, other than antibiotics for someone with a raging infection or a pint of blood for someone about to bleed to death, most things that doctors do are not that clearly linked to preventing death.

I wrote a few months ago about the Republicans attempt to scuttle CER in Congress. Now the medical industry has funded a lobbying group called the Partnership to Improve Patient Care, which trots out the bogus arguments that using logic to determine which treatments work best is wrong because clinical studies do not represent underserved groups like minorities, or that it will lead to the government telling doctors which treatments to use. The National Alliance for Mental Illness (NAMI), a patient advocate group, has also come out as their ally and against using logic and research to evaluate treatments, probably because 56% of their funding comes from drug companies. 

They get backing from right wing radio hosts like Rush Limbaugh, who says that the government is trying to get electronic medical records so they can keep track of what your doctor is doing, and CER is designed to use the government to force your doctor to treat you the way they want you to be treated.

Nuff said

They trot out Britain’s National Institute of Clinical Excellence, or NICE, as an example of government interference.

Now that's not NICE!

Well NICE is a great resource for reviewing the evidence related to the efficacy of different medical treatments, and is sure better than reading the drivel written by many expert consensus committees in the US, which is barely a notch above the fake journal Australasian Journal of Bone and Joint Medicine created and written by Merck to promote its goal of getting all women tested with bone mineral density (BMD), so they can, of course, take their anti-osteoporosis bisphosphonate drugs (see a sample copy here). Merck paid the publisher Elsevier to publish it since they could reprint content already published in Elsevier journals like The Lancet, and appointed an “honorary advisory board” of physicians who apparently did nothing but probably got paid for it anyway. The “journal” contains articles that muse about getting more women on alendronate that bizarrely contain only one or two references.

This week’s New England Journal of Medicine has several commentaries that blow the arguments of the bogus “Partnership” out of the water. First, Garber and Tunis address the straw man that CER will have a negative impact on “personalized medicine,” i.e. that research on groups can only be applied to groups and somehow detracts from individually tailored treatments. They point out that personalized medicine (e.g., genetic testing to pick people most sensitive to a particular drug for breast cancer) is based on research, and that much of that research has not shown things evoked in the “personalized medicine” area to be all that useful. Avorn addresses the argument that CER will lead to government mandates about what kind of care doctors provide as well as rationing. He appropriately argues that the amount to be spent equals less than .05% of the 2 trillion currently spent on healthcare each year, and wouldn’t any company want to know if it’s products work? Whey shouldn’t the US want to know if its healthcare products work? And with medical care comprising 16% of the gross domestic product (GDP) and growing, we are in an emergency and have to do something.