NYT Editorial on 'Comparative Effective Research'

Discussion in 'Healthcare/Insurance/Govt Healthcare' started by Epsilon Delta, May 18, 2011.

  1. Epsilon Delta
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    Epsilon Delta Jedi Master

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    Thought it was interesting and thought I'd share:

    http://www.nytimes.com/2011/05/17/opinion/17tue2.html?src=recg
     
  2. Quantum Windbag
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    Quantum Windbag Gold Member

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    Let me see if I get the gist of this.

    Medicare should force patients to use a drug that, although is just as effective, it has more side effects and has runs a significant risk of hospitalization because, in the long run, it saves money. Isn't the NYT the same paper that harped on Palin's "death panel" characterization of this provision? Why is taking the decision out of the hands of doctors and patients a good idea?
     
  3. CrusaderFrank
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    CrusaderFrank Diamond Member

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    Wait a second. Try it like this...

    "Before you (insert any economic activity), wouldn’t you want to be sure it is the most effective and, if possible, the least costly available?"

    Uh huh...it's called "Shopping"
     
  4. Epsilon Delta
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    Epsilon Delta Jedi Master

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    No, you misunderstood the gist of it, specifically the part that states that there was no evidence that the expensive drug was any more effective than the cheap one. A two-year trial did not find that the expensive medicine was more effective (the causes for extra hospitalization were not made clear, it could have had no relation to the drugs at all). The article stresses that the finding's of the second year and product safety tests are further required.

    The point is that even if both drugs are equally effective and contain no more side-effects than one another, Pharmaceutical companies can encourage and incentivize doctors to prescribe the more expensive one, while Medicare cannot do the same for the cheap one - even if it were just as good. This is what doesn't make any sense, they're using this one example to show it - it could well occur that the second year tests are horrible and the cheap drug is unusable, at which point it shouldn't be prescribed at all. But the same could happen with any other set of drugs.
     
  5. The Rabbi
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    The Rabbi Diamond Member

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    No two drugs are exactly the same. Whether one outperformed another in a trial of 100 or 1000 or 10k people is largely irrelevant to whether the physician feels this patient would benefit from one or the other.

    Again, a big gov't bureaucracy dictating individual health care decisions will result in a much worse quality of care. Just what the Dems want.
    This is because their health care plan calls for reducing expenses. The only way to do that is to kill more people, leaving resources for others.
    IOW the Dem plan is "they want you to die. Now."
     
  6. Quantum Windbag
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    Quantum Windbag Gold Member

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    Funny, this is from your post.

    That sounds to me like there are more side effects, but maybe I just don't have the progressive mindset that thinks side effects don't count if the NYT says they don't.
     
  7. Epsilon Delta
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    Epsilon Delta Jedi Master

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    Again, let me acquaint you with the word example:

    The Avastin vs. Lucentis case is an example. The article is not endorsing one or another of these products. It's illustrating that, if your tax-funded Medicare program has access to two types of medication and both are proven to be equally safe and effective, that Medicare cannot favor the cheaper medicine. In regards to this particular case there are two potential future scenarios:

    1. The second year trial comes back, hospitalization rates are linked to Avastin use. Avastin is shown to be more worse than Lucentis, Medicare has no reason to and shouldn't encourage use of Avastin.
    2. The second year trial comes back, hospitalization rates are not linked to Avastin use. Avastin is shown to be equal in safety and efficiency as Lucentis, yet tax-funded, deficit-driving Medicare cannot encourage its doctors to switch. Assuming this is true, why shouldn't they be able to?

    Taking the example out and making it a more general case, think of it this way: Assuming Med X treats the same ailments as Med Y, and both are clinically shown to be of equal efficiency and safety with the only difference being that Med X is twice as expensive as Med Y, why should the tax-funded, deficit-driving government healthcare provider not encourage the use of the cheaper medicine? That is the question that has to be answered.

    You don't think that if a drug outperformed another drug that this would not have some impact on which drug the doctor feels would be most beneficial for a patient? One would certainly hope it does, but that's not whatsoever what the article is about anyway. The fact is that Pharmaceutical Companies (as Genentech did in this example by offering rebates to doctors) are able to encourage doctors to use one medicine over another [ie, the more expensive one].

    Doctors are not superhuman. They react to incentives just like everybody else. The point here is that private phamaceutical co's can incentivize doctors to pick more expensive medicine, but your tax-funded, deficit-driving Medicare can't incentivize them to pick the cheaper medicine. You seem rightfully concerned about "Big Gov't!" dictating health care, but you seem perfectly fine with allowing "Big Pharma" to do the same. I say, let them balance each other out at least.
     
  8. Quantum Windbag
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    Quantum Windbag Gold Member

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    Except that the very case they use as an example has worse side effects.

    Personally, I always opt for the generic, but they always have more side effects, and are usually less efficacious. A panel of doctors who have not met me, or the person who is more drug sensitive, should not be making that decision.

    That is the entire argument. Post all the examples you want, what actually matters is the individual taking the drugs.
     
  9. Epsilon Delta
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    Epsilon Delta Jedi Master

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    1. Not really, nobody can possibly know that until the full clinical trial is published.

    2. I don't think you understand. The problem are not over-the-counter medicines that you decide to buy. This entire issue is about prescription drugs. You can talk all you want about the "rugged individual with his personal choice," but such a concept is entirely absent in this issue, because most people don't know fuck-all about particular medicines. 99% of people who are prescribed a drug by their doctor will take that drug. I, for one, don't think it's too far-fetched to believe that a doctor is more qualified than I am to decide which of two obscure medications for a particular ailment is better. The problem arises from the fact that doctors are being incentivized by drug companies to sell more expensive drugs.

    Using the general example again, the doctor has a handful of options for what to prescribe, two being Med X and Med Y. He makes this choice FOR YOU - YOU don't make the choice. There IS no "personal choice" matter here. He knows both work just as well as one another, but PharmaCo corporation is going to give him a rebate for prescribing Med X so he will most likely do so, because fuck it, he knows it still works and he's going to get payed more. This becomes a social issue because of the existence of Medicare, which YOUR taxes fund. So in effect, the point here is that a decision by business executives (whose aims are to make more money, because that's what corporations do, and there's nothing wrong with that in particular) will hold sway over the person who makes these decisions for you - your doctor. At the same time, Medicare (whose aims are to control costs so that Congressmen stop screaming over the deficit and the country goes bankrupt, nothing particularly wrong with that either) is being barred from holding sway. The result? Medical costs in the United States have been and will continue to spin out of control and the problem is no longer about "the individual taking the drugs" exclusively.
     
    Last edited: May 18, 2011
  10. The Rabbi
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    The Rabbi Diamond Member

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    I dont know that anyone has shown that offering rebates or other incentives to doctors influences them to write a prescription for one drug or another.
    It's of course more complicated than you lay out. My two older brothers are doctors and I recall some incident about this where a cheaper less effective drug would have worked fine for this patient but Medicare wouldn't cover it.
    In any case I don't want Medicare dictating which drugs my doc can and cannot prescribe. If my doc prescribes the wrong one I can find another doctor or sue him. What do I do with Medicare?
     

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