This afternoon, Reps. Kurt Schrader (D-OR), Ron Kind (D-WI), and Allyson Schwartz (D-PA) hosted a conference call to announce the Comparative Effectiveness Research Act of 2009. The lawmakers acknowledged that our current health care system wastes billions of dollars on unnecessary or ineffective treatments or procedures and argued that research that compares the clinical outcomes of alternative therapies used to manage the same condition could help lower the nation’s health care spending. The bill establishes an independent institute for comparative effectiveness research and a 21-member board of health care stakeholders to oversee the process.
The conference call announcing the legislation included Tony Coelho the chairman of the Partnership to Improve Patient Care (PIPC), the lobbying arms of the drug, device and biotechnology industries. The group seeks to “give industry a seat at the table when federal officials decide what to research” and during the call, Coelho emphasized the importance of a patient-centered approach to comparative effectiveness research:
I’m encouraged by inclusion of these safeguards in this bill…my concern is that cost containment will become the main goal [of research] leading to the misuse of comparative effectiveness studies to approve one size fits all polices that prevent patients from getting access to the care they need.
In January, a coalition of groups who accept money from the pharmaceutical industry sent a letter to Capitol Hill demanding “that any agencies conducting comparative effectiveness reviews be run ‘through an open and transparent process that allows for patients, providers and other stakeholders to participate equally in governance and input, starting from the research planning stage.”
The industry is interested in controlling the data, “how it is reviewed, evaluated, and whether the public and government find out about it and use it.” This is why their seat on the 21-member board is so critical. The lawmakers on the call indicated that the Governing Board would consist of 3 members from each interest group. The public, private industry, and health quality researchers would all be represented. But why should pharmaceutics companies “have a the right to veto controversial inquiries and limit the scope of the research that gets done?” As Merrill Goozner asks, “do publicly traded companies have a seat on the governing board of the Securities and Exchange Commission? Should we give Boeing and Airbus the right to determine the scope of the National Transportation Safety Board’s inquiry into airplane crashes? Does the current financial crisis suggest the banks should have more say over how they are regulated?”
Private industry should not be vetoing the decisions of health quality researchers and the government shouldn’t dictate a certain course of treatment. That should be left to the patient and her/his doctor.
But to reduce the waste in our system, the government can and should provide incentives for providers to focus on care quality. This bill, however, specifies that any research the institute produces “cannot be used to define policy guidelines or mandate any particular regiment or treatment.”
If we can’t guide providers towards adopting best policy practices, then what, after all, is the goal of comparative effectiveness research? If we’re really serious about lowering health care costs and enhancing care value, then the first step is comparative effectiveness research. But as the CBO points out, to really generate savings, “we will need legislation to provide incentives on penalties for following or not following where that information leads.” That isn’t health care rationing. It’s just smart medicine and good economic policy.