Comparative Effectiveness Research

To perhaps make the point from yesterday’s Health Care in 1500 post a bit less obliquely, medicine is a complicated technical subject. And both historically and presently, just jiggering with different ways of paying for medicine hasn’t sufficed to wring ineffective or even counterproductive treatment methods out of the system. People who are ailing want to be cured, of course, but in a first-order sense they also just want treatment in a way that can surpass anyone’s knowledge of whether treatment would be useful. And doctors, too, are in the business of prescribing treatments and have been in that business since long before they had any effective treatments whatsoever to dispense.

Thus insofar as we want to make the allocation of health care resources not just fairer, but actually better we need to do comparative effectiveness research and try to figure out what will actually help people:

With the volume of new medical devices, drugs, and other treatments coming into the U.S. health care system, sorting through the details of each product can be a cumbersome task. Health care providers obviously want to choose the best remedy for their patients based on evidence, not anecdotes or (potentially worse) solely on information received from companies trying to promote their product. Thus, comparative effectiveness research will fill a massive information gap that has left health professionals and patients without the proper evidence to assess which treatments work best for a given condition. […]

What’s more, a better understanding of which medical treatments work and which don’t could save money. It’s estimated that one-third of procedures and treatments administered in the United States have no proven benefit and account for up to $700 billion annually in current spending. Moreover, some of these treatments can have harmful side effects, produce worse health outcomes, and then, as a result, add to the soaring costs of medical care.


Now whether this will save money or not in a budgetary sense over the long run is a question for CBO analysts and such. I don’t think it really matters. The point is that spending $700 billion a year on ineffective and counterproductive treatments is a terrible idea and wringing that spending out of the system is a great idea. Whether that $700 billion ends up getting “saved” and recycled into something else (preschool, bigger televisions, whatever) or ends up being repurposed into $700 billion in additional useful health care spending, we win either way. The point is just that a really fair and efficient way of delivering witchcraft to people isn’t so wonderful and we need to also focus on figuring out how to help people and not just “treat” them.