The Doctor Is In: Government-sponsored medical research will help cut health care costs
byFeb 21st 2009 8:00AM
The $787 billion economic stimulus bill signed by President Obama this week includes more than $140 billion in health care spending. $1.1 billion of that sum will fund medical research comparing the effectiveness of various treatments and drugs.
This type of research is sorely needed to provide physicians with better information so they'll have a clearer idea if a more costly treatment is actually more effective than cheaper alternatives. It will also help control spiraling health care costs by preventing the health care system and patients from spending money on unproven technology and drugs.
For instance, if researchers discover that exercise, physical therapy or medicine are more effective than spinal surgery for some patients, that alone could save tens of millions of dollars. The hope is that the cumulative effect of savings like this will keep insurance costs from rising and produce a better outcome for patients. These savings will also be passed along to the taxpayer as reduced Medicare costs.
It's not as though doctors are taking a shot in the dark when they prescribe a treatment. But many commonly used therapies have small-scale, poorly designed studies backing their efficacy. For now, if it's a toss-up between two equally effective treatments, there is the potential for over treatment with more invasive and profitable therapies, like surgery. Obviously, doctors should have the integrity to make the choice that's in the best interest of the patient. But as profit margins shrink and financial pressures grow, the allure of a therapy that's both effective and profitable may be tempting.
Critics claim that government-sponsored studies will interfere unnecessarily with the doctor-patient relationship and provide an excuse to "ration" care. It's obvious why medical device and pharmaceutical companies don't want this type of research to discredit their latest products.
Yes, some of these new medicines or technologies, such as minimally invasive surgical techniques, turn out to be of great benefit to patients. They also tend to be more expensive, are typically backed by small studies supporting their benefits and then marketed to doctors and the public with flashy ad campaigns.
But there's no lobbyist for exercise and other lifestyle modifications -- which may turn out to be just as effective as more costly new treatments.
At the same time, there needs to be room for a doctor to justify a more expensive treatment if he or she feels it's most effective for a particular patient. The hope is that it will become the exception rather than the rule once large-scale studies are done.
For instance, a choice I am often faced with in my practice is whether to treat abnormal bleeding in patients with fibroids with surgery or prescribe medicines. Over time, if a patient can't tolerate side effects of drugs like birth control pills, surgery, which is equally effective, may be necessary, even though it's significantly more expensive and invasive.
While $1.1 billion seems pricey, in the long run large, definitive studies will lead to more informed decision making.
A decade ago, 60-year-old women were routinely placed on hormone replacement therapy even if they didn't experience menopausal symptoms. As a result of the groundbreaking Framingham Heart Study of 16,000 women, which found that hormone replacement therapy actually increased the risk of heart disease and breast cancer, millions of American women were taken off of the regimen (it's still an appropriate choice for some menopausal women, but a fraction is now spent on hormones).
This study alone saved insurers and the American public billions of dollars. More importantly, it may have prevented untold numbers of women from getting breast cancer. That is priceless.
Russell Turk, M.D. is an obstretrician and gynecologist in Fairfield County, CT. You can ask him your questions about healthcare issues by leaving a comment.