One of the new talking points of ruthless and ethically challenged hacks who oppose any health care reform at all, is that adopting a comparative effectiveness program in the US will result in denial of care to the elderly, so they will die off and thereby reduce health car costs.(1) There are examples of other programs that show how these schemes work: Australia and Germany.
The fiendish comparative effectiveness plot has been adopted in several countries, including Denmark, France, Germany and the UK. Australia began a full program in the mid 1990s, and they have a record. Germany began a relatively weak comparative program in the early 1980s, which was strengthened in 2004. Overall, Germany’s fiendish scheme has been operation long enough to also have a record.(2) Let us see how many elderly died needlessly because of these genocidal schemes.
First of all, what is this comparative effectiveness research? Here is a summary of the proposed legislation from last year that is a model for current proposals.
“[It] would establish a nongovernment-affiliated Healthcare Comparative Effectiveness Research Institute that would work with healthcare experts and stakeholders in healthcare to prioritize interventions and services to be studied. A value-based medicine system of standardized comparative effectiveness and cost-effectiveness data using utilities would allow physicians to assess the total value (improvement in quality of life and/or length of life) conferred by interventions.” (3)
So far, proposals for comparative effectiveness research envision basically an informational function: conducting and evaluating studies of comparative effectiveness and cost of drugs and treatments, synthesizing the evidence, making recommendations. This information would be available to professionals and organizations to improve the cost-effectiveness of care.
Some conservatives ask whether such a thing is needed. Is it not a paternalistic, domineering power grab by arrogant bureaucrats and ‘experts’ who assert that they know better than anyone else? Perhaps. But it will provide information that is not currently available. For example, a company that wants a drug approved in the US does not have to prove that it is in any way better than a current drug. It only needs to show that the drug is safe and effective compared to no treatment.
Some power grabbing bureaucrats and arrogant paternalistic experts (such as, for example, some doctors, pharmacists, public health officials, medical ethicists, and biostatisticians) have become troubled by this practice. They wonder if it is ethical to do a trial for a new drug against a placebo, since that means some trial subjects will forego care known to be effective. They also wonder if the risks and expense of the trial are worth it if it does not even answer the most relevant question for practical use: does the new drug work better than what we are using now.
There is one good reason for testing drugs in a formal randomized controlled trial, with drug or placebo blinded to both patient and doctors, for FDA approval. Until recently it was commonly viewed as the best, and probably only, way to get an accurate and unbiased estimate of whether the drug worked and how well.
New research methods have created increased interest by pharmacists and doctors in comparative research (including trials), but drug companies are not much interested so far.(4) In general drugs companies resist drug trials and any other research that match their drug head to head against other drug and nondrug treatments. There have been several recent scandals where such research did not produce the answer one drug company or another expected to see, so they tried to quash the results.
Comparative effectiveness analysis has already produced some surprising, potentially cost saving, and health improving information. A series of trials comparing different high blood pressure medications clarified when older cheaper drugs were best to use for patient welfare, and suggested that there were many situations where they should be among the first used, instead of more expensive newer medications. (5)
The Australian program is part of its Pharmaceutical Benefits Scheme (PBS) and it covers only prescription drugs, but has a say in whether and how a drug should be reimbursed by the Australian government, and its analysis has been mandatory since 1993. So, since its recommendations determine the amount of subsidy a drug receives, it clearly has the power of life and death over the poor people of Australia.
The German program began in the early 1980s; its organization has changed, and its scope broadened and strengthened several times since then. It is currently called the Institut fur Qualitat und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) (mor or less, I am not going to try umlauts) and has broader scope that the Australian program. IQWiG provides analysis and recommendations for drugs, procedures, and equipment. Its analysis is mandatory, but it has only advisory power.
Australia’s program has been most constant in mission and organization, so let’s look at how it has killed off the elderly.
Life-expectancy in 2006 at age 65, women, Australia: 21.5 years, US: 20.3 years.
Life-expectancy in 2006 at age 65, men, Australia: 18.3 years, US: 17.4 years.
The average annual growth rate (between 1990 and 2006) in life expectancy at age 65 has been larger in Australia than the US.
Germany doesn’t look as good.
Life-expectancy in 2006 at age 65, women, Germany: 20.5 years, US: 20.3 years.
Life-expectancy in 2006 at age 65, men, Australia: 17.2 years, US: 17.4 years.
I guess they are killing the old men in Germany. I’m not sure how that can be, though, because, as with Australia, the average annual growth rate in life expectancy at age 65 has been much higher on average in Germany than the US. In 1980 the life expectancy at 65 was only 16.3 years for women in Germany while it was 18.3 in the US. In 1980 the life expectancy at 65 was only 12.8 years for men in Germany while it was 14.1 in the US. The life expectancy of 65 year olds in Germany has been rapidly catching up with those in the US.
So, I think this question of which health care systems kill off old people and which do not is very important, and should be examined carefully. Don’t you agree?
If you do feel it is important for our nation to look into the issue of health care system elder genocide carefully (especially for women), you might consider contacting the media and ask them to give the facts, rather than passively broadcasting the ravings of political extremists.
News site contacts below:
NBC and MSNBC news shows
(1) Contact the Media:Tell Them Give the Facts, and Call out the GOP on Its Depraved Health Care Scare Mongering Campaign
By: wesgpc Sunday July 26, 2009 10:28 pm
Virginia Foxx – Reliable Source
By: Jason Rosenbaum Tuesday July 28, 2009 5:00 pm
Republicans GONE WILD bat-sh*t crazy on healthcare
By: Neil Tuesday July 28, 2009 8:22 pm
Grandma’s Old Party
By: Eli Tuesday July 28, 2009 6:01 pm
(2) Kalipso Chalkidou, Sean Tunis, Ruth Lopert, Lise Rochaix, Peter T. Sawicki, Mona Nasser, And Bertrand Xerri. Comparative Effectiveness Research and Evidence-Based Health Policy: Experience from Four Countries. The Milbank Quarterly, Vol. 87, No. 2, 2009 (pp. 339–367).
(3) Melissa Brown, Betsy Luo, Heidi C. Brown, and Gary C. Brown Comparative effectiveness: its role in the healthcare system. Current Opinion in Ophthalmology 2009;20:188–194
(4) S Schneeweiss. Developments in Post-marketing Comparative Effectiveness Research. Clinical Pharmacology & Therapeutics 2007; 82:143-156.
(5) Ong H T Cardiovascular outcomes in the comparative hypertension drug trials: more consensus than controversy. Singapore Med J 2008; 49(8): 599.