Agreeing with the President on comparative effectiveness

A physician friend, who wishes to remain anonymous, sent me this guest commentary.

This article (Take the red pill, Mr. President) has a good time poking fun at President Obama for choosing the wrong color, for those who remember a particular movie scene:

“If there’s a blue pill and a red pill, and the blue pill is half the price of the red pill and works just as well, why not pay half price for the thing that’s going to make you well?” — President Obama

In last night’s press conference, President Obama seemed to be reliving that famous scene from The Matrix. The main character is offered a choice between a red pill that makes him see reality for what it is, and a blue pill that allows him to continue living in a pleasant world of illusions.

With his example of the red and blue pills, and another about whether a child’s hypothetical tonsils should be removed, President Obama unwittingly presents the real problem with his plan for reform. Here is a well-meaning government official who so fails to grasp the problem in health care that he can present such absurd oversimplifications and suggest that this sort of thing is the real problem — doctors simply lack the common sense to make obvious medical decisions. President Obama wants us to solve this problem by putting himself and other government officials in charge of rescuing medicine from the medical profession. If medical doctors with a decade of schooling cannot distinguish between good cures and ineffective ones that must be discontinued, then by gosh, we’re lucky that the good folks from the government can.

The article also makes a serious point, arguing against comparative effectiveness testing, telling us that doctors have enough common sense to make correct choices without government help.  The problem is that the choices rely not just on common sense, but also on information, which is not free.

As an example of such a choice, currently doctors use Ritalin for ADHD, based on studies financed by pharmaceutical companies showing its effectiveness.  But what if caffeine is equally effective and better tolerated?  No company would do a study on this because no one can patent caffeine.  As a result, doctors practicing “evidence-based medicine” choose Ritalin, when for all we know caffeine may be better.

Comparative effectiveness studies are to answer questions of this sort.  Since no one else is ready to pay to study caffeine versus Ritalin, why not have to government pay for the study if there is a reasonable expectation of saving money by using a lower cost or better alternative?

July 23, 2009

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