Or so an email correspondent says, contrary to my assertion in my July 12 Examiner column. I thought his email was interesting, and pass it along with his permission. It begins by quoting the column, presents an anecdotes and then some more general thoughts.
“’But comparative effectiveness research is, if not junk science, not a fully developed intellectual enterprise. Medicine is an art as well as a science, and comparative effectiveness research may too often compare apples and oranges.’
It’s worse than junk science—it’s inherently deceptive. A personal anecdote:
I’ve a dear friend who just passed her 5 year anniversary surviving leukemia, diagnosed 8 weeks afte the birth of her daughter and 2 weeks after her 28th birthday.
She’s alive because her treatment at Sloan Kettering was highly individualized, with chemotherapy protocols driven by rigorous, *expensive* genetic analysis of her leukemia cells. The blunt instrument of ‘Comparative effectiveness’ would have ended her.
More generally, the entire concept of ‘comparative effectiveness’ goes against the cutting edge of biomedical research. Evidence mounts daily that humans are far more individualized biologically than previously believed. . . different ethnic groups, age cohorts respond to drugs in ways almost as marked as disparate genders. Comparative effectiveness testing given just those variables quickly becomes more expensive than any possible realized savings.
In short, ‘comparative effectiveness’ is sloppy, shortcut thinking that ignores reality in an attempt to end debate, rather than struggle with the difficult question of how far we individuate treatment.”
Funding for comparative effectiveness research was included in the $787 billion stimulus package passed by Congress in February, and comparative effectiveness research is one of the methods Barack Obama and the Democrats plan to use and which they say will reduce health care costs—or bend the cost curve down, in current parlance. But is comparative effectiveness research a useful tool or a meataxe that will provide worse health care than we get now? My email correspondent makes the case that it will be the latter.
