President Obama speaks about his grandmother's death and the questions it raises about end of life care in an interview published in this weekend's New York Times Magazine. It's a thoughtful and frank public airing of a painful topic. The Times' Peter Baker wrote a related article linking the president's comments to the politics of health reform. The questions Baker raises about scarce resources and decision-making were perfectly legitimate, given the political moment we are in, but they aren't the questions that came to my mind as I read the piece. (On the web, the relevant portion of the magazine interview starts at the end of page 4).
The questions I wonder about were why, exactly, did Madelyn Dunham (Obama's grandmother) get hip replacement surgery given that she was suffering from heart disease, terminal cancer and possibly had had a stroke. I'm not talking about the cost, here. I'm talking about whether it was really the best option for her, or whether she was a victim of our procedure-driven "let's do it because we can" medicine. Did she fully understand the risks and implications, not just while she was in surgery but during the recovery? How well did anyone explain other less invasive options? Who—if anyone—was coordinating her care? Were the various specialists (that may have included oncologist, surgeon, cardiologist, orthopedist, hospitalist and/or internist and who knows who else) communicating and how? Was a pain or palliative care specialist consulted?
You know all those polls that show Americans distrust Congress—but like their own Congressman (or woman)? Well, here's the health care corollary. About half of Americans now believe that people get unnecessary tests and treatments. But—yep, you guessed it—the tests and treatments they themselves get aren't unnecessary.
Half of those surveyed said we have a "major problem" with unnecessary tests and treatments, and two-thirds said too many patients are "not getting medical tests and treatments they need." But only 16 percent thought they had ever received any unnecessary care. Guess it's the Dartmouth Atlas equivalent of NIMBY.
We've heard from insurers, businesses, politicians, think tanks, concerned citizens, and many other groups interested in health care reform. This week, a new paper from the Center for American Progress focuses on ensuring that the professionals who actually provide care have their voices heard in the debate.
In Health Reform: Delivering for Those Who Deliver Health Care, co-authors Robert A. Berenson and CAP Associate Director of Health Policy Ellen-Marie Whelan argue that health care professionals have an essential role to play in the health reform debate, and their active engagment can help produce a better system for both patients and clinicians.
We wrote earlier this week about generic drug use increasing between 2004 and 2008. This is good news for the Blue Cross Blue Shield Association—over the past several years, they've been working to promote the use of generic drugs to save money while maintaining safety and effectiveness. BCBS presented the results of their efforts this week at the event Generic Drugs: A Proven Way to Enhance Quality and Value.
Blue Cross Blue Shield increased utilization of generic drugs by five percent between 2007 and 2008 through a combination of community outreach, media campaigns to inform doctors and patients about the benefits of generic drugs, and partnerships with employers. Blue Cross Blue Shield analyzed 51 million subscribers in 32 Blue Cross Blue Shield companies, and found that the increase in generic drug use yielded 2.5 billion dollars in savings.
We're beginning to get some ideas of what the comparative effectiveness research under the stimulus package may look like, at least the portion under the NIH's purview. NIH this week listed challenge grants, including several dozen comparative effectiveness topics ranging from treating alcoholism to detecting Alzheimer's to the pros and cons of robotic vs conventional surgery.
Round one of the comparative effectiveness played out during Congress's consideration of the stimulus bill this Winter, and $1.1 billion for the research survived. It's a bit quieter on that front at the moment as attention focuses on financing health care and the role of a public plan. But we strongly suspect we'll be hearing more about comparative effectiveness again shortly as part of the attempt to lump many aspects of health reform under the scary-sounding banner of "Socialized Medicine."
So let's look at the NIH list for a minute and remind ourselves about what we could gain from this research. Multiple hat tips to the WSJ Health blog, which spotted the NIH list first, and noted that it means "scrutiny for some of the best-selling drugs for heart conditions and asthma, among others."
(we're reposting this to correct a typo that might have confused you.. we wrote "payments" once where we meant "patients"..our proofreader was apparently too fixated on the ear to use his eyes...)
Not many people can incorporate Machiavelli, chemical energy barriers, and proton beam therapy for prostate cancer into a single health reform speech to a bunch of doctors in a hotel ballroom, but Ezekiel Emanuel did just that this week.
Zeke Emanuel, an oncologist and chair of Bioethics at NIH who is now a health policy adviser to OMB director Peter Orszag, went over what (to our blog readers) is probably familiar ground about health care cost trends, quality and evidence gaps, treatment patterns, and how parts of the country that pay more for health care don't get more in actual health.
Wonder what comparative effectiveness could actually look like? Check out Consumer Reports Best Buy Drugs.
For the past four years, the same folks who help you decide what car to buy and which toaster to purchase, have been putting out independent, unbiased easy-to-understand information to help consumers make informed decisions on what drugs work best for them. After all, if even super-health literate informed patients—like New York Times "Well" columnist Tara Parker-Pope—end up paying for expensive new drugs when cheaper older ones did the job, a bit of objective guidance should help the rest of us. And that means knowing, too, when it's worth spending the extra money on a better medication that will help us heal faster or keep a chronic condition under control.
We got the latest hard copy from our friends at Consumer Union (the parent organization and publisher of the well-known magazine), but the entire project is available online at: www.crbestbuydrugs.org
New America is in the midst of moving offices... in a snowstorm... and our server has been down... and we're still holding our Capitol Hill event today on the future of the health insurance marketplace... In the midst of all this health reform news... So we're going to quickly catch you up on a few things that caught our eye, and weigh in more as soon as we figure out the phones and find the missing keyboards....
1) You know of course it's Kathleen Sebelius to HHS, but both the New York Times and the Washington Post take a look both at her grasp of the health care issue and the trouble she, a Democratic governor, had in trying to reform health care in a very red state. But she's not in Kansas anymore, and she'll have more health-minded allies in a Democratic Congress. President Obama, in his budget, has already started the heavy lifting.
We wrote several posts (including here and here) about comparative effectiveness in the economic stimulus package. The Los Angeles Times has a nice account of how the conservative attack on the proposal unfolded—as well how health reform advocacy groups launched a strong and organized counterattack.
The "ferocity of the struggle," as the newspaper put it, surprised observers who had not anticipated that comparative effectiveness (in this case, government-backed research into which treatments work and which ones do not) would ignite such a fierce opening battle in the health care wars. Foes of the research depicted it as the first step down the path to—you guessed it —socialized medicine. Or worse.
Rush Limbaugh joined the fray. So did an Iowa advocacy group that targeted Capitol Hill with a fierce e-mail campaign. The conservative Washington Times suggested that what Obama wanted to do might lead to Nazi-style euthanasia, and the paper posted a photo of Adolf Hitler next to an editorial denouncing the bill.
We recently blogged about a report by the American Cancer Society and the Kaiser Family Foundation on the costs of cancer. More specifically, we wrote about how vulnerable even people with health insurance can be when they get a serious and costly disease like cancer.
Merrill Goozner, a blogger and author whose work we like reading, commented that we should have written more about the reasons cancer costs are so high, especially the pricey new drugs. At the Kaiser event itself, he had also raised a very intriguing point about how to glean knowledge from ongoing cancer treatment, which can be a sort of a trial and error affair for individual patients. The goal is to harness that clinical experience so we can do a better job treating other patients with a similar disease and trajectory, or as he put it, how we can "turn cancer care into a learning system." We'll come back to that in a moment.