If you have a cold, what should you do? Take aspirin? Vitamin C? Flush your sinuses out with a little pot that looks like a lamp a kid would rub to release a genie? (I have one of those.) What about pain from gallstones? Should you let a doctor take out your gall bladder? (I used to have one of those.)
Dr. Elliott S. Fisher of Dartmouth Medical School in Hanover, New Hampshire talked to The New York Times this weekend about funding in the stimulus bill for what is known as effectiveness research. The money will be for “head-to-head comparisons of different treatments,” he told Robert Pear for a Sunday story. (Dartmouth has led in this area of research – finding out what works and what doesn’t.)
The research, as he told the Times, will ask questions like:
Is it better to treat severe neck pain with surgery or a combination of physical therapy, exercise and medications? What is the best combination of “talk therapy” and prescription drugs to treat mild depression? How do drugs and “watchful waiting” compare with surgery as a treatment for leg pain that results from blockage of the arteries in the lower legs? Is it better to treat chronic heart failure by medications alone or by drugs and home monitoring of a patient’s blood pressure and weight?
Conservatives, however, object to what they see as the government dictating – often via bedside computers — how doctors should deliver care. They used to call it “cookbook medicine.”
Here’s what radio host Rush Limbaugh said about it last week:
The stimulus pork bill being voted on in the Senate contains the nationalization of health care, the computerization of everybody’s health records, rationing of medical care for seasoned citizens. (Editor’s note – RL-speak for the elderly) If you’re a seasoned citizen and you go to the doctor, you have an ailment of some kind, the doctor will do a test. The doctor will then consult your medical records. The doctor will then consult federal guidelines to find out if you are to be treated. And if the cost of your treatment as a seasoned citizen is deemed by the government to be too expensive based on how much longer you have to live, then you don’t get treated.
Here’s a response to Limbaugh from a blog called Media Matters, which promises to correct “conservative misinformation in the U.S. media.”
The bill “does not establish authority to ‘monitor treatments’ or restrict what ‘your doctor is doing’ with regard to patient care, but rather addresses establishing an electronic records system such that doctors would have complete, accurate information about their patients “to help guide medical decisions at the time and place of care.”
So, expect to see effectiveness research cast one way by the administration and very differently by Limbaugh-style conservatives.
2/20 Update — WBUR’s On Point did a show on this recently — Getting Health Costs Right
2/24 — I see the Washington Times compared this approach to Nazis doctors experimenting on Jews, complete with a photo of the führer.