Newtered

NEWTERED....Later today Hillary Clinton will be unveiling her healthcare plan. The New York Times reports on a few of the details:

Clinton aides said her plan would preserve a large role for private insurance companies; would promote the use of health information technology and low-cost generic drugs; and would create a public-private institute to evaluate and compare drugs, devices and medical treatments.

So what about the federal government? Well, back in the day we had an agency called AHCPR that had a small budget to compare and analyze medical therapies. Unfortunately, Newt Gingrich didn't like the idea of a federal agency potentially putting the kibosh on lucrative but useless medical technologies (makers of useless medical technologies contribute to political campaigns too, after all), so after he took over Congress he whacked it. Shannon Brownlee, author of Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, tells the whole story in "Newtered," upcoming in our October issue:

There is surprisingly little government oversight of medical practice. The Food and Drug Administration, which many people imagine oversees it, in fact only regulates the marketing of drugs and devices....When it comes to medical procedures, the FDA has zero authority to make sure they actually work. If your surgeon wants to try removing your appendix through your back, that's between you and your surgeon and the hospital.

....One day medical historians will look back at many current medical practices and see twenty-first-century equivalents of bloodletting and leeches. According to the Institute of Medicine, perhaps half of medical practice is based on valid evidence. Dr. David Eddy, an expert in the field of medical evidence, thinks as little as 15 percent of what doctors do is based on good science.

....Of our more than $2 trillion national health care bill, we devote less than one-tenth of 1 percent to answering the myriad questions about what actually works in medicine. What's the best way to get people to lose weight and exercise in order to prevent heart disease and diabetes? Nobody knows. Is a cesarean section necessary if a woman's previous child was delivered by cesarean? Can a million-dollar da Vinci surgical robot, touted by many hospitals that have purchased the device, really improve outcomes, or is it just a fancy way to spend money? If a man has prostate cancer, which remedy is best? There are four different surgeries, several types of implantable radioactive seeds, and multiple external radiation regimens to choose from. Macular degeneration, a disease that causes blindness in 200,000 Americans each year, can be treated with one of two drugs, Lucentis or Avastin, but thre's no head-to-head evidence to show which one is better, or which one is best for a particular patient.

....All of which points to the need for a national strategy for improving the evidence base of medicine. We need an independent agency that would fund systematic reviews of the medical literature, as well as clinical trials to test the comparative effectiveness of everything from drugs to treatments. An agency that could help Medicare and other payers know what to cover, and what's still experimental. An agency, in short, that would look a lot like the AHCPR probably would today if it hadn't been derailed in 1996.

It doesn't much matter who does it, as long as the job gets done. It could be a new institute, as Senators Barack Obama and Hillary Clinton have called for. The NIH could take it on, provided the director could be persuaded that testing existing treatments is as important as finding new cures. Or, it could be a beefed-up version of the AHRQ.

This whole topic, by the way, is sort of the red headed stepchild of the universal healthcare debate. Mostly we talk about how to fund universal care and how to cover everyone, but it's equally important to talk about strategies for reining in costs. A serious program does both.