March 12, 2009

Stimulus Funds Ignite Debate On Healthcare Decisions

Much is at stake when it comes to determining which health treatments are best, leading a coalition of health industry and patient advocacy groups to reframe the debate over how such decisions are made to ensure their interests are protected.

Driven by $1.1 billion in funding in the recent economic stimulus bill for "comparative effectiveness research," the coalition launched a new campaign on Thursday with former California Rep. Tony Coelho, a prominent Democrat and disability rights advocate, as its spokesman.

Coelho, who suffers from epilepsy and was a main sponsor of the Americans With Disabilities Act, said the fundamental issue is whether patients would receive the care they need.

"On this issue we need to be at the table," Coelho told the Associated Press.

"Comparative analysis is wonderful, if it's done appropriately."

Coelho's concerns echo those articulated most forcefully until now by Republicans and conservative commentators, namely that "comparative effectiveness" could translate into "cost effectiveness," with government bureaucrats refusing treatments to those who need them.

It's also a significant concern for biotech and drug firms, since they could lose out if their treatments are deemed less effective than a rival's.  However, drug company profits are not likely to generate as much public sympathy as a disabled person's healthcare needs, making Coelho a good symbol for the Partnership to Improve Patient Care.

The group formed last fall as the issue began to surface, and is funded by organizations such as Friends of Cancer Research, Easter Seals, the Alliance for Aging Research, the Advanced Medical Technology Association and influential pharmaceutical and biotech lobbies. The coalition also includes some women's and minority groups, the majority of which are nonpaying members.

These groups argue they can be underrepresented in studies of medical procedures and seek to ensure that doesn't happen with the stimulus funds.   Their concern is that "research done with a very limited segment of the population would be applied to everyone," said Alicia Diaz, federal affairs director for the Cuban American National Council, in remarks made after the partnership's press conference Thursday.

However, officials with the Obama administration say that won't happen, pointing to part of the economic stimulus bill that requires comparative effectiveness research to include minorities and women, and pledging inclusion of disabled people as well.

The purpose of the research is to provide doctors and patients with information to assist them in generating the best possible outcomes, and to improve the performance of the U.S. health system, according to administration officials.

"Information about the relative advantages of different treatments is critical to helping people with disabilities be better advocates for their own care," Jenny Backus, a spokeswoman for the Health and Human Services, said Thursday.

Replying to questions about whether or not reducing costs was also a goal, Backus said the research is "really about quality of care."

The controversy about the issue grew out of language accompanying a House version of the bill, which suggested that comparative effectiveness research would result in less effective and expensive procedures "no longer be prescribed."

However, the final bill contained different language, specifying no intent to "mandate coverage, reimbursement or other policies for any public or private payer."

Additional information about the Partnership to Improve Patient Care can be viewed at the organization's Web site, http://www.improvepatientcare.org/ .