Thursday, March 12, 2009

Doctors Vs. Begley

The March 9, 2009 Newsweek published an inflammatory piece by Sharon Begley entitled, "Why Doctors Hate Science".

Her basic premise is that doctors refuse to follow science, which is why we need "comparative effectiveness" research to help guide them into appropriate practice patterns.

Others have warned that this is just a smokescreen for government control of medicine (and subsequent rationing). Of course doctors don't hate science -- that's the basis of our profession. But we do hate bureaucrats telling us how to practice. As I wrote in my DC Examiner piece:
The Obama administration would control costs by creating a new Federal Coordinating Council for Comparative Effectiveness Research to determine which treatments are deemed most effective and thus eligible to be paid for by government. These decisions would be based on statistical averages that cannot take into account specific facts of individual patients.

Yet good physicians must consider precisely these specifics when treating their patients. If you are suffering from abdominal pain due to gallstones, who should decide whether medication or surgery would be more effective for you?

The doctor who has felt your abdomen, listened to your heartbeat, and knows your drug allergies? Or the bureaucrat who got his job by telling the right joke to the right person at the right Washington cocktail party?
And now physician-blogger "Orac" has chimed in with his own debunking of Begley's article entitled, "'Why doctors hate science'? More like: Why does Sharon Begley hate doctors?"

I don't necessarily agree with all of Orac's points, but he is correct to note that comparative effectiveness research is going to be used to control costs.

My contention is that it's also going to be used to control physicians. If the government says, "A is cheaper than B, therefore we'll only pay for A", what's going to happen when the doctor believes that B is better for his patient?