If "Evidence Based Medicine" is like "Sex Based Intercourse" then "Comparative Effectiveness Medicine" is like . . .?

President Obama is in a bit of a bind, lets face it with his laudable goal to have health coverage for all uninsured Americans. The health care math is simple: we already spend a ton on health care and his goal will require spending more.  His options are to generate new revenue, or the other option (the needed option, I would say) is to cut costs. But you saw what happened to Hilary years ago when she tried that. To quote from a great series of articles in the Annals of Internal Medicine, "A dollar spent on medical care is a dollar of income for someone."  Cutting costs means cutting income for lots of different players and they won't be happy, and yet there seems to be no other way.

But President Obama thinks he can raise money largely through three methods that no one has proven can save money:

1) Investing in Information Technology: I don't see how that saves money but it does ensure that America's doctors will get better tans on their faces from long exposure to screen glow; the iPatient in the computer will get great care while the patient in the bed will wonder where the doctors are.

2) Preventive medicine: Studies actually suggest this usually costs more money, despite all the theories of how it should save money 

3) And finally the President wants to invest in "Comparative Effectiveness" research so that we only pay for what works.

What helped create our present mess is a payment system that rewards procedures and expensive  diagnostic testing, but does not reward primary care; it has necessarily resulted in a profusion of people and places who do things that are well reimbursed and a dearth of physicians doing primary care.  We don't need comparative effectiveness research as much as we need a retooling of the payment system and some caps on spending.  Let's pay for what works right now, and stop paying for what's not needed.

I worry that "Comparative Effectiveness"  or "CE" is going to be the next medical buzz word, just like "Evidence Based Medicine" or "EBM" has been the buzz word for a decade.  "Evidence Based Medicine" is a term which makes about as much sense as "Sex-based intercourse"--Were we practicing based on zodiac signs before EBM came along?  (By the way, I borrowed "sex based intercourse" after hearing a prominent chair of medicine say it--I don't know if he coined it, but I thought it was brilliant). Soon we'll have a generation of physicians who are CE experts to bump out the EBM experts.

Lets take away the incentives to do to patient and instead create incentives to do for patients, to be with patients. We don't need to do comparative effectiveness trials to see if that works; we can just ask patients.

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Abraham Verghese is an author, physician and med school professor. He is the author of Cutting for Stone and his writing has appeared in many major publications. More

Abraham Verghese is a physician and writer. His third book and first novel, Cutting for Stone, was published by Knopf in 2009. He is also known for two acclaimed non-fiction works, My Own Country, which was based on his experiences working with persons living with HIV in Johnson City, Tennessee; that book was a finalist for the National Book Critics Circle award and was made into a movie. He followed that with The Tennis Partner, also a New York Times notable book and a national bestseller. His writing has appeared in The Atlantic, The New Yorker, The New York Times , The New York Times Magazine, Sports Illustrated, and The Wall Street Journal as well as many medical journals. Verghese is board-certified in internal medicine, pulmonary medicine and infectious diseases. He attended the Iowa Writers Workshop at the University of Iowa where he earned his MFA. He currently practices and teaches at Stanford University School of Medicine where he is a tenured Professor and Senior Associate Chair for the Theory and Practice of Medicine in the Department of Internal Medicine.

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