Evidence? Who wants evidence?
Ezra Klein recently called for a national medical effectiveness agency:
The final point is that we don't currently have good drug effectiveness information that could help insurers make value-based decisions. As such, they make cost-based decisions. The insurers are behind a national body that would produce this research, as well they should be. Zirkelbach is suggesting that the tiering system, with its somewhat arbitrary nature, is all they can do in the meantime.
I was thinking the same thing when I wondered why the FDA doesn't actually do the clinical trials; surely, the drug companies could pay for the trials the FDA conducts, which would remove the taint of self-interest from the proceedings, and ensure that results don't get buried.
But there are, as this post notes, some political problems associated with assembling that kind of data; how does that information get used? The question I worry more about, though, is does that information get used?
I've been reading (actually, listening to) Supercrunchers, by Ian Ayres. The gist of it is that the advent of huge datasets and better statistical methods is enabling us to replace intuition with vastly superior data-based analytics.
He covers everything from predicting wine quality, to Direct Instruction, to evidence based medicine. And the major unifying theme: in every case, experts have fiercely resisted quantitative methodology. This is why DI and EBM are still not widespread, even though they clearly offer vastly superior results: the professionals who need to implement them don't want to.
Ayres attributes this to overconfidence: even when we know that the script beats the human, we still think that we can beat the script. But he does not, in my opinion, linger long enough on the major source of resistance: the script makes professional jobs less fun. Being the voice, and arms, of a computer is a lot closer to being a data entry clerk than what doctors and teachers envisioned when they entered the profession. So despite overwhelming evidence, both efforts have stalled.
If we're going to have a federal institution do anything, it should be facilitating the roll-out of these kinds of data-driven systems. But the political power is on the side of the providers. I wonder with efforts like the one Ezra proposes whether it wouldn't be dogged by similar problems.