Tuesday, November 16, 2010

Yes, There Really Are Death Panels

If you thought there weren’t death panels in Obamacare, here an expository piece that lays it out in some very plain language. Be very afraid . . .
An Exercise in Fatal Futility: Trying to Objectify the Subjective
Earlier in October, in a demonstration of my statistical insanity, I attended a (and presented at) conference of statisticians conferring as one might expect on statistics. The conference revolved around one particular software package the identity of which is irrelevant to this post (but if you really want to know, it’s SAS). However, one presentation I attended actually spilled over into realms of which I suspect the author was aware, but did not explicitly state at the time. An exposition of the topic is relevant to the current political landscape, so I thought I would address the gorilla in the room with the following commentary and observations since it is an interface of the kind addressed by this blog.
The paper was entitled “Comparative Effectiveness Analysis and Statistical Methodology” and if that doesn’t put you to sleep, be assured that what follows will, or should, wake you up. Let me give you the relevant portions of the paper summary as a framework for my analysis (with emphases added):
The purpose of comparative effectiveness analysis is ordinarily defined as a means to compare the benefits of drug A versus drug B. However, particularly in relation to cancer drugs, there is only drug A. Therefore, comparative effectiveness analysis tends to compare drug A to a quality adjusted threshold value, with a frequent conclusion that the cost of the drug is not worth the additional life. Ordinarily, a societal perspective is used to deny the drugs, since the additional life may be worth the drug cost for the patient. The British organization, the National Institute for Clinical Excellence (NICE) has denied many cancer drugs to their patients. The Centers for Medicaid and Medicare want to initiate a similar process, denying treatments that exceed a quality adjusted price of $50,000. There are similar provisions in the Healthcare Reform Act. With the emphasis upon medications, medical procedures are not as subject to this comparative effectiveness scrutiny; procedures can frequently exceed the cost of medication treatments. However, each medication is considered separately; no analysis examines the total contribution of the treatment to the overall cost of healthcare. more

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