Applied Statistics

Does the Senate Finance Committee version of the health-care bill threaten to cripple evidence-based medicine?

Posted by Andrew Gelman on November 22, 2009
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A colleague sent me an article by Harry Selker and Alastair Wood about the rules for comparative effectiveness research (“evidence-based medicine”) in the House and Senate versions of the health-care bill. The key point:

The [Senate] Finance Committee bill also includes language requested by industry lobbyists (pages 1138-1139) that threatens to withdraw federal funding for 5 years from any investigator who publishes a report on research funded by the proposed institute that is not “within the bounds of and entirely consistent with the evidence.” Determinations regarding such consistency would be made by the newly created research entity, which would have industry involvement both in its governance and in study design.

Selker and Wood continue:

To allow scientists — and their institutions, which receive the support for the conduct of research — to be punished for the publication of work that is not approved by this entity is essentially to cede authority over the dissemination of government-funded research to a body that is at least partially controlled by persons with a potential commercial interest in its outcome. This move would be a major retrograde step that would both inhibit the conduct of CER and call its integrity into question. In addition, because researchers and their institutions will seek to avoid such punishment, this provision is likely to result in prolonged arguments, taking place out of public view, regarding which data are acceptable to publish, thereby impeding and delaying publication.

I don’t really know anything about the details here–this was just something sent to me by email–but I’m inclined to agree that this kind of gag order can’t be a good idea.

If any of you know more about this, feel free to comment and educate me on this.

P.S. The second author of this article works for Symphony Capital, a New-York based company that describes itself as a “private equity firm dedicated to collaborating with leading innovative biopharmaceutical companies, helping them capture more of the value in their most important clinical development programs.” I don’t know where that puts them on any conflict-of-interest scale. (As a sometime consultant myself, I certainly wouldn’t say that working for a private investment firm should automatically disqualify someone from opining on these topics.

P.P.S. The answer is no. The offending language is no longer in the bill (perhaps in response to Selker and Wood’s article).

P.P.P.S. Somebody checked again, and the offending language is still there!

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Comments

  1. #1 ZBicyclist
    November 22, 2009

    Fundamentally, the entire health care “dialogue” is mostly so much bad faith by the vested interests and the uninformed.

    This is being done so fast, and with such attention to getting 60 votes, that there are probably dozens of things that either (a) are this stupid, or (b) are this malevolent or (c) are this poorly thought out.

    Perhaps the only way to get ANY bill through the American political process is to get it through and hope you have the votes to clean up some of the really stupid stuff later.

    Historical question: did this happen with Medicare? Doesn’t seem to me that it did (i.e. that stuff was cleaned up later). I don’t know enough to post intelligently on those events, but perhaps there are others lurking around who know more.

  2. #2 David
    November 22, 2009

    Blocking federal funding to scientists who publish reports not consistent with evidence is heavy-handed, and it potentially creates a new level of bureaucracy susceptible to manipulation. But it has the potential to silence pseudoscience. After all, which doctors (witch doctors?) publish unsupportable nonsense? As I see it, most of the grant recipients who feed at the trough of NCCAM would be put out of business.

    Real scientists publish credible papers supported by facts. Unless the new bureaucracy is politically manipulated they have nothing to fear.

    So my gut impression is that this is a bad thing, because of the potential for manipulation, but I do see a potential bright side.