Lifelong Health by Dr. David Lipschitz

Proposed health care reform will likely include increased funding for comparative effectiveness research, where one form of treatment is compared with another to determine which approach is best. Recently, Sen. Tom Coburn, R-Okla., attacked this element of the legislation, claiming that comparative effectiveness research is dangerous and a clear reason to oppose health care reform. He is concerned that irreparable harm will come to the 30 percent of patients who will not receive a specific treatment because it was proven to be of no value, dangerous or not as good as other approaches to care.

The senator maintains that no physician would ever treat or perform a procedure that was of no proven value. Unfortunately, that is simply not the case. The evidence is compelling that we frequently provide unnecessary, unduly expensive and potentially harmful care.

The purpose of comparing one approach to treatment with another is to educate the physician and the patient. Patients should be provided with as much information as possible to feel sufficiently empowered to choose the right treatment. By truly understanding the pros and cons of any therapy, the physician and patient will feel comfortable that the best approach is being undertaken. More importantly, this sort of research provides basic guidelines for best practices in virtually every aspect of medical care. By funding comparative effectiveness research, we are promoting and valuing evidence-based medicine — which is a vital component to health care reform.

I see the need for evidence-based medicine every day. Recently an 88-year-old patient complained to her cardiologist that her legs were swollen and “blotchy.” The cardiologist determined it was an indicator of vascular disease, even though there was no evidence to support it. He ordered a CT scan of the arteries of her abdomen and legs. The scan showed significant narrowing of her arteries, which is very common in adults her age. She was immediately referred to a colleague who planned an angiogram and an angioplasty to open up the narrowed vessels. Before agreeing to the treatment, she came to see me.

We elected not to do the angiogram, as she had no symptoms of vascular disease and the procedure would not improve her quality of life.

The specialists who evaluated this patient sincerely believed that the diagnostic and therapeutic approach was appropriate, even though there is no evidence that this treatment was of value at her age. Moreover, the side effects are significant. For every patient who elects not to do this sort of treatment, there are many more who blindly trust their doctors and undergo potentially dangerous therapies.

The importance of understanding the benefits and disadvantages of treatment is further illustrated by a study published in The New England Journal of Medicine. Researchers examined the amount of irradiation more than 1 million middle-aged adults received from diagnostic tests. Remarkably, 19 out of every 1,000 individuals received sufficient radiation to increase the risk of cancer. The single most frequent test causing excessive irradiation was a CT scan of the heart to screen for coronary artery disease. Many patients have this test on more than one occasion, and many institutions actively market the Heartsaver CT at a very low cost in the hope of identifying heart disease. Sadly, studies have shown that neither the staff nor the patient understands that the amount of irradiation received is excessive and that the test should never be used as a screening tool. With clear government-funded research and guidelines for care, this sort of unnecessary and dangerous treatment could be avoided.

Comparative effectiveness research is not an underhanded approach to eliminate the state-of-the-art medicine that characterizes the American system and has brought many scientific breakthroughs in recent history. Rather, it is to determine when these cutting-edge techniques are appropriate. In addition, as these advances in care become widespread, comparing one approach to another becomes all the more important.

In America, no one should have unnecessary, inappropriate and dangerous therapies. Supporting research to determine which treatments are most appropriate is not rationing health care. Rather, it is promoting rational health care — something that everyone should wholeheartedly support.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.DrDavidHealth.com.

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