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February 24, 2012

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Conventional Wisdom: Top-notch health care depends on preserving a diversity of options and patient choice.

The Contrarian: Elizabeth DeVita-Raeburn says we need fewer choices and more evidence.

Americans have always valued the right to make their own choices, especially about health care. So it is not surprising that federal health-care reform, popularly known as Obamacare, has sparked fears that the wise counsel of doctors could be replaced by the rubber stamps of government bureaucrats. The common belief is that only doctors truly know what works and what doesn’t.

But the argument falls apart because most doctors lack the evidence to compare various treatments in any absolute way. In 2009 the nongovernmental Institute of Medicine (IOM) released a list of 100 disorders, including lower back pain, atrial fibrillation, and early prostate cancer, that it says require research analyzing which treatments work best for different groups of patients.

Having lots of treatment options is useless if we have no way to intelligently choose between them. That is exactly what we need to remedy in our health-care system: Instead of offering a vast array of choices, we must eliminate options that are needlessly risky and expensive by providing more proof of what works best.
The government has pledged $500 million annually, beginning in 2014, to do exactly that. Comparing various treatments and supporting the most effective won’t ruthlessly eliminate patient choice. It will help patients and doctors make better treatment decisions. It may end up limiting choice but only by removing the wrong options.

Case in point: a 2007 study in The New England Journal of Medicine comparing the long-term effectiveness of treatments for heart-related chest pain. It found that angioplasty, a surgical procedure to open clogged arteries, was no more effective than medication—a far cheaper, less invasive alternative. “It was a gorgeous study,” says Harold Sox, an internist who cochaired the IOM report and was not involved in the study. Similar research has recently sorted out treatments for spinal fractures and heart disease.

Funding more of these studies, guided by the IOM recommendations, is critical for strengthening American health care. Patients may like having many choices, but they will love knowing the right one.

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