Excerpts from the Wall Street Journal Review and Outlook Section for Today, March 18. If you want to read the whole story (I really didn’t take out very much) you have to be a member of WSJ.
The Pro-Diabetes Board
Washington state targets modern medicine. Coming soon to D.C.
The future tragedies of government health care will include today’s
many warnings about how it operates in practice. The
subsidize-mandate-overregulate insurance model is imploding in
Massachusetts. Then there’s Washington state, where a government
board may decide that modern medicine is too expensive for kids with
Seriously. In 2006, Washington created a board to scrutinize the
cost-effectiveness of various surgeries and treatments, known as the
Health Technology Assessment program. At a hearing today, the panel
will debate glucose monitoring for diabetic children under 18. In
other words, the board is targeting the fundamental standard of
diabetes care that has been the established medical consensus for at
least three decades.
This state issue deserves far more scrutiny, if only because
ObamaCare and the stimulus devoted billions of dollars to comparative
effectiveness research… In theory, it sounds great. But the Health
Technology Assessment is an example of how comparative effectiveness
will work in the real world, as the political system tries to find
ways to restrict or limit treatment to control entitlement spending.
do so either with finger sticks that are read by an electronic meter
or continuous glucose monitors that track blood sugar levels
virtually in real time.
The Health Technology Assessment has homed in on both technologies,
claiming that the “effectiveness and optimal frequency of
self-monitoring of blood glucose in patients is controversial.” Not
among physicians. But in a recent report, the panel suggests that
there isn’t enough “evidence” to support monitoring among childhood
and adolescent diabetics, and that the randomized controlled trials
that have been conducted aren’t high quality.
Such a trial would violate medical ethics: A group of children would
essentially be required to not monitor glucose putting them at risk
for long-run complications from too high or low blood sugar,
including seizures and even death. Following a landmark 1993 trial on
tight glycemic control, and the vastly improved outcomes since, the
clinical benefits of intensive management are irrefutable.
Except, apparently, to a government board looking to scrimp.
Washington’s Health Technology Assessment makes decisions for
state-subsidized health care, including Medicaid beneficiaries,
public employees and prisoners about 750,000 people. If it bans
continuous monitors or limits finger sticks to a certain daily number
at today’s hearing, pediatric patients and their parents will lose
the tools and the more and better information they need to manage
More to the point, as shown by the arbitrary Washington state method,
political comparative effectiveness isn’t about informing choices.
It’s really about taking away options.
Which brings us from Washington state to Washington, D.C. The Health
Technology Assessment program’s director, Leah Hole-Curry, was
appointed last year as a governor of the comparative effectiveness
board established by ObamaCare. The national board is known as the
Patient-Centered Outcomes Research Institute, yet at an early meeting
in November, Ms. Hole-Curry and the other 14 governors debated
whether or not patients were the institute’s “primary constituents.”
Now this agenda is on autopilot. The institute is built on
self-executing funding that is, not subject to annual appropriations
like other federal programs and dedicated taxes on insurers. At the
very least Americans deserve some honesty about who these people are
and what they favor.