This month, the Supreme Court will rule on President Obama's health care law. But contrary to popular belief, it will not be considering whether to overturn the entirety of the president's health care agenda. Even if the court finds the Affordable Care Act unconstitutional, other troubling aspects of the president's policies will remain intact unless Congress fixes them.
Consider a program created by the 2009 stimulus bill, known as academic detailing. The program sends government representatives, akin to drug representatives, into doctor's offices to influence prescribing decisions.
The more information physicians have, the better equipped they are to provide quality care to patients. But under academic detailing, the government may be grossly misinforming doctors about medical choices. Thanks to a total lack of transparency in the program, there is no way for the public to know.
Physician outreach on the part of medical companies is a valuable and legitimate source of information. But because drug companies naturally want to sell more of their branded medicines, this type of communication is heavily regulated to counter possible conflicts of interest, while still allowing the sharing of scientific information that could help improve patient care.
The government's academic detailing program is similar, but it is curiously exempt from the same patient-protecting transparency standards applied to the drug industry. The Agency for Healthcare Research and Quality, the agency responsible for academic detailing, is spending nearly $12 million in contracts with public relations firms, yet it refuses to disclose exactly what its detailers are telling doctors. Contrast this with onerous burdens on industry representatives, who must get every word approved by the Food and Drug Administration.
AHRQ is not overseen by any outside authority in government. The agency has excused itself from reporting which doctors it contacts, citing as its rationale a privacy law Congress wrote to protect patients, not doctors. Congress should make it clear that not only may AHRQ disclose which doctors they are approaching, but that they must report this information both to FDA and to the public, just as pharmaceutical companies must do.
Setting aside the broader question of whether the government should pay PR firms to influence doctors in the first place, there is no way to avoid the conclusion that doing so in private creates a dangerous situation. Academic detailers focused on cost-cutting are likely to gloss over the fact that less expensive treatment options that work for most patients often won't work for some of them.
Cutting medical costs is a national priority, but an overaggressive adherence to this type of research must be accompanied by a balanced recognition of individual patient needs. This is not a hypothetical concern. The initial academic detailing grants are intended to disseminate the findings of comparative effectiveness research, which studies treatment outcomes on a systemwide (as opposed to patient-specific) level. CER findings, applied without recognition for individual patient differences, can be harmful to patients who don't respond to medicine the in the same way as a majority of patients. As a result, seemingly credible government-funded detailers could advise doctors to prescribe the least expensive medicines, even if they don't work at all for some patients. This could actually increase medical costs. Without transparency, how are we supposed to know whether CER findings are being explained in a responsible, balanced way?
The government has a clear interest in controlling health care costs --- a worthy goal, but one that must be pursued responsibly, with a clear emphasis on transparency and respect for individual patient needs. As long as it presumes to advise doctors, the government should acknowledge that it is not a wholly disinterested party. In its dealings with doctors, it should have to abide by the same scientific oversight and transparency standards it rightly demands of others.