The Data Agenda

Friday, May 10, 2013

How to take over medical academia: call it research

Are you ready to become a data point?
Under Obamacare program, doctor visits would become data points
By Sarah Kliff, Published: April 23, 2013 at 12:45 pm

A new nonprofit is putting millions of Obamacare dollars towards an effort to turn routine doctor visits into a treasure trove of data on what medical treatments work best.
And by "doctor visits," we are, just to be clear, talking about your actual visit to your doctor. Supposedly it's been "deidentified," but that will be put to the test.

The Affordable Care Act created the Patient Centered Research Outcomes Institute (PCORI) to support comparative effectiveness research, studies that identify the most effective treatments when a whole array of options might be available.
PCORI and "comparative effectiveness research" would, respectively, be better known as a rationing board and the reasons why certain treatments won't be funded.

PCORI announced Tuesday how it would move forward on that mission: spend $68 million to fund a network of health-care systems that cover as many as 12 million patients. The idea is to use all the doctor visits that already happen — and all the treatments that doctors prescribe — to figure out which ones do best for a certain type of patient.
If you're doctor uses a computer (EMR) during your doctor visit or shortly thereafter, then your doctor visit is, to borrow a phrase, "99.9999 percent" likely to be part of the "doctor visits that already happen" they're talking about.

“There is so much promise in natural experiments that we could run,” PCORI Executive Director Joe Selby says. “Across the country, there is a lot of variation in how diseases get treated. This is a golden opportunity to study which leads to better outcomes.”
Any time the conversation centers on "promise" and not observed results, the best question to ask is, "Who is funding this?"  In this case, the federal government is funding PCORI (directly or indirectly), and the federal government has "trillions" of reasons to find ways to reduce medical costs and find reasons not to pay.

Right now, health-care experts say that doesn’t happen: Most doctor visits don’t do much to inform which treatments are most effective.
It shouldn't happen.  Most doctors already stay informed on treatment, and know how and where to speak up when they have experiences otherwise.  It's not as if the federal government is the only one who knows how to determine a treatment is effective. Further, we already have a thriving medical academic community.

“Right now, were spending trillions on health care and 99.9999 percent doesn’t contribute anything to medical knowledge,” says Farzad Mostashari, national coordinator for health information technology at Health and Human Services. “That’s the real vision, that we actually take routine care, the heallth (sic) care happening in the real world, and have that contribute to knowledge.”
The real vision is for a massive centralization of data (power) in the federal services data hub.

PCORI will spend as much as $68 million to fund “clinical data research networks,” which will each consist of at least two health networks that cover a minimum of 1 million patients. They will each propose three sets of patients to study: one focused on a common disorder, a third focused on a rare medical challenge and the last looking at patients with obesity or diabetes.
Sounds a lot like open-ended (no agenda) research, doesn't it?


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