Bureaucrats threaten personalized medical breakthroughs

The Detroit News
By Peter Pitts
Wednesday, February 20, 2008

American health care has come to a fork in the road.

On the one hand, science is opening up exciting possibilities. The booming field of "personalized" medicine recognizes that every one of us is unique -- not just in some sort of philosophical sense, but in the ways we get sick and the ways we get better.

Personalized medicine can size up our gene sequences to find out what ailments we're likely to get, and even prescribe preventative treatment.

Cancer doctors can now look for "biomarkers" on proteins to detect disease early and determine which treatments are most likely to work.

And this same science can help our doctors understand what medicines are wrong for us, avoiding unnecessary pain, suffering - and expense.

Unfortunately, just as these groundbreaking therapies are coming within reach of consumers, politicians and bureaucrats are threatening to make them off limits. As science makes ever-more-targeted treatment possible, politics could drag us right back to a one-size-fits-all system.

Several of the 2008 presidential candidates have proposed so-called "universal," or government-run, health care. Governors in California and Illinois have spoken in favor of similar statewide programs, and Massachusetts is already launching one.

The problem with these schemes is that they only provide lowest-common-denominator health care, while putting cutting-edge medicine ever further out of reach. That's because when big bureaucracies are faced with finite budgets, they put cost ahead of individual patient care.

We already have numerous examples of big-bureaucracy health care. The results are sometimes deadly.

Take the Veterans Affairs health system. To limit costs, it tightly controls its drug formulary, or the list of medicines it covers.

Of the 300 most popular drugs for America's seniors, the VA covers just

65 percent of them. Of those 300 meds, 132 of them are brand-name pharmaceuticals -- and the VA only covers only 42 percent of them. By comparison, the two largest Medicare Part D drug plans cover more than

94 percent of those 300 medications. At least one study has found that this limited access to medicines lowers veterans' life expectancy.

Part D, of course, isn't run by the government -- it's managed by the private sector.

The VA may be an extreme example. But any system of centralized control will impose a limit on drugs and therapies covered.

Meanwhile, U.S. politicians are also talking about implementing "comparative effectiveness." The House of Representatives has proposed a new Center for Comparative Effectiveness to run studies on the relative cost of different treatments, and such a center would almost certainly become a feature of any future universal health care system.

Great Britain shows us where that can lead. Its National Health Service

(NHS) already bases treatment decisions on comparative effectiveness.

Consequently, doctors have switched many patients with heart conditions from atorvastatin, which is sold under the brand-name Lipitor, to the generic drug simvastatin. Both drugs lower cholesterol in cardiac patients, but because the patent on simvastatin has expired, it's cheaper.

Put another way, doctors switched patients off of the drugs they had been taking simply to save the NHS money.

The result? Earlier this year at the European Society of Cardiology Congress, scientists released the details of an eight-year study of nearly five million British cardiac patients. It found a 36 percent rise in major cardiovascular events, such as heart attacks and strokes, among patients who had been switched to the cheaper generic.

That fatal outcome is not even the end of the woes caused by government-run health care. Centralized systems ration not just drugs, but also access to doctors and hospital surgery rooms.

In Canada, that means that the average patient must wait four months between a referral by a primary-care doctor and an appointment with a specialist.

More than 800,000 Canadians are on waiting lists for necessary treatments, including surgeries. And some 10 percent of Canadians can't even find a primary-care physician.

Big bureaucracies, to be sure, must find ways to limit costs. But that's precisely the problem with entrusting our health to them. We should be putting patient needs ahead of costs.

We hear a lot about sustainability these days. We want our ecosystem and our economy to be hale and hearty over the long term. But we also need a health care system that creates sustainable individuals. A market-driven system can do that, by bringing all the latest treatments to the public and letting competition drive down prices. Bureaucracies, by contrast, are mainly in the business of sustaining themselves. A move to government health care will take us down the wrong path.