By Mian A. Jan, M.D.
As a board certified cardiologist and a practicing physician for over 25 years in Chester County with a diverse group of patients from a variety of different backgrounds, I believe no two patients are the same. I strive to give the very best care depending on the patient’s specific case. I apply a one-on-one relationship model to the treatment and care of all my patients.
It is for this reason that I recently participated in a healthcare forum at La Comunidad Hispana with a panel, which included Congressman Joe Pitts (R-16), to discuss a new program – Academic Detailing – that is raising red flags in the medical community and is concerning to many physicians and patients alike.
Academic Detailing is a U.S. Health and Human Services (HHS) program that promotes information gathered from research to help health care givers to make decisions based on research but also cost-effectiveness.
In 2009, the Economic Stimulus Package allotted $1.1 billion towards Comparative Effectiveness Research (CER), research that essentially aims to figure out what works best in medicine. On paper this sounds like it would be money well spent. Unfortunately, as with most things in Washington, the devil is in the details and as we have seen with the rollout of the Affordable Care Act, although much needed the reality of federal healthcare programs is that they do not always turn out the way they were promised or intended.
To date, more than $30 million in CER stimulus funds have been spent on this program where government contractors or detailers visit physician offices, provide them with CER research and try to convince the physician to make treatment recommendations based on the CER studies. While it is always helpful for physicians to have the latest research, it’s not in the best interest of the patient to be told what kind of medicines should be prescribed for them based on one-size government research and cost-effectiveness data.
Abiding by Academic Detailing recommendations to make medical decisions is especially worrisome to physicians because the studies tend to be overly broad and do not take into account major factors such as age, race or disabilities. CER studies are conducted to reflect what works best for the majority of people. However, the patients we see have specific medical needs and often-complicated conditions that must be dealt with on an individual case-by-case basis. Every single patient is different, which is why it is so critical that CER is never used to prevent any medical treatment in an effort to cut costs. Medicine should never be assembly line.
We must value the doctor-patient relationship and the trust that goes with it. New research data and information should be made available to doctors and patients, but not in a manner that pressures physicians and obstructs a patient’s access to personal, individualized care. We simply cannot let government detailers replace doctors and patients as the ultimate healthcare decision makers. As a physician we are very open to research data and information and appreciate any information we get regarding CER and if two treatments are similarly effective there is no reason not to use the less costly treatment but that decision should be based on research as it pertains to that patient and should be undertaken for the best interest of the patient and patient alone, if a physician wants to order a PSA test or a mammogram that decision should be based on patient and patient alone and not simply on data which may not address the patients sex, race or ethnicity.
In summary, we as physicians need to look at all available data, including comparative effectiveness but final decision should be based on what is best for our patients.
Mian A. Jan, MD, FACC is the past president of the Chester County Medical Society and a practicing cardiologist in Chester County.