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Sally Pipes on comparative effectiveness: flat-out wrong

Sally Pipes thinks using evidence-based medicine to produce better outcomes and avoid killing patients is “rationing.”

What utter nonsense. Pipes whole piece – in Forbes nonetheless -is rife with errors of fact, contortions of logic, and sloppy research.  Her highly selective parsing of others’ work is nothing short of intentionally misleading.

Here are a few of Ms Pipes’ errors.

“CER advocates say that it’s designed to correct a “market failure.” Right now, they argue, drug firms need not demonstrate that their product is better than those already on the market — only that it is effective at treating the disease it targets. Drug companies have little incentive to compare their products to those made by other firms — as they may not come out on top.”

Actually, CER advocates point to a failure of Congress and then-President Bush, not the “market”. Those elected cretins are the ones responsible for forbidding CMS from considering efficacy or effectiveness when determining how much is paid for a new drug or device (notably missed by Ms Pipes).  Yep, the 2003 Congress and Bush are the ones at fault when they passed the Medicare “Modernization” Act.

After all, why would you, dear taxpayer, ever want the Feds to care about wasting your tax dollars on marginally useful but really expensive drugs or devices?  Nope, far better to force CMS to pay whatever pharma or device manufacturers charge for stuff that might not work nearly as well as something that costs far less.

Ms Pipes goes on to find fault with CER, saying “for starters, doctors don’t always agree on what comparative-effectiveness research is actually telling us”.

No @&%$()*^.  THAT’S WHY WE NEED CER!  There’s waaay too much variation outside accepted practice norms, and this variation kills patients, drives up taxes, and increases employers’ costs.  Newsflash to Ms Pipes, some “doctors” are lousy, profit-seeking, patient-hurting, incompetent, or just plain bad.  Here’s just one example.

Next up; “Back in 2009, the U.S. Preventive Services Task Force — another government-run panel of independent experts — revised its breast-cancer screening recommendations by telling women to wait until age 50 before undergoing routine mammograms. Previously, the group had encouraged women to start mammograms at age 40.

One reason the Task Force cited for the change? Cost.”

As if somehow cost is bad?  Another newsflash for Ms Pipes – health care costs are out of control, largely because we do way too many procedures that we should not do. Ever heard of “entitlements”, Ms P?

Also note cost is only ONE FACTOR. Increased risk of cancer from too many radiation screenings received much more attention – as it should.

Why is Ms Pipes so blatantly, obviously, completely in error?   Perhaps an inability to grasp basic concepts of high school science is to blame, or maybe she has really poor reading comprehension.

Of course, neither is the case. Ms Pipes just chooses to ignore facts that run counter to her ideology in favor of made-up conclusions based on nothing more than her ideology. .

Shame on you Forbes.  Your corner of the mainstream media is indeed in decline.

4 thoughts on “Sally Pipes on comparative effectiveness: flat-out wrong”

  1. Gee Joe. Quit being so wishy-washy and take a stand on something. :)

    The only way to address the profit motive that is so persuasive in our healthcare (and WC) is through evidenced based standards and a focus on outcomes. Understandibly, there is much resistance to this from those who are making a significant profit on such issues.

    I get tired of hearing things like the UR provider needs to be located in state X to be credible. Last time I checked, human anatomy was basically the same in every state. Whenever I see resistance to things like evidenced based standards, I follow the money. It will lead you to the reason for their arguments.

  2. Joe, as you so eloquently outlined, the costs of health care is significant, with the United States spending more per capita and more on health care as a percentage of GDP than any other nation. Yet many individuals lack the information they need to choose wisely among available treatments, and clinicians do not always have adequate medical evidence to make informed decisions. If I am interpreting Ms Pipe’s column correctly, we should carry-on and hope clinicians and patients are able to sort this all out and we don’t all fall off the financial cliff of out-of-control health care spending. I respectfully disagree, and believe strongly that health outcomes research is needed to assist clinicians and patients to identify the most effective medical decisions.

    The most critical initiative of PCORI is building a research base for CER. Identifying studies/measures for health outcomes needs to be carefully chosen. Much of the research available fails to measure health outcomes.
    In CER, studies that measure health outcomes are given more weight than studies of intermediate outcomes. Additionally, studies that measure benefits and harms over an extended period of time are given more weight than studies that examine outcomes over short periods.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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