Research and Policy

Everyone says they are for evidence based policy, but it can be tricky because sometimes it goes against the accepted consensus. The New York Times has a story about vertebroplasty, a procedure that fills small cracks in the spine with cement. It has been widely used, but never subjected to a clinical trial--whereby people are randomly assigned to get the treatment and a placebo. This trial found that people getting the procedure were no different from those getting placebo in terms of pain and function. Medicare has long covered such procedures, with doctors and patients deciding whether to use the procedure or not. There are calls for no research...in fact, it was hard to do the study in the first place because many people just assumed the procedure worked, so were not willing to sign up for a clinical trial in which they could be randomly assigned to placebo.

Physicians have an obvious incentive to keep doing this as they get paid to do so. And apparently many patients swear it helps them. That benefit just couldn't be documented in the gold standard way in which medical science operates. For the time being, Medicare will continue paying and private insurance will follow the lead of Medicare. A case study of how hard it will be to actually use evidence based medicine to inform treatment coverage decisions....and also how it is the only way we have a chance of controlling health care costs.