Those who fear Obamacare will be eliminated by an unelected
Supreme Court can put down their Xanax: the un-elected American
Board of Internal Medicine Foundation (ABIMF) and its un-elected
proxies are working hard to get doctors to implement the health law
by encouraging them not to diagnose their patients too often. You
read that right.
The foundation’s “Choosing Wisely”
campaign is
framed as a voluntary program to encourage doctors to cut down
on “unnecessary medical tests.”
In its “lists” the campaign offers 45 tests to avoid from 9
different medical groups. The selection process is portrayed as the
product of deep thinking of leading experts in keeping with the
medical edict of first do no harm. Each recommendation begins with
the words — much like the Ten Commandments — “do not.” But the
definitive tone of denial repudiates the Hippocratic Oath and
replaces it with spirit of The Hunger Games.
Indeed, Choosing Wisely is designed to sustain the rationale and
ideology that shaped Obamacare. Ruling out any test prior to even
seeing a patient is a political edict, not a scientific decision.
As one of medicine’s early innovators, William Osler, noted:
“Variability is the law of life, and as no two faces are the same,
so no two bodies are alike, and no two individuals react alike and
behave alike under the abnormal conditions which we know as
disease. Clinical judgment begins with uncertainty about the
underlying causes of symptoms and ruling out conditions requiring
even more tests and ineffective treatment.”
Indeed, the “lists” are not the product of evidence-based review
of practice and they come with a disclaimer inconsistent with the
absolute certainty of their rightness that these statements are not
medical claims. That’s a caveat more commonly associated with
weight loss informercials than with a physician’s advice. But
Choosing Wisely is not about patients exactly. It is part of the
ABIMF and the American College of Physicians (ACP) charter designed
to help make doctors “better stewards” in the “just and cost
effective distribution of finite [medical] resources.” If this
rhetoric rings a bell it’s because you have heard it before from
environmentalists who justify government killing off oil production
while spending billions on a failed solar energy business model as
stewardship. It was also used by Garrett Hardin in The Tragedy
of the Commons and Obama science adviser John Holdren to
justify forced sterilization to save the planet from
overconsumption. And, in The Hunger Games, by the
Capitol to justify having tributes from each district kill the
other until a sole victor remains.
The ABIMF campaign doesn’t promote such measures (though we
should be assured that the president’s science adviser thinks such
actions are, like Obamacare, constitutional). But it is designed to
give the doctor’s seal of approval to Obamacare’s practice
guidelines and rationing. And it’s the blueprint for the campaign
ABIMF is underwriting to get doctors to change how they practice
medicine in order to bring about the Obamacare revolution.
Harold Sox, ACP’s former president, noted: “I hope that we will
look back upon [Choosing Wisely’s] publication as a watershed event
in medicine.” Sadly it is. Choosing Wisely is the first collective
effort on the part of professional medical societies to decide how
to practice medicine on the basis of cost first and foremost. The
list of thou shall nots is redundant and highly subjective. Out the
45 “don’ts” nearly six are the same (no pre-operative screenings )
and 16 pertain to cardiac imaging. Almost all are discouraged in
patients at “low to moderate” chance of getting sicker or dying
from a disease or treatment complication. And the list leaves no
room for mixed or inaccurate measurements. Someone goes Code Blue
because their doctor chose wisely? Oh well. As Katniss Everdeen
observed: “It’s easier destroying things than making them.”
Moreover, it reflects political cravenness on the part of its
creators who seek not only to promote Obamacare but cash in on it.
Consumers Union, the group that puts out Consumer Reports
and also supports a government-run health system, is part of this
effort. In 2008 it pushed hard for a highly criticized and widely
ridiculed system of rating health care quality in terms of how
little care was delivered. By allying with ABIMF and ACP to promote
Choosing Wisely, Consumers Union can relaunch its early failure
with a medical seal of approval and use it to try to boost
subscriptions to its newsletters and magazine. The ABIMF is giving
cash to the National Physicians Alliance (NPA). Christine Cassell
who heads up the ABIMF, is also on NPA’s board along with Rachel
DeGolia, director of the Soros-funded Universal Healthcare Action
Network. The Bayview Healthcenter in Baltimore, which employs ABIMF
board member David Hollander, also received Choosing Wisely dough.
Cassell, along with former ACP president Harold Sox, were early
advocates of comparative effectiveness research (CER). Sox
appointed Cassell to the Institute of Medicine panel that decided
how CER should be conducted.
The Choosing Wisely campaign is ultimately led by people who
also stand to benefit from Obamacare contracts. Indeed, the closed
cabal of docs and consultants who have received CER money in the
past from the Agency for Healthcare Research and Quality (AHRQ) and
have received most of the (taxpayer) money given out by the
so-called Patient-Centered Outcomes Research Institute include
ABIMF trustees such as Steven Pauker and Peter Basch (who is also a
senior fellow at the virulently anti-Israel Center for American
Progress). Richard Baron, an ABIMF trustee, is now a senior
official at Health and Human Services, in charge of initiatives
worth billions.
Together, CER and Obamacare innovation grants make up the
biggest cesspool of single source contracts in government. These
dwarf the crony capitalism of the Obama alternative energy program
in dollar amount, political correctness, and sheer cronyism. ABIM
and ACP are among the first groups to criticize doctors who receive
support from drug and medical device companies for training and
research. But they have no problem in campaigning for expansion of
federal programs they have helped design and benefit from
financially and politically.
Most important, Choosing Wisely looks backwards to ration older
procedures that are rapidly being replaced by tests that, by
identifying which patients respond best to what care, can avoid
duplicative or ineffective treatments. Programs such as Horizon
Healthcare Innovations’ patient-centered medical homes give doctors
more freedom to decide how to treat people and what to test for:
the initiative has reduced hospitalization and emergency room use
by keeping people healthy.
As Dr. Eric Topol notes in
The Creative Destruction Of Medicine about the practice of
medicine in general, Choosing Wisely “relies on the wrong concept
that the median of patients is the message.” Choosing Wisely is
silent on getting doctors to use point of care and hand-held
devices that can deliver individualized care frugally, if for no
other reason than the insistence that CER be used to determine who
has access to such advanced treatment and when. In order to
maintain just distribution of medical resources, of course.
Topol notes: “[We] are right at the cusp of having new tools to
affect that change — the ability to define each individual in
‘high definition’ at the biological, physiological and anatomical
levels. While we have long appreciated that each human being is
unique, it is only now that we can leverage this information to
improve medicine.” That is truly choosing wisely, something
Obamacare’s medical mercenaries have failed to do in forsaking
patients for a political agenda.
