The Right Prescription


The mammogram-restricting agency receives of clean bill of health in the new Obama budget.

By 2.5.10

This week the British medical journal Lancet officially retracted an already discredited article it published by Andrew Wakefield which falsely claimed vaccines caused autism. (See how the journal was shamed into doing the right thing here.)

At the same time, President Obama increased the budget of the Agency for Healthcare Research and Quality (AHRQ) -- charged with developing information about what are the best and most cost-effective medical treatments -- by $640 million, including money for anti-vaccine groups who regard Wakefield as a hero and push studies examining the effectiveness of treatments and diets based on Wakefield's study for reversing or curing autism.

AHRQ is the same agency that provided the United States Preventive Services Task Force (USPSTF) the data for recommending women under the age of 50 not get a regular mammogram. Before every major health group rejected the decision, the administration said the guideline was based on the "best available science."

Mentioned twelve times in the health bill, AHRQ states its goal is "translating research into improved health care practice and policy. " In fact, AHRQ was and is the administration's go-to agency for "bending the healthcare cost curve." Hence, in 2009 AHRQ's budget increased from $300 million to $1 billion for "comparative effectiveness research" (CER): studies looking at two or more treatments or a diagnostic for the same disease to see if one delivers equal or better results for the same amount of money. The studies would be used to create government guidelines for hundreds of medical treatments like the mammogram decision.

Proponents claim that CER helps doctors make better "patient-centered" decisions instead of one-size fits all recommendations. But AHRQ spends all its money making comparisons based on research -- as it did in producing the study recommending against routine mammography for women under 50 -- that ignores individual differences in patients.

So, for instance, in reviewing the "science" of mammography, AHRQ ignored "differences in outcomes among certain risk subgroups, such as women with BRCA1 or BRCA2 genetic susceptibility mutations, women who are healthier or sicker than average, or black women who seem to have more disease at younger ages than white women." As a result, the study only provided "estimates of the average benefits and harms."

That's why Nobel Prize winner and NIH Director Francis Collins who helped map the human genome worries that CER studies are a step backwards because they consider "everybody equivalent, which we know they are not." Collins says that CER -- and AHRQ by extension -- fails to use "all that we have gained in understanding how individuals differ and how that could be factored into better diagnostics and preventive strategies."

Meanwhile AHRQ allows CER researchers to hand out money to each other.

For instance, Dr. Alan M. Garber of Stanford University has received millions of dollars of AHRQ grants over the years and is a member of member of AHRQ's panel for determining what evidence should be packaged into guidelines. Garber also advises Congress on what AHRQ should spend money on. HMO's also happen to operate CER research centers that get much of AHRQ's funding.

Dr. Mark Helfand -- who contributed research to the mammogram decision -- runs the Oregon Health & Science University Drug Effectiveness Review Project that receives millions from AHRQ each year. Helfand also directs AHRQ's "science" board for its CER program.

Sean Tunis, another AHRQ consultant also advised Congress on the AHRQ agenda. Tunis once said he never saw adequate evidence to justify paying for new medical technology.

AHRQ's involvement with anti-vaccine groups is also longstanding. It has given millions a year to Consumers United for Evidence Based Care (CUE) an organization that "advocates for local and federal legislative changes," in favor of CER. CUE includes groups like the Center for Science in the Public Interest and the National Center for Trangender Health. The anti-vaccine groups SAFEMINDS and the National Vaccine Information Center are also active parts of CUE.

CUE participants use CER to push their own political agenda with AHRQ help. In 2005 CUE coordinator Dr. Kay Dickersin (another AHRQ grant recipient) and transgender advocacy groups challenged Washington State's Medicaid program decision not to cover sex change operations. SAFEMinds used CER to claim that you couldn't rule out vaccines "causing" autism.

And now AHRQ is funding the NVIC/SAFEMINDS pet project that looks at the effectiveness of controversial and dangerous autism treatments such as chelation therapy, which have killed several children.

Given the deficit, AHRQ's budget should be cut, starting with is funding of outdated science, transgender advocacy and anti-vaccine movements. That would insure CER actually improved the public health.

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About the Author
Robert M. Goldberg is vice president of the Center for Medicine in the Public Interest and founder of Hands Off My H ealth, a grass roots health care empowerment network. His is new book, Tabloid Medicine: How the Internet is Being Used To Hijack Medical Science For Fear and Profit, was published last month by Kaplan.