Paying for a placebo

By Dave Anderson:

A common surgery used to relieve back pain and improve mobility is no more effective at those tasks than a placebo treatment. Here is some info from the Wall Street Journal on the testing:

But in the first two studies to rigorously examine the effect of the procedure, known as vertebroplasty, researchers found no detectable benefit when compared with a placebo group of patients who received a sham procedure that only mimicked the real thing.

Vertebroplasty is usually performed by radiologists, who inject bone cement directly into a fractured vertebra to shore it up. The procedure, which is covered by Medicare, ranges in cost from $2,000 to $5,000.

After a month, both groups saw a substantial reduction in various measures of disability and pain, assessed by a questionnaire. But the reductions were a statistical tie�the actual procedure yielded no gain beyond the placebo effect of the sham surgery.

A separate study, including 78 patients and conducted similarly, was funded by the Australian government and Cook Medical Inc., a U.S. manufacturer of bone cement. It reached a similar conclusion: Vertebroplasty didn�t relieve pain any more than the sham surgery, measured three months later.

This is a good argument for comparative effectiveness research in determining what gets paid for by Medicare or a public option. We as a society want to pay for things that work and not pay for things that offer solely a placebo effect as a few white lies and Lidocaine are way cheaper as a placebo than actually sticking bone cement in someone's back. Defenders of the procedure argue that accepted, ancetodal wisdom should trump a double blind statistical study or more convincincly argue that perhaps the study group was composed of individuals with less severe pain and mobility issues than the general popualtion of recipients. If that is the case, then more research should be conducted, while reserving the invasive and called into doubt procedure as a special approval application after cheaper and similiarily effective regimes are tried.

Comparative effectiveness research should be used to encourage best practices by linking payment to those best practices and not paying for treatments that are no more effective but much more expensive than placebo treatments. This should be common sense and not a source of great controversey or political costs.