If President Obama’s healthcare bill is passed there is certain to be an increase in taxes, an increase in the budget deficit and a rationing of healthcare.
The President promised an increase in funding for preventative medicine. The term preventative medicine should mean discovering a disease process before it manifests itself through its complications. After discovering the disease it should be treated in the best possible way available.
The federal government is going to spent billions of dollars expanding a bureaucracy to further evaluate best practices.. The Agency for Healthcare Research and Quality was created to standardize the practice of medicine. The organization encouraged medical specialty organizations to write guidelines for the care of diseases in their specialty. A National Clearing House was created that published these guidelines. These guidelines are to be updated every five years.
I was suspicious of the intent of the AHRQ. Medical knowledge changes at about 10% per year. I believe that physicians in a specialty area have an obligation to physicians in all specialties to help them keep current. Guidelines are usually devoid of clinical judgment.
I was afraid the AHRQ would use guidelines as a weapon to punish physicians who were not current.
I was chair of the AACE guidelines for the treatment of Type 2 Diabetes Mellitus. I was also the co chair for AACE’s guidelines for hyper and hypothyroidism, thyroid nodules and thyroid cancer.
My goal was to help primary care physicians understand the Clinical Endocrinologists’ interpretation of the state of the art diagnosis and treatment of endocrine diseases. AACE had no ulterior motive. I hoped the AHRQ had no ulterior motives.
The U.S. Preventive Services Task Force is a branch of the Agency for Healthcare Research and Quality. USPTF started writing its own guidelines for diagnosis and treatment of many diseases. The USPTF does not seek input from subspecialty groups. The panel selects major articles on diseases from the literature and grades these articles. From the grading of the selected articles it develops guidelines on the use of procedures and treatments.
There are several problems with this method of developing guidelines. There is a danger that the best articles are not selected by non experts in that disease. There is also a danger that the natural history of the disease is overlooked. The natural history of many diseases is not considered in many “major” articles.
Experts in osteoporosis who understand the natural history of osteoporosis would disagree. The panel of U.S. Preventative Task Force did not ask osteoporosis experts for an opinion about the guidelines and disregarded the guidelines written by experts in the area.