Tag Archives: comparative effectiveness research

Health care rationing by the Klan Parenthood, Sebelius

Thanks, Dr. Manny Alvarez, for your opinion, Secretary Sebelius, stop hiding behind bureaucratic rules and save a child’s life.

This is just the beginning of health care rationing by the compassionate bureaucrats of Obamacare, in this case, by the Klan Parenthood shill, Kathleen Sebelius. The Klan Parenthood always loves to see children die, and it’s all perfectly legal.

Go get ‘im, Tiger! Romney lands punches against subdued Obama in first debate – The Hill’s Video

President Obama can be rumbled.

Romney lands punches against subdued Obama in first debate – The Hill's Video.

Here is a great move by Romney to rumble the weakling BHO:

Romney, who has narrowly trailed Obama in recent polls, seemed to be looking to shake up the race with a strong attack on Obama’s record, talking directly to the president as he spoke.

That is the way to do it, Mitt. Go, man, go!

Unknown meaning of the number 11: Examiner Sunday Reflections by Glenn Harlan Reynolds: Obama presidency turns government up to 11 | WashingtonExaminer.com

Glenn Reynolds, Instapundit

Glenn Harlan Reynolds, Instapundit

It is inspiring to know that President Gutsy has figured out the unknown meaning of the number 11 and has turned up the amps to 11.

Examiner Sunday Reflections by Glenn Harlan Reynolds: Obama presidency turns government up to 11 | WashingtonExaminer.com.

You have to laugh.

Except that he simultaneously sliced $716 billion from the third-rail Medicare program so that Ezekiel Emanuel can have a steady job supervising comparative effectiveness rationing on the Death Panels.

The Jerusalem Post: The Europeans’ skewed view of circumcision

The Jerusalem Post: The Europeans’ skewed view of circumcision.

The Chief Rabbi presents an interesting way to analyze this as “justification by the highest source of authority in the culture at any given age.”

I agree with you, Chief Rabbi. In every age they try to destroy the Jews, but usually by some new strategy —

This time it is just to persecute and destroy them because of _______.

— and you fill in the blank with the highest source of authority in the prevailing culture.

And it makes one wonder: what other grinning works of violence do they seek to establish under color of law or justice?

Ezekiel Emanuel

Medical mayham from Senator Baucus et al.

Obviously, the U.S. Senate is having difficulty getting a harmonious outcome from health care “reform" that, first, does no harm.

Instead, it looks like higher insurance premiums, government efficiency and deficits. That is mayham, my friend.

Famous neurotherapist

Famous neurotherapist

A Former Radical Goes Back to the Future at the 9/12 March

Super article from an experienced protester who dates back to the 1960s. It’s graceful and links to many photos she captured from among the marchers.

A Former Radical Goes Back to the Future at the 9/12 March

In 1967, I was the radical Alinsky wrote the rules for. On the political cutting edge, I’d been arguing with fellow students and coworkers for years about Vietnam, and my growing disgust with my country led me down many winding roads of anti-American thought. I was counterculture before there was a name for it, skipping my prom and graduation as “bourgeois,” going barefoot, braless, and unshaven, and collecting tattoos at the only place in town those days — a crummy hole-in-the-wall next to downtown D.C.’s Greyhound station.

…On the morning of September 12, I left for the march with my camera. Since every picture’s worth a thousand words, I thought that would be the easiest and fastest way to communicate what really took place.

But what was going to take place? How many people would show? Though in my gut — with the latest victories of the new media over the old (Van Jones, ACORN) — I felt momentum building, I was really just one person going without a group, a strategy, or a plan…

All seemed informed and concerned, but cheerful and optimistic. I knew this feeling from before — it begins when you move from concern to action.
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The best sign in the gallery

The best sign in the gallery

Something I noticed from her photos: There were no black bloc of people wearing the black garb and black masks.

Clueless goombah Moe Greene senators

These goombah representatives and senators duck the town hall meetings. Advanced cluelessness. They do not see that the town hall is the exact antidote to what troubles the President’s health care takeover plans.

Explaining Town Hall Protests (John C. Goodman)
…there is no way the kind of spontaneous outpouring we’ve witnessed could be bought or organized by anyone.

Why are they so angry? The reasons are manifold, but the single biggest reason is the arrogance of our elected officials in Washington. Think about it. For the past seven months a small group of politicians has been meeting behind-closed-doors with powerful special interests to decide whether you will be able to keep your current insurance, where you will be directed to get new insurance and at what price, what fines you and your employer will have to pay if you don’t conform, and how they’re going to get your doctor to change the way he or she practices medicine. In the process, they never asked you what you thought about anything. If you are not mad about this, odds are you don’t understand the situation.

If they could work through the town hall meeting process, with as many town hall meetings as they can squeeze in, and stay late after each meeting to talk to every last voter that wants to, they would modulate a lot of the anger people feel. That is the way it goes on the street.

Do you know who I am?

Do you know who I am?

But these guys are suits, not street-level activists.

They have that Moe Greene outlook:

You don’t talk to me, I talk to you! Do you know who I am? I am Senator Barbara Boxer. Do me a favor, say "senator" instead of "ma’am." I made my own latté to get that title.

Meet Rahm Emanuel’s Brother: Dr. Zeke the Bleak

Tom Blumer gives a good rundown on Ez. Emanuel’s charnel house, including the oxymoronic "whole lives" ethical system, the fig leaf to be used by these guys for rationing.

Meet Rahm Emanuel’s Brother: Dr. Zeke the Bleak
Zeke recently embarked on a reputation rehab tour and now squeaks that he’s no longer so bleak. You can tell that the administration knows it has a serious problem on its hands, because the doctor even found time in his interview rounds to get with the lefty-despised Washington Times.

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Another telling detail is the emergency visit to the Washington Times by Ez. Emanuel for an interview. Highly unlikely in fat times, but necessary this month.

President’s new pain pill



There is an announcement on http://www.conversation.gov just minutes ago, introducing the new federal pain pill recommended by your president.

Here are some specs:

Trade name: PainCor-B
Generic name: I-taxubeyonddeathformyjet

Once you have been Pelosified in this way, and Nancy gets into your head, your aches and pains will disappear and you will finally believe everything you read in the news papers.

So forget about the pacemaker your doctor wants for you. Just go with the red pill.

Do it for Nancy.

Ezekiel Emanuel and his charnel house

Ezekiel Emanuel’s infamous advocacy of death panels, under color of a "complete lives ethical system," results in a decision curve that the death panel would likely have in mind as they decide our health care rationing choices. Here is the lone figure from a recent article by Emanuel in the British journal The Lancet. It is a decision curve for the death panel, displaying their age-based priority for receiving scarce medical interventions under the complete lives system.

Dworkin's curve.  Click image to view full size.

Dworkin's curve. Click image to view full size.

● We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles…

● Rather than saving the most lives, prognosis allocation aims to save the most life-years. This strategy has been used in disaster triage…

● We consider several important objections to the complete lives system.

The complete lives system discriminates against older people. Age-based allocation is ageism. Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years. Treating 65-year-olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not…

article summary and subscription link to The Lancet
Figure, cf. RM Dworkin, Life’s dominion, Knopf (1993).

Back-of-the-envelope estimate of national health cost per age group

Back-of-the-envelope estimate of national health cost per age group

What the authors, Ezekiel Emanuel, Alan Wertheimer and Govind Persad leave out of their article is a curve that expresses the relative fraction of the national health care bill that each age group generates. It might look something like this back-of-the-envelope estimate (at left). We all know that a large fraction of health care costs go to helping our seasoned citizens …perhaps not 65% as shown but still a relatively large percentage.

This large percentage is what the complete lives system targets for elimination. This curve is what motivates the intellectual gymnastics of the complete life rationing system, and it will surely be on the table at the meeting of each death panel convened by the Health Choices Commissioner, which will use both curves to decide which health care choice you get.

The Emanuel article claims as an advantage his "intuition that death of adolescents is worse than that of infants or elderly."

That is the intuition of a charnel house.

I do not consent to that intuition. I am a humanist, advocating the incomparable value of every human person.

Obama encodes rationing plan

The online Wall Street Journal has an interesting "Notable and Quotable" blurb, a piece of an interview of the president by the NY Times in April. POTUS tells the story of his grandmother receiving a cancer diagnosis and a hip replacement in the months before her death.

The end of the excerpt is what sets off my alarms. Can you see the code?

The President: So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right? I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.

Mr. Leonhardt: So how do you—how do we deal with it?

The President: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place.

Every code appears to be a non sequitur, a symbol that does not seem to follow logically from what preceded it. Here is the code sequence:

  1. potentially 80 percent of the total health care bill
  2. how do we deal with it?
  3. there is going to have to be a conversation

This conversational sequence is a non sequitur: You face a pay-the-bill problem and deal with it by using a "conversation"? That does not follow. Your basic pay-the-bill problem means you grab your wallet or cut up your credit cards — or, in the case of a Democrat politician, you grab somebody else’s wallet or run up another trillion dollar credit card bill.

But using a conversation in this context does make sense to the president. To him, it is not a non sequitur.

It is just how he thinks about health care costs. So simple, the code deciphers itself:

"there is going to have to be a conversation" = cost cutting

This is just the thing that Sarah Palin warned us about in her Facebook article. In the context of cost-cutting, the conversations are alarming, viz.

Now put this in context. These consultations are authorized whenever a Medicare recipient’s health changes significantly or when they enter a nursing home, and they are part of a bill whose stated purpose is “to reduce the growth in health care spending.” Is it any wonder that senior citizens might view such consultations as attempts to convince them to help reduce health care costs by accepting minimal end-of-life care?

Thanks, Sarah. You are right on the mark. We have to be very careful about this death panel conversation with the government ethicists.

Mighty nervous: GE Healthcare/Amersham PLC in UK

GE Healthcare also has its "global" headquarters in the UK, northwest of London, out by the A413:

as well several sites clustered near Milwaukee, Wisconsin.

I would be skeptical about health information in general and comparative effectiveness data being outsourced and run from the UK, an already entrenched socialized health care system. Maybe Americans are quite reasonable when all this government health care takeover makes them mighty nervous.

Trust the Government

Newt Gingrich also worries about comparative effectiveness decisionmaking, viz.

Trust the Government

The problem is that, in the context of a government-run health care system, comparative effectiveness research becomes a way to find a cheaper, one-size-fits-all approach to medicine that will limit health care choices for patients.

But don’t just take my word for it. Congressional Democrats included $1.1 billion in the Stimulus Bill for CER. Report language explaining the bill noted that the treatments found to be “more expensive” as result of the research “will no longer be prescribed” and that “guidelines” should be developed to manage doctors.

Congressional Democrats also killed several amendments to the current health care bill that would have prevented CER from being used to ration care.

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Thanks for agreeing with me, Newt. 😉


Thanks, Sarah Palin, for the Facebook post, Concerning the “Death Panels”

President Obama can try to gloss over the effects of government authorized end-of-life consultations, but the views of one of his top health care advisors are clear enough. It’s all just more evidence that the Democratic legislative proposals will lead to health care rationing…

All I have to say is, GO SARAH GO!!!

Mighty nervous: GE Healthcare (West Chester, Ohio) and comparative effectiveness research

It is interesting to view the worries and troubles at GE Healthcare, with all its tentacles, including West Chester, Ohio, as it watches the government healthcare takeover. The HR 3200 takeover will likely enable the Immelt/GE juggernaut to earn a ton of money in the administration of health care rationing-that-is-not-rationing under the guise of "comparative effectiveness" viz.

GE is a global leader in healthcare. We are deeply engaged in medical diagnostics and information technology…

GE expects to grow its revenues by 2-3 times the U.S. gross domestic product and increase earnings…

Comprehensive reform must include properly structured Comparative Effectiveness analysis including the value of healthcare choices – for example, physician and hospital quality and efficiency, health plan options and treatment and pharmaceutical options.
GE Viewpoint: Enabling Better Health and Healthcare Reform

Good. Very nice. But…. effectiveness compared to what?

Critics, like Betsy McCaughey, point out that comparative effectiveness means seasoned citizens and Mike Sola’s son would get rationing, or as the president famously suggested, a painkiller instead of a pacemaker.

The stimulus bill, American Recovery and Reinvestment Act, has plenty of money for comparative effectiveness research (CER). Dr. Eugene C. Rich, in Journal of General Internal Medicine, states that there has not been enough high quality research on the matter.

Perhaps no issue in the CER debate is more controversial than the role of assessment of the comparative “value” or cost of clinical services. This subject was explored in depth in a recent series of Annals articles, and anxieties of manufacturers and some patient advocacy groups have been highlighted in the recent editorializing over the comparative effectiveness research provisions in the American Recovery and Reinvestment Act of 2009. In brief, opponents of CER view the inclusion of cost or value within the context of comparative effectiveness research as equivalent to payer-oriented cost-effectiveness analysis (CEA). Such CEA is assumed a precursor to nationwide coverage determinations and rationing of access to expensive but effective therapies. Advocates for patients with rare conditions, and for disease groups with particularly expensive treatments, are of course particularly alert to these concerns, as are the developers of expensive innovations.

I conjecture that the government still has a sense of shame and will not justify rationing decisions without the fig leaf of CER.

But is CER really pernicious or is it a gray area — maybe pernicious, maybe not, depending on the how-what-when-where-why of the research. Here are a few grant categories underwritten by the porkulus act:

05-AG-101* Data Infrastructure for Post-Marketing Comparative Effectiveness Studies. (p. 12)
The challenge is to create the data infrastructure that will enable comparisons of particular therapies, prescribing patterns, and benefit designs on health outcomes. Problems with currently available studies include omission of key patient groups (such as the elderly in nursing homes)
05-AG-103* Imaging and Fluid Biomarkers for Early Diagnosis and Progression of Aging-related Diseases and Conditions including Neurodegenerative Diseases. (p. 13)
Diseases and conditions of aging have a huge public health burden… most studies have not compared multiple imaging and/or fluid biomarkers in the same study with the same study participants to evaluate their comparative effectiveness at being able to provide for the early diagnosis or for following the progression of disease.

Maybe a professor of bioinformatics could explain that this research is hard to come by because of the nightmarish Tuskegee Syphilis Study. Please post a comment if you are a bioinformatics professor. Comparative effectiveness research will probably be worthless unless somebody allows a LOT of seniors go for a few years without expensive treatment for Alzheimer’s disease or some other disease.

Ordinary rules of scientific research would preclude such studies today, but the American Recovery Reinvestment Act and its CER funding might reverse that protection. Dr. H. K. Beecher expressed this very worry back in the 1960s: big research money as a factor in unethical medical research in the United States.

A similar worry exists regarding the health care takeover legislation HR 3200. Lots of money at stake, lots of pressure for unethical methods.

The government is asking for all of us to trust them with ALL life and death medical decisions: pre-birth, newborn, grade schoolers and teens, adults, seasoned citizens. That would make any normal person mighty nervous.