“Newspeak,” as Orwellian cognoscenti know, is the official language of Big Brother, designed “not to extend but to diminish the range of thought.” Its goal was to “make all other modes of thought impossible.”
Which brings us from the nightmare fantasy of 1984 to the health care debate of 2011 and the concept of “cost-think.” And nowhere is cost-think more crucial than when it comes to publicly bankrolled dissemination of taxpayer funded and government-fielded comparative effectiveness research.
There are many important questions yet unanswered. Will these studies be peer-reviewed before release? To whom will they be communicated—and how? Will physicians be “academically detailed?” Will physicians be given incentives to spend time with Uncle Sam’s comparative effectiveness angels and punished if they do not? How will Uncle Sam decide which doctors are to be visited? Will “high prescribers” of on-patent medicines be on a priority list, identified by mechanisms being developed to enforce states’ physician sunshine laws?
What kind of safeguards will be in place to certify physicians are presented with information that is unbiased? And who will define what “unbiased” means? Previous government studies (CATIE, ALLHAT) have focused on short-term cost savings vs. a more patient-centric approach treatment.
Who will decide what these detailers can say? Will government “reps” have to play by the same rules as their pharma counterparts?
“Words,” said Rudyard Kipling, “are the most powerful drug used by mankind.” We allow them to be usurped and corrupted at our own peril.