Don Taylor recently noted the likely resistance to Blue Cross Blue Shield’s refusal to cover the ineffective, costly procedure known as proton beam therapy. Austin Frakt has a terrific post up at JAMA Forum that presents more reasons why the decision will probably not stick:
The historical record provides some clues. In general, there is a strong bias in the United States in favor of covering new technology. This is among the reasons why technology is one of the leading drivers of health care spending growth. We pay for itâ€”a lot.
Austin mentions autologous bone marrow transplantation for breast cancer as another example of an ineffective medical technology that became political impossible not to fund. As related in the must read book False Hope, scientific evidence that a technology doesn’t work has little chance of being influential once compelling advocates with emotional stories capture the limelight. No Members of Congress want to preside over a panel of grieving families blaming them for denying care to a deceased love one (yes, even ineffective care) and in a media battle with a “plucky patient who is taking on the insurance industry fat cats” on one side and a bespectacled nerd with randomized clinical trial results on the other, the patient will carry the day almost all the time.
In the case of autologous bone marrow transplantation for breast cancer, that meant that a number of breast cancer patients “won” access to a needless, ineffective and absolutely excruciating medical procedure. Proton beam therapy advocates will probably “win” a similar victory, sustaining another center of high-cost, ineffective medical technology in the U.S. health care system