Opinion: Politics Should Not Trump Science in Medicine

Medicine has been taken over by administration, which stifles scientific innovation.
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I tell my patients there are three types of science: 1) investigative science, which sometimes gets it right; 2) science in the courtroom, which is junk science; and 3) science in Washington, D.C., which is political science.

Our decisions are based on art and science; our patients’ medications are brought to market based on science. And yet the way we are now extorted to treat and mandated to care for our patients is not based on any science. It is political science.

We need to make medicine great again. What’s happening? Here are a few examples:

Prior Approval

We write an FDA-approved medication prescription for our patient for a specific medical condition, and then we are told by the patient’s insurance company that we cannot use that medication; we need to use another FDA-approved medication in the compendium, which does not have an FDA label indication for the medical condition we want to use it for. This medication is not what we want to use, but if we don’t, we cannot treat our patient. Then they turn the tables around when we want to use an FDA-approved medication supported by literature to work for a condition not listed on the approved label, and they decline it based on the package insert—right drug, wrong disease.

In these examples, science does not trump politics or economics. This practice is executed by insurance companies and is called non-medical switching. It’s not based on medical science, but on insurance pseudo-science.

Electronic Medical Records

I think electronic medical records (EMRs) have great promise.¹ I began using one program, QD, in 1998 for that reason. Slowly, it was integrated into my care, and we have used it full time since 2008. QD was developed by physicians, including rheumatologists, for physicians. It is still great and gives me the ability to personally change the program on the fly at any time to help the care of the patient. (Note: You can’t do that with the big guys, where program changes need to be implemented centrally and take a long time.) But the typical EMR picture is one of a physician typing on the computer with his back turned to the patient.

Thus, the computer is imposed and now takes precedence in the doctor–patient relationship. The AMA white paper on the inefficiencies of EMRs emphasizes that they are time consuming and prolong patient visits.² Only an approved EMR allows one to qualify for Meaningful Use, but EMRs have not truly shown a benefit in patient care or reduction in cost of care. Hopefully, the assistance of the AMA and its presence on this issue will help us in this setting. Edward J. Schloss, MD, writes that healthcare documentation is performed for three reasons:³ 1) Healthcare delivery (that’s the obvious one); 2) Regulatory compliance (checking all the boxes our government and payers think are important); and 3) Malpractice avoidance (no one wants to get sued).

Hence, EMRs are commissioned by administrators for administrators and are not focused on patient care, but rather on regulatory compliance. Where is the science to prove this helps healthcare? It’s just not there. We see fewer patients. It is less efficient. The only saving grace I see is in electronic prescribing, but even that has shortfalls: You can’t find the pharmacy; it may not have all of the medications the patient takes; and you have to fill out an electronic prior approval, which takes even longer, so unfortunately, I still have to use paper and faxes for prior approvals.

Red Tape

Medicine has been taken over by administration, which stifles scientific innovation. Science has been lost in this environment. Medicine has been kidnapped by a bunch of government-driven regulations that cost billions of unnecessary taxpayer dollars for oversight. There is no science in this bureaucracy, which has exploded out of control. Medicine should be about the patient–physician relationship and how to apply science to this art, not excessive regulations that require countless numbers of people to oversee checkboxes for regulatory compliance instead of delivering medical care.

What about ICD-10?

We are told we need ICD-10 to collect better data and improve quality of patient care. It is expected to lead to better justification of medical necessity and improved implementation of national and local coverage determinations. The result will be more accurate payments, and fraud detection will be improved. We have learned differently.

ICD codes were developed by the World Health Organization for mortality statistics. We are told that every country in the world uses ICD-10. But for most, this is for demographics or, in some countries, hospital coding. For us, ICD codes are used for one reason alone—to file claims and get paid, and by insurers to deny payment. The U.S. is the only country using ICD codes to pay physicians. ICD-10 codes will result in more claim denials.⁴ The cost savings from the ICD-10 conversion is based on paying fewer dollars to providers. As physicians, we have seen that we are spending more time with EMRs and coding, our efficiency is decreased, and we earn less money. The data collected will be meaningless.

The ICD-10 burden is placed on top of cuts in insurance payments and excessive administrative demands, such as Meaningful Use, Physician Quality Reporting System (PQRS) and increasing insurance authorizations. For some physicians, it will be the final straw—forcing some to close their doors and abandon the practice of medicine, leaving thousands of patients without care.

Changes in medicine should include a rational, fact-driven, common-sense approach to change supported by scientific evidence. It should be evidence driven and not public policy driven—unless there is a clear, measureable public health benefit. We, as physicians, and our patients have the most to lose, but we have had the least input. All voices need to be heard before these programs are put into practice. This system of crony capitalism is hurting healthcare and practitioners.

We need to bring science back into medicine and medical decision making. We need to make medicine great again!

For information on how you can help, email [email protected] or visit the ACR’s Legislative Action Center.

John A. Goldman, MD, is a former clinical professor of medicine, Emory University School of Medicine in Atlanta. He is currently president of medical quarters and chief of rheumatology at Emory St. Joseph’s Hospital, Atlanta. He is in solo rheumatology, immunology and osteoporosis practice in Sandy Springs, Ga. He has been named a Master of the American College of Rheumatology (ACR) and a Fellow of the ACP, and is a certified clinical densitometrist.

Editor’s note: This article was adapted with permission from an article that originally appeared in RheumNow (Nov. 25, 2015).

References

1. Kavanaugh A. The electronic medical record: The good, the bad and the ugly. RheumNow. 2015 May 4.
2. American Medical Association. Press release: AMA calls for design overhaul of electronic health records to improve usability. 2014 Sep 16.
3. Schloss EJ. Why healthcare documentation is so bad. Blog: Left to My Own Devices.
4. Croft SM. The argument against ICD-10 implementation. Neurology Advisor. 2015 Jul 22.