Senator Clinton's Healthcare Proposal

One of Senator Clinton’s Proposals is to set up an institute similar to the National Institute for Clinical Excellence (NICE) in the United Kingdom Below you can read the specific language in her proposal:

• Fund and Distribute Independent Research to Compare Effectiveness of Treatments:


In the past decade, there has been an 80 percent growth in the numberof drugs prescribed, 100 percent growth in new medical device patents, 300 percentgrowth in teaching hospital procedures, and 1,500 percent growth in diseases withgene tests.iv Patients, providers and payers need information on how treatmentscompare to one another. The American Health Choices Plan funds a Best PracticesInstitute that would work as a partnership between the existing Agency for HealthcareResearch and Quality and the private sector to fund research on what treatments workbest and to help disseminate this information to patients and doctors to increasequality and reduce costs.

This proposal sounds like the creation of a new bureaucracy similar to the UK’s NICE (National Institute for Clinical Excellence). This government entity serves as a gatekeeper, and has ruled against reimbursement for many drugs and devices. For example, neither the beta interferons nor Copaxone, which are used to treat multiple sclerosis, have been approved for reimbursement in the United Kingdom. I excerpt in bolded italic NICE press releases referring to other examples of drugs that are used in the U.S. but whose reimbursement has been denied or greatly restricted in the UK:

The National Institute for Health and Clinical Excellence (NICE) has today published final guidance on the use of pemetrexed (Alimta) for the treatment of locally advanced or metastatic non-small-cell lung cancer. The guidance does not recommend the use of this drug and means that the appeal by Eli Lilly and Co. against the recommendations contained in the Final Appraisal Determination (FAD) has not been successful.

Draft guidance from NICE on the use of ranibizumab (Lucentis) and pegaptanib (Macugen) has been issued for public consultation today (14 June 2007). The guidance recommends the use of Lucentis for about 20% of patients with wet age-related macular degeneration, a condition which causes sight loss and blindness. The draft guidance recommends Lucentis for people with predominantly classic subfoveal choroidal neovascularisation (CNV) wet age-related macular degeneration. It recommends Lucentis should be used when both eyes are affected, and that it should be used in the better-seeing eye. The guidance does not recommend the use of Macugen.

The National Institute for Health and Clinical Excellence (NICE) has today published final guidance on the use of bevacizumab and cetuximab for the treatment of metastatic colorectal cancer. The guidance does not recommend the use of these drugs for first line therapy for metastatic colorectal cancer (bevacizumab) and therapy following the failure of an irinotecan containing chemotherapy regimen (cetuximab). In this case, our advisory committee was certainly aware thatcolorectal cancer is an aggressive disease and that the treatment options availableare limited. However, the assessment of the evidence shows that neither of these drugs represents a good use of NHS resources.”

I’ve been thinking about her proposal, and I’ve come up with the perfect name for the institute:

Biomedical Institute To Control Healthcare