AHRQ: The (Scary) Little Agency That Thinks It Can

Can do the impossible, that is, which to prescribe which medicines and medical procedures are both most efficacious and most cost-effective. So far, I can find little proof of AHRQ's accomplishing anything near this goal on the site of the Agency for Healthcare Research and Quality. AHRQ is in the news since it just got a whole new set of fangs in the Obama stimulus plan (aka the Tom Daschle stealth strategy for health care reform). Rush Limbaugh and the Washington Times have equated the new powers of AHRQ to Hitler's program of euthansia for the old, infirm and disabled of any age. These people are not productive, so why treat them and waste resources? Get rid of 'em. Daschle, of course, is not prescribing euthansia per se, but he wants a federal agency (which is now the AHRQ, ironically started under Dubya in 2004) to determine, among other things, when someone in the last stages of life should be denied services and asked to give up the ghost. Daschle says that seniors should gladly accept “hopeless diagnoses” and “forgo experimental treatments,” except when it comes to pols like himself who will get the gold standard of cradle-to-grave health care. (Can you imagine Ted Kennedy's being denied brain-tumor surgery last year even when a majority of doctors proclaimed it a waste of time and money, which they actually did?) I keep bringing up Daschle's name because it was his prescriptions for a federal agency to determine most cost-effective treatments and to track everyone's health care through electronic records that was slipped into the stimulus bill under the innocuous-sounding name of the Health Information Technology for Economic and Clinical Health (HITECH) Act--and then rushed into law before anyone had a chance to thoroughly read it. Except Betsy McCaughey, former lieutenant governor of New York who's been tracking health care matters, when she did read it and warned that you can "Ruin Your Health With the Obama Stimulus Plan," especially if you're a senior citizen. Is the AHRQ really that scary and powerful? Not yet. I read through some of its Web site pages and found nothing revolutionary. In fact, it looks to be an impossible task for any person or agency to make valid health care cost-containing assessments. The best AHRQ could do was to compare findings of 61 studies on treating hypertension and to conclude that both angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are equally effective, though the former have generic brands available while the latter don't, yet. Which means that the best anyone is going to do in measuring effectiveness in health care is to rule out quackery--and then just to rule out high-cost medicine, with a few rare exceptions (Daschle and company). Which is where it all really gets scary--down the line in the future when Obama and others call it a "health care crisis" and "we have to act now." Wham, bam, no more angioplasties (fill in the blank) after age 62 (fill in the blank) and so on. What really got me scared came when MSNBC's Keith Olbermann, who's never gotten any fact or issue correct in his life (except baseball arcana), felt compelled to devote a whole show to "debunking" the charges by Limbaugh and McCaughey. McCaughey's response? "Let's hold a debate." Problem is, people like Olbermann don't won't a debate--they want a crisis, real or imagined.