THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: Tuesday, November 22, 1994 TAG: 9411220027
SECTION: FRONT PAGE: A14 EDITION: FINAL
TYPE: Editorial
LENGTH: Short : 46 lines
Even experts on high blood pressure say their blood is boiling because of new guidelines issued by the National Institutes of Health.
NIH has recommended which drugs doctors ought to use first in treating high blood pressure - diuretics and so-called beta-blockers. The Wall Street Journal reports that the experts think newer drugs - ACE or calcium-channel blockers - may often be a better choice. NIH says it couldn't recommend those because long-term trials of them haven't yet been completed.
At first blush this looks like an esoteric debate among scientific colleagues. But a government recommendation carries so much weight that the critics of NIH say this pronouncement may have unintended consequences. By recommending one method of treatment over another, it may force doctors to conform to guidelines though it goes against their own best professional judgment.
There are at least two ways that can happen. First, insurers may not agree to pay for the newer, and more expensive, medications since the government doesn't recommend them. Second, doctors who go ahead and use the newer drugs may find themselves more liable to malpractice suits. Plaintiffs' attorneys may be able to stigmatize their choice as not government recommended.
Assuming the new drugs may actually be better, an agency dedicated to improving health care can, ironically, end up sabotaging the cause. Here's one more instance of medical decisions that ought to be made by individual physicians being influenced and sometimes short-circuited by people and institutions far removed from the actual examining room.
When a doctor treats a patient today, he's got NIH and FDA bureaucrats looking over his shoulder, insurance companies breathing down his neck and malpractice lawyers staring him in the face, even though no one gave any of them a license to practice medicine.
Any health-care reform must aim at leaving doctors in charge of the doctoring. And all the interest groups and regulators who impinge on the practice of medicine would do well to observe the same rule that doctors are admonished to follow: First, do no harm. by CNB