In more and more countries, ratings of medicines have become part of the already lengthy process that stands between new treatments and the patients who might be helped. Some ratings take the form of medical-benefit or innovation scales that try to predict the contributions of new medicines to health outcomes, often by comparing new and existing treatments.
In France, for example, the so-called Medicines Evaluation Commission uses a five-point scale ranging from “no improvement” to “major innovation” to rank new medicines against treatments already in use. A recent study of all 10 cancer medicines launched between 2003 and 2005 found that not a single one received a “major innovation” rating from French authorities—though several went on to become widely recognized standards of care.
Other systems—such as England’s—place the new medicines on cost-benefit curves, declaring whether or not they have met certain thresholds before the National Health Service will pay for them. These efforts are known as Health Technology Assessment or comparative-effectiveness research, or CER. Thanks to ObamaCare, CER now is heavily funded in the U.S. It is intended to evaluate established treatments but could evolve quickly into a gate-keeping system….
These efforts have two critical problems. First, it is almost impossible to predict the ultimate value of new treatments before they have been used widely in the actual practice of medicine. Second, expectations about outcomes that dismiss what appear to be small improvements ignore the very nature of progress against cancer. Science, medicine and public-health efforts have moved forward against cancer not in giant leaps but incrementally.