Grading PolitiFact: Stimulus bill bureaucracy patterned after British NHS board?

If there is justice in the world, the volume of manure produced at PolitiFact will result in the required purchase by The St. Petersburg Times of large quantities of carbon offsets under any proposed cap and trade system.

Fact-checking the fact checkers

The issue:

An ad produced by Conservatives for Patients' Rights suggests that a government entity created by the stimulus bill passed early in the Obama presidency has its parallel in the controlling board for the National Health Service in Great Britain. CPR's chairman, Rick Scott, serves as the spokesperson in the ad.

The PolitiFact presentation:

"Deep inside the stimulus bill Congress buried an innocent-sounding board, the Federal Coordinating Council for Comparative Effectiveness Research," Scott says in the ad. "It's not so innocent. It's the first step in government control over your health care choices. This federal council is modeled after the national board that controls Britain's health system."

And the ad itself:



The fact checkers:

Angie Drobnic Holan: writer, researcher
Bill Adair: editor


Analysis:

Drobnic puts her focus on Scott's claim that the entity created under the American Recovery and Investment Act has some sort of parallel in the NHS board in Great Britain.

The ad is correct that the stimulus bill includes language creating the Federal Coordinating Council for Comparative Effectiveness Research. But to say it's modeled after the British health system is wrong. The board is simply an effort to pull together disparate federal agencies to find the best health treatments.

Neither Scott nor Drobnic mentions it by name, but the National Institute for Health and Clinical Excellence appears to qualify as a close parallel to the "Coordinating Council."

The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.
(nice.org.uk)

Or, more specifically:

NICE produces guidance in three areas of health:

• public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS
• clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

They make it sound almost like a centralized government effort to find the best health treatments. And though Scott did not it by name, Amy Menefee of the Galen Institute did.

An example of NICEness from Reuters:

The National Institute of Health and Clinical Excellence (NICE) said Roche's (ROG.VX) Avastin, Bayer's (BAYG.DE) Nexavar, Pfizer's (PFE.N) Sutent and Wyeth's (WYE.N) Torisel could extend patients' lives by some months but were not cost-effective.

The drugs -- known generically as bevacizumab, sorafenib, sunitinib and temsirolimus -- should therefore not be a treatment option for advanced and/or metastatic kidney cancer, NICE said in its preliminary recommendation.

NICE policies have resulted in a good number of similar news stories, so the organization qualifies as controversial. Perhaps controversial enough that Democrat advocates of health care reform would not like the comparison. But as a "first step" toward government control of patient care, the characterization seems fair on its face. Aside from ignoring the existence of NICE, what is Drobnic's objection to the comparison?

Comparative effectiveness research is an effort in health care to determine which treatments work best. The new board's goal, according to the bill's conference report, is to "reduce duplication of comparative effectiveness research activities within the Federal government." The legislation requires that half of the board's 15 members be physicians or "other experts with clinical expertise."

Up through the last sentence, NICE looks like a dead ringer for the new board. And another visit to nice.org.uk once again tightens the comparison:

NICE guidance is developed using the expertise of the NHS and the wider healthcare community including NHS staff, healthcare professionals, patients and carers, industry and the academic world.

The functions are essentially the same, and both have healthcare professionals intimately involved in the development of standards. So obviously they could not be more different. Or something.

But Drobnic keeps trying:

The legislation also specifically states it does not permit the board to "mandate coverage, reimbursement, or other policies for any public or private payer" and that the none of the board's reports or recommendations "shall be construed as mandates or clinical guidelines for payment, coverage, or treatment."

This stands in sharp contrast to the British system, where government entities run the health care system and a national board, the National Institute for Health and Clinical Evidence, determines whether particular treatments are covered or not.

So Drobnic knows about NICE, but ignores the similarities in favor of noting the one principal difference--the difference most dispassionate readers might take to constitute the distinction between a "first step" toward a UK-style system of central oversight and the last such step.

Ain't fact-checking grand?

In defending its ad, the group has said that its ad makes clear that the Federal Coordinating Council for Comparative Effectiveness Research is simply a "first step" toward the British system.

CPR pointed out the obvious to Drobnic.

But that seems to be the group's opinion more than a fact.

When you see a reporter use the word "seems," it is a pretty sure sign that subjectivity has reared its head. In other words, Drobnic's statement seems to be more her opinion than a fact. And the fact is that NICE shares quite a bit with the "Coordinating Council" established in the stimulus package, and the latter would seem poised to segue NICEly to an expanded role in overseeing national standards for treatment. Though if one keeps one's eyes tightly shut, no doubt it is easy enough not to see it.

This is not to say that implementing comparative effectiveness research will be painless for the general public ...

So she peeked, albeit a few paragraphs later. Not that it ultimately affects Drobnic's conclusion:

It is right that the economic stimulus bill created the Federal Coordinating Council for Comparative Effectiveness Research. But the ad is wrong that it is "modeled after the national board that controls Britain’s health system." We see no evidence for that.

NICE and the Federal Coordinating Council for Comparative Effectiveness research have parallel purpose and membership (partly health professionals), but Drobnic sees no evidence of the one modeled in the other. Perhaps Drobnic insists on a parallel to the great overarching structure of the entire British system? As a "first step"? That would be odd.

Because the ad significantly distorts the reason for the board's existence, we rate its claim Barely True.

?

How did the ad distort "the reason for the board's existence"? The ad did not refer at all to the reason for the board's existence except to state that its creation was "not so innocent." And the parallel to NICE withstands scrutiny, as Drobnic obliquely acknowledged when she admitted to the pain of implementing comparative effectiveness standards in health care.

Fact-checking performed while blind to legitimate parallels should not count.

If the ad is inaccurate at all, it would owe to the lack of inspiration from across the pond. Direct borrowing is neither established in the ad nor addressed by Drobnic. In any case, the ad tries to make the point that the new board has a parallel in the British system, and though Scott fails to mention it by name, NICE seems to fit the bill with its relationship to the NHS serving England and Wales.

It seems as though Drobnic was not interested in the facts, though perhaps she was interested in minimizing the comparison between the health care reform measure in the 2009 stimulus bill and the British health care system. And any other PolitiFact staffers who reviewed the piece were happy to let it stand.

The grades:

Angie Drobnic Holan: F
Bill Adair: F


Afterword:

It's worth comparing the Media Matters version of the same story. Media Matters is known for making attempts to influence news coverage by traditional sources. I assess there is a good chance that a fair bit of mail received at PolitiFact comes from folks attached in one way or another to Media Matters.


May 14, 2009: Fixed goofy spelling of "bureaucracy" in the title