Pretty much every sensible expert believes that the best hope for curbing medical expenses in the future is to be more choosy over which treatments patients get. Fortunately, it also turns out that we presently pay for a lot of care that is unnecessary, if not downright harmful.

The most compelling and comprehensive evidence for this comes from John Wennberg and his fellow researchers at Dartmouth, who have demonstrated that patients in places like Miami get far more care than patients in places like Minneapolis--and yet the Miami patients don't seem to be better off for it. If you want a more thorough treatment of this issue, I recommend picking up a copy of Shannon Brownlee's Overtreated or Merrill Goozner's The $800 Million Pill. (Or just keep up with Merrill's blog, Gooznews.)

The silver bullet for health care reform--the way to save money without compromising the quality of medical care--is to compile more evidence on what works and what doesn't. But it will take time to compile that information, time to apply it, and then more time to realize the financial benefits.

That is why forward-thinking members of Congress have been pushing this idea for a while--and why, in the economic stimulus package, they included funding to begin those studies. (You have to hire researchers, plus support staff, to collect and analyze data; you have to purchase equipment and build infrastructure for their operations. All of that creates jobs...)

But guess who's opposing the idea? The drug and device industries, who--needless to say--make an awful lot of money on all of that unnecessary care. Alicia Mundy has the story in today's Wall Street Journal:

The drug and medical-device industries are mobilizing to gut a provision in the stimulus bill that would spend $1.1 billion on research comparing medical treatments, portraying it as the first step to government rationing. ...

The House version of the stimulus package sent shudders through the drug and medical-device industry. In a staff report describing the bill, the House said treatments found to be less effective and in some cases more expensive "will no longer be prescribed."

A Senate version backed by Finance Committee Chairman Max Baucus (D., Mont.) doesn't mention cost as a subject to be studied. And the industry won a battle to add the word "clinical" in describing the research -- adding to the implication that the comparison studies won't look at bang for the buck. The final language is likely to be hammered out later this week in a House-Senate conference committee. ...

The $1.1 billion in research funding would be doled out to the National Institutes of Health and other government bodies. "We should focus on producing the best unbiased science possible," said Rep. Henry Waxman (D., Calif.), a strong proponent of the House language. ...

Officially, drug and device makers don't object to that sentiment. But they warn of a slippery slope where the government ends up axing useful treatments just because they cost too much.

Oh, and get used to hearing about this fight. It will figure prominently in the debate over health care reform as it moves forward.

Update: Elizabeth McCaughey is up to her old tricks again. Not content to have poisoned one major health care debate, she seems determined to poison this one, too. Here she is, at Bloomberg.com yesterday, getting predictably worked up about efforts to scrutinize treatments for effectiveness. And here is Igor Volsky at ThinkProgress with the rejoinder.

Update 2: Also worth reading is this Philadelphia Inquirer profile of Republican Senator Charles Grassley and his posture towards the drug industry. Keep in mind that Grassley could play a key role in health care legislation, since he is ranking minority member of the all-important Finance Committee.

--Jonathan Cohn