How do we know what’s necessary and effective? The short answer is by comparing results of different preventions and treatments tried on similar groups of people. To choose winners, the groups and trials must be carefully controlled. That’s science. But some Americans, who believe the winners of boxing matches and auto races, learned no science in school. They find sciences effete and not to be trusted. This is their right as free Americans, but we depend on free media to counter their fake news and charges that scientists are “death panels.”
Meanwhile thousands of career investigators in America and around the world are busy developing and testing treatments. Most are in universities. Many are financed by the National Institutes of Health. In England they are in the independent, volunteer Cochrane Collaboration. The most productive and trusted are appointed to editorial boards of the world’s leading scientific journals, e.g. Science, Lancet and The New England Journal of Medicine, which assure no commercial bias. These men and women elect their most respected colleagues to the National Academy of Medicine, a non-governmental, nonprofit society of volunteers who advise the Congress and the Executive branch on the safety and effectiveness of medical practices. So the long answer to how do we know is we listen our most trusted advisors.
Being told by our most expert and trusted advisors that a treatment is ineffective need not mean that it cannot be manufactured, advertised and prescribed. If it is harmless to others, a treatment should be available to any willing buyer. That’s freedom. But it should not be bought by the government with taxpayers’ money. That’s not freedom. According to our model, restraint will be exercised as it is now by Medicare: by refusing to pay providers for medically unnecessary or ineffective treatments.
Expert advice is not binding on Congress. In recent years lobbyists have enabled doctors to perform hundreds of thousands of useless spine procedures and to prescribe tons of narcotics falsely advertised as non-addictive. These are challenges for another question and answer, but for now the solution is for the government not to pay for waste with taxpayers’ money.