Favorite Quotes
"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
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"I hear and I forget. I see and I remember. I do and I understand." - Confucius
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"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
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" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
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"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
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"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
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"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
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"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
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"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
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"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
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"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
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"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
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"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
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"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
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"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
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"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
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"There are no facts, only interpretations." - Nietzsche
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"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
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"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow ====
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Comparative effectiveness research
13 Feb2009
I received an email about the health care implications of the stimulus package. It included this paragraph:
Comparative Effectiveness Research
The conference agreement also includes $1.1 billion for comparative effectiveness research (CER), appropriated to AHRQ. Of that amount, $300 million will remain with AHRQ; $400 million will be transferred to the NIH; and, $400 million will be transferred to the Office of the Secretary of Health and Human Services.
The agreement specifically states the conferees’ intent that the research not be used “to mandate coverage, reimbursement, or other policies for any public or private payer.” Rather the funding is to be used to conduct or support research to evaluate and compare clinical outcomes, effectiveness, risk, and benefits of two or more medical treatments or services that address a particular medical condition. They add that they recognize that a “one-size-fits-all” approach to treatment is inappropriate and that subpopulations must be considered when research is conducted or supported with these funds.
I strongly believe that CER will help physicians practice better, more cost-effective medicine. Some critics have tried to paint CER as government control of physician decision making. I suspect that the pharmaceutical lobby has injected that concern into the discussion.
Why is CER so important? When the FDA evaluates a new treatment, they do not require that the company compare the new treatment to existing treatments. Clinical trials often have many layers of complexity. As I have observed new drugs over the years, the pharmaceutical company can always find a reason that we should use the new drug.
As a physician I really want unbiased comparative data. I love new drugs, when they provide a significant advance over older drugs. Without CER we can only guess about the relative benefit of a new drug, or a new diagnostic technique, or a new operation.
I understand the worry about directing medical decision making, and I reject that worry. We need the best possible data to make good medical decisions. CER will provide us with such data.
As long as money is involved, industry will do their best to convince physicians and patients to spend more money for their profits. That is their job. My job as a physician is to not spend money unnecessarily. When I can spend less money for equal benefits, then both the patient and I are happy. CER will provide the data to help us make such decisions.
Bravo!
Related posts:
- Organizations in favor of CER
- Comparative effectiveness research – more thoughts
- We need comparative effectiveness and cost effectiveness
- A specious argument against CER
- The Medscape Roundtable on CER
Related posts brought to you by Yet Another Related Posts Plugin.
- In: Medical Rants
9 Responses to Comparative effectiveness research
Dr. Bob (FP)
February 13th, 2009 at 6:04 pm
This is exactly the kind of thing we need.
What’s better for an osteoporis patient in my office? Actonel, Vit D, or an exercise program?
Is there really any benefit of Altace over Lisinopril?
What would be better for mild cognitive impairment? Aricept, exercise, or placebo?
Should I add Byetta, Januvia, Actos, or insulin when metformin isn’t enough?
I’m sure the drug companies will lobby against in many subtle ways, but American medicine badly needs CER.
Jim Breiling
February 13th, 2009 at 9:27 pm
Bravo! Well said!
Jim Breiling
February 13th, 2009 at 9:30 pm
Might one (preferably more) of the medical professional associations affirm or reaffirm their support for such a program of evaluations and for evidence-based medicine as the best way to provide effective and cost-efficient care?
Bruce Kaler M.D.
February 14th, 2009 at 2:25 am
CER clearly provides more useful information for both patients and health care providers. The pharmaceutical industry has rarely done head to head studies unless they could upstage a competitor. Unfortunately due to the fortunes required to bring a product to market the process has been skewed much by profits. Too often we see review of a new medication offers no advantage over existing available treatments, other than providing market share for the newest manufacturer joining the field.
As a physician, anything that can provide guidence to the most practical and cost effective treatment is welcomed. CER is long overdue.
Jeffrey A. Tkac
February 15th, 2009 at 9:22 pm
Perhaps a CER program is “long overdue”, but adding it to a bill supposedly written as a emergency stimulus measure is underhanded and deceitful. How long will it take this research to bear fruit that benefits the economy????
Ann Weaver Hart
February 16th, 2009 at 10:55 am
Please let your representatives and senators in Washington know that you support CER. It is a logical and reasonable approach and it is badly needed.
We need comparative effectiveness research, or, I agree with Paul Krugman for the first time ever | Telecom News
February 18th, 2009 at 11:13 pm
[...] Cross, Robert Centor, and Bob Doherty offer their take on the [...]
Nick Berry
March 2nd, 2009 at 6:16 am
The idea of CER is great, but why must the taxpayers pay for it. Especially of comparing privately researched treatments. I understand the need for government funded research. If you in the medical field want to study something do so with your own private dollars. Not mine. It’s benefiting not only the patients, but the bottom lines of private industry.
Caroline
November 19th, 2009 at 4:46 pm
I thought you might be interested in "sitting in on" a panel discussion on CER that was held last week in Baltimore. there's a video of the meeting here:
http://speakhealth.org/are-there-changes-ahead-for-the-science-of-medicine/
Feel free to pass it along to colleagues who may be interested, and by all means leave your thoughts.
~c