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!
{ 8 comments… read them below or add one }
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.
Bravo! Well said!
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?
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.
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????
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.
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.
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
{ 1 trackback }