My hopes for CER


Category : Medical Rants


One of my favorite blogging colleagues (James Gault) writes

There is no doubt that comparative effectiveness research would be of great value to both patients and physicians if it could be done in an unbiased way uninfluenced by the special interests that seem to play such a role in much of the the government does,mission statements to the contrary notwithstanding. I hope it works out well but then I had that hope for Medicare.

Another writes (What will the stimulus bill mean to health care?)

Perhaps the more relevant question is whether such clinical research is best done by the government. The most notable example of government sponsored CER is ALLHAT. ALLHAT is also a notable example of agenda driven research, faulty design and inappropriate spin, every bit as much as you’ll find in pharma sponsored research.

I understand their concerns, but I cannot imagine a worse situation than we have now.  I will give one simple example that we discussed on rounds yesterday.  63 year old man is admitted with classic new onset angina. Because we are a VA facility, we do not have atorvastatin, rather we use simvastatin.  All the data on acute use of statins for CAD come from atorvastatin studies.  We assume that the beneficial effects on plaque stability are class effects, but we do not know.  I would love a comparative study of simvastatin (generic) and atorvastatin (still a trade drug.) 

I see CER research as doing more of those studies than the ALLHAT type study.  If the money were going to CMS I would have greater worries than the money going to NIH and AHRQ.

I know many investigators who plan to apply for CER studies.  I hope they try to design unbiased studies.  I believe they will.


Comments (3)

I know this reply is a bit off your main point, but I cannot resist raising the following. Why is it that the government restricts use of a medication that has proven benefit in stabilizing coronary plaques? Why should not veterans have the same therapeutic benefit that is available to folks on Medicare through Part D?

[…] rad to the max! placed an observative post today on My hopes for CERHere’s a quick excerptI hope it works out well but then I had that hope for Medicare. Another writes (What will the stimulus bill mean to Bhealth/B Bcare/B?) […]

Do not agree that things cannot get worse. In my view, when we look back in 2014, we will wish for these days again. The 20B$ will have been used to create havoc as we are now headed for a big train wreck. Anyone who has witnessed EMR implementations will tell you that it is a lot like making sausage. It takes a lot of know how to prepare, great training, and a lot of cooperation. So far, the ones who have been the leaders are probably the best technology folks. As we get more into the thousands of practices out there, we will find a mess. Even with hospitals, their ability to drive these implementations is severely limited and the larger the hospital, the bigger the challenge. Also, the companies that will be able to be certified will never have enough people to pull this off in 5 years and thus training and support will get very bad. They will not be able to find enough good people and even if the could, would they hire enough knowing that if it is successful and everyone gets on EMR that their sales at that time will tank.
also there is no doubt that government plans, especially under the more socialist thinking group now in charge will be to gain access to control the type of healthcare delivered with rationing using their new found access to information. This will not be pretty because for reasons detailed above, most of the info will be FUBAR and garbage in will lead to garbage out. Decisions made by payers as we saw with HMO’s is never good for the patient in the long run and now it will be some government beaurocracts.

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