Why we need CER – the short story

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Category : Medical Rants

 

Many med bloggers do not appear to support CER.  Many "conservatives" appear to oppose CER.  I truly believe that opposition is not based on an understanding of CER’s importance.

Let me give a couple of examples of the need for CER.  We know that high dose statins decrease the risk of coronary events – even when used acutely.  We have data from RCTs of trade name statins, but do current generics perform as well?

We need more head to head trials of ACE-I vs. ARB’s for delaying progression of CKD.  Nephrologists promote the more expensive ARBs – are they worth the money?

Kevin has argued that UptoDate has the information – but the information database is dramatically incomplete.

I would like a study of hctz vs chlorthalidone – which should we use as a blood pressure treatment – and does it matter.

Drug companies will not fund these studies.  I need that information to make cost effective decisions with my patients. 

CER will provide more unbiased data – I do not understand how that could be bad.  Please read Hal Sox’s Keynote Address:  IM 2009 for a better explanation.

Comments (8)

DB,
I am not opposed to CER per se but I may be one of the bloggers you reference in your post. At any rate, in light of your post, I think it may be a good time to clarify some of the skepticism on the part of myself and others towards the current agenda of CER. I have a post in preparation which will probably go up Monday morning. I hope you will read it and share your thoughts.

I think that CER is a great goal. However, I think it will ultimately be very different than we’re all envisioning. The key reason is (from the linked Keynote Address): “…the agencies that make grants for CER must care deeply about these key attributes and the mission of CER”.

Government agencies tend to get filled with career appointees whose main goals in life become: 1) sustaining their own employment and 2) expanding the number of people who report to themselves. I just don’t the confidence in government agencies that so many others seem to display.

Maybe your faith in statins is overplaced. A new scientific review of 900 studies shows statins have too many harmful side-effects:

http://www.wellnessresources.com/freedom/articles/researchers_document_the_dangers_of_statins/

Maybe the correct question should be: Are there any proven, safe alternatives to statins:

http://www.lef.org/magazine/mag2007/mar2007_atd_01.htm

What I don’t understand is how CER is qualitatively different from just regular old clinical research? What’s to stop you — or anyone else, for that matter — from studying chlorthalidone and HCTZ? I realize that it’s all tied to funding, but wouldn’t it be easier, quicker and cheaper just to direct NIH to adjust their focus and increase funding for such “basic” studies, instead of creating an entirely new “CER” bureaucracy?

What if you used fewer acronyms (UFA), or explained them the first time you use them (EFT)? I love reading your blog, and I often don’t know what the heck you’re talking about. I’m an anesthesiologist with many years in academic medicine and private practice, but I’m often unable to think of words that fit a particular set of letters. I’ll bet others, particularly nonmedical readers, miss the benefit of your thinking and find themselves out of the loop as well. Please, in support of being more widely understood, consider limiting or explaining acronyms.
Thanks.

I was preparing a reply but I find that Dr. Robert Donnell’s recent blog entry ( http://doctorrw.blogspot.com/2009/04/db-on-comparative-effectiveness.html) said everything I wanted to say. ( OK I did one anyway).My blogs on the subject have not been “against CER” but have expressed serious concern about a government funded and managed CER agency.

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[…] perform as well? We need more head to head trials of ACE-I vs. ARB’s for delaying progression click for more var gaJsHost = ((“https:” == document.location.protocol) ? “https://ssl.” : […]

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