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 ====
Nov - 15
Dec - 19
Jan - 21
Feb - 7
Mar -
Why we need CER – the short story
25 Apr2009
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.
Related posts:
- A specious argument against CER
- Organizations in favor of CER
- 15 days at the VA – day 10
- Can we avoid paternalism?
- Another performance measure challenged – BP goal
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- In: Medical Rants
8 Responses to Why we need CER – the short story
Robert W. Donnell
April 25th, 2009 at 8:12 pm
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.
Tom
April 25th, 2009 at 9:17 pm
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.
Jeff
April 26th, 2009 at 1:12 am
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
#1 Dinosaur
April 26th, 2009 at 10:56 am
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?
Bigislandmike
April 26th, 2009 at 1:55 pm
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.
James Gaulte
April 27th, 2009 at 2:00 pm
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.
Why we need CER - the short story < It’s all about the trends
May 4th, 2009 at 5:08 pm
[...] 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.” : [...]
Why we need CER - the short story < It’s all about the trends
May 4th, 2009 at 5:08 pm
[...] 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.” : [...]