I have reread the blog post several times, and each time I find it an attack on CER. Now, I understand that we all see every issue through a prism of our own biases and beliefs.
Why am I so passionate about CER? I am showing my bias about what kind of research we (the people and the government) should fund. I believe we have funded basic research quite well, but we have shortchanged the research that we now call CER.
In general CER focuses more on patients than diseases, asking a fundamental question, what strategy will best help our patient? Basic research is obviously very important, but by its nature it must be disease oriented.
My passion comes from a belief as a clinician that we must balance our knowledge of individual diseases with an understand of how multiple diseases impact a patient. As I view CER, it answers questions about patients. The examples I gave earlier this week hold for this formulation.
As I read the aforementioned blog post, I read (through the prism of my own paranoia) disdain for the present in which I must help patients make decisions and an excitement about the wonderful revelations of the future. We need both types of research and denigrating CER makes me mad.
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CER is a good step but real world patients are affected by so many externalities and that will make it hard to do "all-inclusive CER".
Thanks for the clarification. I only hope that people who question the agenda behind CER or express concerns about unintended consequences don't automatically get labeled as anti-CER. I've often been critical of the way CER is debated and promoted. If we didn't know each other better I might worry that, through your lens, I'd be perceived as anti-CER. Which, of course, I'm not.
Thanks, RWD. I follow your blog posts avidly and at times felt that you were anti-CER. I found this a bit baffling. Happy to admit that I was mistaken. 2 recent posts in BMJ on CER and translational research:
http://www.bmj.com/content/341/bmj.c3615.full
http://www.bmj.com/content/341/bmj.c4363.full?ath_user=cym019amitnsingh&ath_ttok=%3CTHaKZKP6hSd8KQyeag%3E
I have supported the concept of CER, before I knew the term CER. This is going to be very, very tough to implement, because careers, money and industries are at stake. These guys will not fall on their swords to serve the greater good.. CER results that suggest that a medication or device be retired, will be attacked as flawed science with poor study design. Studies with opposite conclusions will be publicized. We have only to reflect back to last year's Mammagate to witness how public opinion and our goverment can roll over sound medical evidence.