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!