The Manufactured Outrage over Comparative Effectiveness Research

Elyas Bakhtiari, for HealthLeaders Media , February 26, 2009

Let's say, for instance, that researchers conclusively find that physical therapy combined with medication is a more effective treatment for neck and back pain than surgery. Or that the latest heart failure medication isn't as effective as previous options combined with careful home monitoring. That's not news an implant or drug manufacturer wants to hear.

Without third-party research, physicians have to rely on pitches from drug industry representatives or journals that have lost some credibility due to recent medical ghost-writing scandals. The Food and Drug Administration only tests new drugs and products on their individual merits, not in comparison to existing treatments. So without some sort of objective evaluation, it's difficult for doctors to distinguish between the effective and the favored.

"Clearly, the pharmaceutical and device industry would like both the public and physicians to continue to assume that "newer means better." Not asking these questions allows them to continue promoting profit-making, brand-name treatments," says Kevin Pho, MD.

To be clear, I'm not suggesting there aren't valid reasons to oppose comparative effectiveness research. Well-intentioned concepts often become mangled in the machine of bureaucracy, and a debate about how to keep research neutral and avoid mandated care protocols is needed. And, as McCaughey pointed out, this should have been discussed as part of a broader healthcare reform effort, rather than included in the stimulus package.

But this debate is too important for more comparisons to Nazi Germany and fear mongering about government-run healthcare.

During his address to Congress this week, President Obama promised to bring together "businesses and workers, doctors and health care providers, Democrats and Republicans" next week to begin work on what may be one of the biggest public health initiatives in U.S. history. What happens in the next year—maybe the next few months or even weeks—could cement the structure of the healthcare system for decades.

Physicians have an important seat at the table. And as respected members of their communities with a front-line perspective of the healthcare system, they can't afford to let partisan hacks and special interests drown out their voices and derail legitimate healthcare improvements.

People listen to and respect physicians. I hope more doctors in the coming weeks will challenge inaccuracies in the media (from both sides), give policy makers feedback, and discuss these topics with colleagues—anything that contributes to the conversation.

Because this will likely be the last chance for this type of change for a long time.

Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at
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