Monday, April 27, 2009

DB on comparative effectiveness research

DB was recently blogging from the ACP national meeting. His post on the keynote, about comparative effectiveness research (CER), opens with:

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.

I am one of the med bloggers who has been less than enthusiastic about the new CER agenda and I am a political conservative. While I don’t know if I am one of the bloggers referenced by DB as being opposed to CER I think this would be a good time for me to clarify my views and pose some questions.

First, I don’t know of any med bloggers or politicians who are truly opposed to CER. If they were they would have raised objections to the CER that has been going on for decades long before it became a political agenda.

In over 30 years of clinical practice I have taken advantage of a great deal of CER to help me make decisions. Ever aware that science is a work in progress and that we will always need more and more research at many levels it never occurred to me that we needed a special agenda. I have never been opposed to CER, but I am suddenly very skeptical now that it has become politicized.

So, I don’t think this discussion is mainly about CER. I think it’s about an agenda for more government largesse based in part on distrust of the pharmaceutical industry. I had to laugh when I read this paragraph from Harold Sox’s keynote at the ACP meeting (italics mine):

In summary, the public isn’t getting its money’s worth from our system of industry sponsored clinical research. The public pays the costs of drug trials through higher drug prices drugs but gets research with tells us everything we need to know to make good decisions. We get more for our money with the NIH-sponsored trials that we support with our taxes.

Again I'll remind readers that we've already spent about a billion on research sponsored by a subsidiary of the NIH which by any reasonable account has been a tremendous waste.

DB concludes with:

CER will provide more unbiased data - I do not understand how that could be bad.

No one that I know of is objecting to more unbiased data. But CER is not inherently unbiased. Moreover, it is inherently susceptible to design flaws for reasons I pointed out here, with several examples. Bias has more to do with who’s sponsoring the research than the type of research. There’s no reason to think that the government would introduce less bias. In fact, the government policy makers who are pushing CER are explicitly very biased. If you don’t believe me just read the Congressional Budget Office paper which was pushing for CER, which I cited here.


Ben Hansen said...

Be sure to read Dr. Grace Jackson's "Open Letter to the Federal Coordinating Council for Comparative Effectiveness Research" posted at the Institute for Nearly Genuine Research web site:

james gaulte said...

Sometimes( more often than not) advocates of government funded CER leave out the "government" part when they argue for their position.The government part is one of the core reasons for my concern. Arguing for the desirability of CER is easy as there probably are no opponents.