Monday, May 17, 2010

Comparative effectiveness video

Comparative effectiveness is discussed in this video from the Medscape one-on-one series. My own view of comparative effectiveness research was vindicated in the opening remarks by panelist Milton C. Weinstein, PhD. He said that CER is not new. We've been doing it for half a century---it just has a new name.

JoAnn E. Manson, MD, DrPH, made a little appreciated point (about 7:30 in): research, even research that compares treatments, doesn't address real world situations very well. It's all about the distinction between effectiveness (how a treatment performs in the real world) and efficacy (how a treatment performs in the hands of clinical investigators in controlled conditions). What's popularly known as comparative effectiveness research, then, is really comparative efficacy research. Translating that into comparative effectiveness remains a challenge. True comparative effectiveness research is, almost of necessity, “lower level” on the EBM hierarchy, e.g. observational studies, before-and-after studies and the like.

Dr. Manson made another distinction (8:25): of equal importance to comparing treatments is comparing ways of doing and organizing health care. For example, are performance measures and bundles effective?

Finally, all the comparative effectiveness research and comparative efficacy research in the world (and we already have a great deal of both) won't address the fundamental problem: doctors do a poor job of using the research information they already have. But they need tools, not coercion (see below) to help them do better.

So, well and good, you might say. Comparative effectiveness is great. Sure it is in its pure notion. But listen carefully at 9:28, where Dr. Manson reveals the true agenda of comparative effectiveness as a government sponsored movement: to leverage more involvement by policy makers and payers in clinical decisions. In other words take EBM away from the doctors. Can that work in the U.S.? Look at the history of managed care or Medicare.

There's more. While I don't agree with everything the panelists said, this video adds needed clarity to the often confusing discussion on CER.

1 comment:

james gaulte said...

When you hear the words "leverage" and "collaboration" in this sort of context,be afraid.