Tuesday, August 24, 2010

Comparative effectiveness research---more heat than light

The heated debate on CER is rife with logical fallacies: appeal to belief (it's something new, doctors have no research data with which to compare treatments), the straw man (so and so is opposed to CER), false dichotomy (you are either for us or against us in the debate on CER) and others. This is well illustrated in a recent exchange of blog posts and comments. DB accuses another blogger, guest blogging at Kevin MD, of being anti-CER. That goes beyond what the blogger was saying. DB is not alone. The straw man about people out there being against CER is pervasive. I gave additional examples here. Yeah, maybe there's some nut-job out there who really opposes the pure notion of CER, but I have yet to encounter such opposition among physicians or on either side of mainstream politics.

I've been watching the “debate” on CER for over a year now with some amusement. It conflates issues directly linked to comparative effectiveness research with other concerns about misguided government policy, conflicts of interest, perverse cost incentives, things that have nothing to do with whether doctors need research to help them compare treatments (which most everybody agrees they do) which, for the sake of clarity, might best be discussed separately.

At least DB did acknowledge in his post that CER is nothing new, citing research findings about antiarrhythmic drugs and mortality. That research, CAST, comparing flecainide, encainide and moricizine, and its companion pilot study CAPS, comparing those three drugs alongside procainamide and impiramine, was from the 1980s!

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