Comparative Effectiveness Research
Regardless of what happens to the current health care reform legislation, it appears that the government's push for more research into the comparative effectiveness of treatments will get continued emphasis in 2011. In the recently proposed 2011 budget, the Administration has requested almost $300 Million for the Agency for Healthcare Research and Quality (AHRQ) to conduct comparative effectiveness studies. This would be on top of a little over $300 Million authorized in the current year.
I don't think many people would disagree that innovations and new treatment options are occurring very rapidly in the medical field and that it is difficult for physicians to keep on top of these developments and make informed recommendations to their patients as to the best alternatives for them. Understanding and then following "best evidence" medicine is not easy for the busy practitioner. Better research on comparative effectiveness will certainly help this situation.
But as we saw in 2009, a change in recommended treatment based on comparative effectiveness studies is not an easy pill to swallow. The proposed revision in the use of screening mammography exams caused an uproar, as it was seen as a possible justification for third party payors to deny payment for routine screening exams for younger women with no history or indications of problems.
The bad press and angry reactions surrounding that relatively simple proposed modification in recommended treatment highlight the difficulty of gaining general acceptance to "best evidence" medicine in the United States. We are accustom to being entitled to get whatever we want in medical care, without consideration of comparative effectiveness. While physicians overwhelmingly may want to recommend what they think to be the best treatment for the specific patient, there is not a good support system in place for a doctor who wants to follow "best evidence" medicine if payors will permit anything the patient or doctor want to try and if the doctor has to worry about liability for his or her recommended course of care. Managed care in the 1990's tried to control expensive treatments that had no proven degree of effectiveness, and were shut down in those efforts by media and political uproar based primarily on the isolated anecdotal story of the effects of a denial of coverage.
We can spend $300 Million each year on comparative effectiveness research, which undoubtedly will benefit practicing physicians as they consider treatment options, but until we as a society start to discuss and come to a consensus on what it means for an individual to have access to appropriate health care, expect more outrage every time some panel suggests that the benefit of a test or treatment is not effective enough to justify its use.
