Thursday, May 19, 2011

Comparative-Effectiveness Research: How Many Lives Will It Cost?

I write a lot over at John Goodman's Health Policy Blog.  For every original post, I also write about half a dozen comments on others' posts.  I don't usually share the latter here.

However, I was interested to see Dr. Goodman's take on a new paper published by the Center for Medicines in the Public Interest, an outfit which is often tagged as simply a mouthpiece for Big Pharma.  Here's what I wrote:
Yes, I certainly appreciated the last “dig” and I shake my head at the irony of PhRMA funding research designed to push back key elements of a law for which PhRMA lobbied and invested. I doubt that Obamacare would have passed without PhRMA’s support. If PhRMA had resisted Obamacare, the threat of Comparative-Effectiveness Research (CER) would not be nearly as great as it is today.

But that is water under the bridge. IMHO, Vernon & Goldberg have written a very good paper. Deriving a point estimate from one factor in a function that has many factors is obviously risky, but they have used scholarly sources appropriately. And they are obviously trying to have an impact on public policy so they communicated their findings in such a way as to generate as much “heat” as possible.

Isn’t that why we are in think tanks and not academic departments at universities? So that our research has impact in the real world and not just in articles in scholarly journals that few read?

If we are going to challenge people solely based on where they get their funding, without considering the work, then we must logically accept only research by amateur gentlemen who do if for free! I don’t think anyone fits that bill.

Even if we think the point estimate derived by Vernon & Goldberg is overconfident, it complements a principle that we champion: CER cannot be effectively achieved by a centralized bureaucracy. CER can only be effective when millions of patients, prescribers, scientists, and entrepreneurs are trying new medicines free of central control.

1 comment:

Wanda Jones, President, NCHI said...

Well, John--there are concrete reasons why the CER idea will be bad for the public. Think about the makeup of the committee--some 15 people. No matter how many staff they have, most of them will have to read something. How many different diseases and procedures are there? Let
's just say between 10,000 and 25,000.
If they try to be rigorous, they'll ask for the kind of professional research that is contracted out, and reported back in an academically pure fashion. How much time will that take? Add on the obligatory comments from the affected professional societies, so that another year goes by. At best 3 years per diagnosis or procedure. (It will cost real money to do this, too.) In the meantime, the science isn't standing still. What will happen is a kind of mudpie. People will be slogging through for an answer, all the while knowing that it will be obsolete when it comes out. But the most terrible thing is that it will stand as an answer until the next funding cycle, so that gradually the knowledge capital of healthcare will be eroded. Politicians believe that the best methods will be identified and will prevail. No, the methods considered standard by the current publishers of standards and protocols will prevail.

We are in the hot bed of genetics research; I dare the CER people to do an honest comparative of cancer treatments against honest to God genetic cures. Imagine protecting future patients from chemo--a true debilitating set of drugs.