The Manufactured Outrage over Comparative Effectiveness Research

Elyas Bakhtiari, for HealthLeaders Media, February 26, 2009

What if physicians could make decisions about which drugs, devices, and treatments to use based on objective research into which options were most effective?

The concept is called comparative effectiveness research, and many physicians believe it could improve quality and loosen the stranglehold the device and drug industries have on healthcare. The American Medical Association has endorsed the idea, as have several other physician organizations. In fact, it's difficult to find many doctors who consider it, in concept, a bad idea.

Here's how one physician blogger explains its value: "As a physician I really want unbiased comparative data. I love new drugs, when they provide a significant advance over older drugs. Without [comparative effectiveness research] we can only guess about the relative benefit of a new drug, or a new diagnostic technique, or a new operation."

Yet the $1.1 billion allocated to comparative effectiveness research in the economic stimulus package sparked one of the most vitriolic political debates over healthcare reform in a while. Why?

The controversy began when Betsy McCaughey—the same Betsy McCaughey who laid the groundwork for the rally against Bill Clinton's healthcare reform efforts in 1993—wrote an op-ed implying that the comparative effectiveness research provision would lead to healthcare rationing, and it reached fever pitch when the Washington Times ran an editorial, complete with an accompanying photo of Adolf Hitler, suggesting that it might lead to Nazi-style euthanasia.

Consider that a taste of what's to come when Washington undertakes larger healthcare reform efforts.

Some of the disagreement is ideological, and as we've seen in recent weeks, those divides are difficult to bridge. But the lobbying effort against comparative effectiveness research seems to be coming from the drug and device industries (McCaughey has even been forced to defend her own ties to the industry recently, including her board membership at Cantel Medical Corp.).

And that gets at what's really at stake here: Money. Lots of it.

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