The Manufactured Outrage over Comparative Effectiveness Research

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.

Let's say, for instance, that researchers conclusively find that physical therapy combined with medication is a more effective treatment for neck and back pain than surgery. Or that the latest heart failure medication isn't as effective as previous options combined with careful home monitoring. That's not news an implant or drug manufacturer wants to hear.

Without third-party research, physicians have to rely on pitches from drug industry representatives or journals that have lost some credibility due to recent medical ghost-writing scandals. The Food and Drug Administration only tests new drugs and products on their individual merits, not in comparison to existing treatments. So without some sort of objective evaluation, it's difficult for doctors to distinguish between the effective and the favored.

"Clearly, the pharmaceutical and device industry would like both the public and physicians to continue to assume that "newer means better." Not asking these questions allows them to continue promoting profit-making, brand-name treatments," says Kevin Pho, MD.

To be clear, I'm not suggesting there aren't valid reasons to oppose comparative effectiveness research. Well-intentioned concepts often become mangled in the machine of bureaucracy, and a debate about how to keep research neutral and avoid mandated care protocols is needed. And, as McCaughey pointed out, this should have been discussed as part of a broader healthcare reform effort, rather than included in the stimulus package.

But this debate is too important for more comparisons to Nazi Germany and fear mongering about government-run healthcare.

During his address to Congress this week, President Obama promised to bring together "businesses and workers, doctors and health care providers, Democrats and Republicans" next week to begin work on what may be one of the biggest public health initiatives in U.S. history. What happens in the next year—maybe the next few months or even weeks—could cement the structure of the healthcare system for decades.

Physicians have an important seat at the table. And as respected members of their communities with a front-line perspective of the healthcare system, they can't afford to let partisan hacks and special interests drown out their voices and derail legitimate healthcare improvements.

People listen to and respect physicians. I hope more doctors in the coming weeks will challenge inaccuracies in the media (from both sides), give policy makers feedback, and discuss these topics with colleagues—anything that contributes to the conversation.

Because this will likely be the last chance for this type of change for a long time.