February 25, 2009

Evidence-Based Medicine Gets a Nod in Stimulus Bill

As Christine mentioned in her most recent Political Diagnosis, the recently passed stimulus bill includes $1.1 billion for comparative effectiveness research, which compares “the clinical outcomes, effectiveness, and appropriateness of items, services, and procedures that are used to prevent, diagnose, or treat diseases, disorders, and other health conditions.”

Comparative effectiveness research is intended to inform medical decision-making. For example, it may ask whether an expensive new drug really works any better than an old, generic treatment, or whether it is enough of an improvement to justify the added cost. It may take the form of new clinical research, or of systematic reviews of the existing evidence. As respected medical blogger Kevin, MD explains regarding the value of this type of research:

Physicians need an authoritative source of unbiased data, untainted by the influence of drug companies and device manufacturers. With treatments and medications announced daily, having an entity definitively compare these newer, and often more expensive, options with established treatment regimens will be particularly useful in everyday practice.

The only way to tackle such a huge project is with money, and indeed, the Obama administration recognizes this fact by including $1.1 billion in comparative effectiveness research in the economic stimulus package.

Kevin also notes the source of some objections to this type of research:

“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.”

Indeed, a Wall Street Journal piece published prior to the passage of the stimulus bill suggested that drug and medical-device industries were “mobilizing to gut” the provision. Others critics have suggested that the funds will result in the government mandating or withholding medical treatments; the conference report on the stimulus bill, however, specifically states that a Federal Coordinating Council for Comparative Effectiveness Research will be created to coordinate the efforts, and that:

“…nothing shall be construed to permit the Council to mandate coverage, reimbursement, or other policies for any public or private payer. Further, the conference agreement includes language to clarify that none of the reports submitted or recommendations made by the Council shall be construed as mandates or clinical guidelines for payment, coverage, or treatment.”

As the New York Times noted in their coverage of the funding, supporters of the provision include “Consumer groups, labor unions, large employers and pharmacy benefit managers,” who expect the research to “fill gaps in the evidence available to doctors and patients.”

For resources related to evidence-based medicine, systematic reviews, and comparative effectiveness, see:

Full disclosure: one project I contribute to in my daily work is funded through the AHRQ, an agency which will receive some of the comparative effectiveness dollars included in the stimulus package.


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