Letter to the Editor: The Proper Integration of Comparative Effectiveness Research

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A recent editorial in The New York Times (Is Newer Better? Not Always, Sept. 11, 2010) suggests that the comparative effectiveness research (CER) provisions of health care reform are a solution to curtailing ever-increasing medical costs by providing patients, doctors, and the government better information about the efficacy of different drugs and treatment strategies. It also suggests that the real opportunity is in giving policymakers more power to enforce CER-informed practice guidelines. 

In response, I sent a Letter to the Editor, agreeing that CER can be part of the overall solution. However, I also cautioned that thinking simplistically about medical innovation as the “problem” and CER-based guidelines as the “solution” overlooks the value that medical advances like those in personalized medicine hold for patients, and for helping address rising health care costs.

“If we lock ourselves into a one-size-fits-all paradigm, we will strangle the power of personalized medicine to prescribe the right drug for the right patient at the right time.” This approach could turn CER “into a blunt instrument that smothers the opportunity to improve care and reduce costs.”

Also worth noting is a separate letter from Tony Coelho, head of the Partnership to Improve Patient Care, who argued that the CER provisions of the health reform law “can be an important part of the solution to rising health care costs over the long term, but only because the health reform law gives patients and doctors the assurance that the program is centered on our health care needs.”

Read both of these published responses below and continue the discussion by contributing your own comment at The Age of Personalized Medicine Blog.

* * *

To the Editor:

Your editorial correctly states that new health care technologies often lead to medical progress, but also regrettably to increased and unaffordable costs, unlike in other fields where new technology usually causes costs to decline.

The danger is that the proposed solution, comparative effectiveness research (CER), could turn into a blunt instrument that smothers the opportunity to improve care and reduce costs.

When President Obama sought to explain how it would work, he said that with the new funds allocated for CER, researchers would be able to compare the red pill with the blue pill to determine which worked better and thereby, presumably, save money.

The key question to ask, as neither your editorial nor President Obama does, is which medicines work for whom? While the blue pill may work for me, there is a good chance it won’t work for you, especially if the diagnosis is cancer.

If we lock ourselves into a one-size-fits-all paradigm, we will strangle the power of personalized medicine to prescribe the right drug for the right patient at the right time. Personalized medicine enables us, over time, to save enormous sums because patients who should not receive particular medicines will not get them.

Edward Abrahams
President
Personalized Medicine Coalition
Washington, Sept. 13, 2010

* * *

To the Editor:

Creating a body with the power to enforce national guidelines for treatment based on clinical and cost effectiveness would be a serious distortion of the comparative effectiveness research (CER) provisions of the health reform law. It would confirm the fear of many that the real intent was to give government decision makers new power to cut costs by denying patients access to medically beneficial tests and treatments.

Fortunately, Congress took a different tack in the health reform law and got it right. It acted not in reaction to fear-mongering but because, as stated last year by one Democrat, the CER research center must be a partner to patients.

Yes, CER can be an important part of the solution to rising health care costs over the long term, but only because the health reform law gives patients and doctors the assurance that the program is centered on our health care needs. Newer isn’t always better, but in the case of the new patient-centered approach to CER in the health reform law, it is.

Tony Coelho
Washington, Sept. 14, 2010
The writer, a former member of Congress, is chairman of the Partnership to Improve Patient Care.

A version of these letters appeared in print on September 20, 2010, on page A30 of the New York edition.

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