NEJM Perspectives Examine Comparative Effectiveness Research

• "Debate About Funding Comparative Effectiveness Research," New England Journal of Medicine: In the perspective, Jerry Avorn -- a professor of medicine at Harvard Medical School, chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital, and director of the Harvard Interfaculty Initiative on Medications and Society -- examines the "vigorous and well-coordinated backlash" against the $1.1 billion allocated for CER in the federal economic stimulus package. He writes, "What is the moral responsibility of the physician to care for a patient for whom the best therapy may not meet conventional standards of cost-effectiveness? These aspects of the debate will need to continue as we begin to implement CER with this vital new funding." According to Avorn, "Given the quality and cost crises we face, preserving ignorance would have been a poor strategy for improving the effectiveness, safety and affordability of health care" (Avorn, NEJM, 5/7).
  
  
• "Does Comparative Effectiveness Research Threaten Personalized Medicine?" NEJM: In the perspective, Alan Garber, a professor of medicine and director of the Centers for Primary Care and Outcomes Research and Health Policy at Stanford University, and Sean Tunis, founder and director of the Center for Medical Technology Policy in Baltimore, write, "The deepest concern about CER is that it will be misused, which is why some legislators seek to prohibit information on comparative effectiveness from influencing coverage policy and payment decisions." They continue, "But surely these decisions will not be improved by discouraging the use of the most relevant and valid information about what works and in whom." Garber and Tunis write, "CER is not a panacea, but it is a key to individualized care and innovation, not a threat" (Garber/Tunis, NEJM, 5/7).
  
  
• "The Neglected Purpose of Comparative-Effectiveness Research," NEJM: In the perspective, Aanand Naik, an investigator at the Houston Veterans Affairs Medical Center's Health Services Research and Development Center of Excellence and an assistant professor at Baylor College of Medicine, and Laura Petersen, director of the Center of Excellence and leader of the Clinical Services and Health Policy Core at Baylor's John M. Eisenberg Center for Clinical Decisions and Communications Sciences, write, "Surprisingly little attention has been paid to" whether CER will "significantly improve the quality and safety of the health care received by the average patient." They write that the Federal Coordinating Council, which was established to provide HHS guidance on how to use the stimulus funds, "must remain mindful that the primary goal of CER is to enhance the translation of new medical discoveries into safe and high-quality health care for all Americans" (Naik/Petersen, NEJM, 5/7).