Wednesday, February 25, 2009

Still More on comparative clinical effectiveness and the role of government

A number of medical bloggers have offered their opinions regarding the inclusion of "stimulus money" for a federal CER (comparative effectiveness research) unit . A particularly well balanced view is presented here by Dr. Val who has obviously spend some time and effort in trying to understand exactly what has passed and offers some thoughts about what it all might mean.

It seems like a major influence in this undertaking will be forthcoming from our colleagues at the Institute of Medicine (IOM) whose reports ring like pronouncements floating above the level of criticism and discussion that ordinarily pertains to comments by most other folks. They apparently will be given one million dollars to prepare a report indicating on what areas the early efforts at CER should focus. This will give some people at the IOM considerable clout since there are endless issues that could be addressed but for the limits of time, money and manpower so what gets studied is what it is all about. So the locus of lobbying and influence may shift for a while to this non-governmental organization.

DrRich offers his view on CER here. Among other insightful comments he tears into comments from the ACP that they will not countenance rationing,which some fear may result from the decisions issued by the federal CER group:

"The ACP seems to be delusional. Despite the ACP’s new protestation that they will not countenance healthcare rationing, this organization is one of the chief signatories of the recently updated version of medical ethics, updated to honor the “new realities” of the 21st century, which explicitly recognizes physicians’ inability to fully advocate for their individual patients in today’s healthcare system, and which therefore gives them permission to ration healthcare at the bedside in order to meet the demands of our larger society. (
As DrRich has argued, this new version of medical ethics fundamentally wrecks medicine as a true profession.) So for the ACP to come out at this time foresquare against rationing seems somewhat hollow."

Also ringing hollow to me are comments that the results of the CER studies will not be used to limit care. Although verbiage from government sources denies that will occur regarding government funded programs(and if we can't trust the government who can we trust) as Dr. Val points out isn't it likely that private insurers will pounce on results that can be used to save them money.

Dr.RW expresses his view on CER here and in this typically strong and well researched posting Dr. RW shows us why the premise that we don't already have have CER is just plain incorrect as he lists case after case of useful CER that was done without the federal goverment's largess.

Dr. Robert Centor,whose views are always worth considering seriously,offers a more optimistic take here. I hope he is right and the new federal agency can do better than the ad for chiropractors that NCCAM published and that I commented on here. KevinMD also expresses a positive view of the fed funded CER effort seemingly surprising himself that he agrees with Paul Krugman in that regard.

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