People usually like research. Unless it happens to be comparative effectiveness research. Then they get scared. Why? I think it’s because the word “comparative” signals that there will be a “winner” and a “loser.” When we compare things, we tend to think in such black and white terms. If we compare a Ferrari to a Ford Focus, we will say that the Ferrari is faster, for example, although that is only one dimension of comparison. And if there is going to be a winner and a loser in health care, people tend to gloss over the word “effectiveness” and get concerned that the loser might be the very thing that they need. Perhaps it has been shown by someone to be ineffective, but they believe–perhaps rightly–that it may be effective for them.
As Eric Cassell puts it, “The proposal for studies of comparative effectiveness have raised the fear that doctors will be forced to follow the dictates of the studies whether they apply to an individual patient or not….Comparative effectiveness studies don’t get in the way of the doctor-patient relationship; they provide a reason for making it better.“
Comparative effectiveness is not about a bureaucratic decision-making panel that says only “treatment X” is allowed. It is about making information available to providers so that they are empowered to make the best treatment decisions for their patients.
As Peter Ubel writes, “A treatment that brings no benefit to the majority of patients, but a substantial benefit to a minority of patients could very well deserve to play an important role in the treatment of that subgroup of patients. CER can potentially identify such subgroups.” Comparative effectiveness is not about denying care. It is about improving the quality of care we deliver in this country, by ensuring that it is appropriate. That’s something of which we should all be in favor.