Comparative effectiveness research. Does the public want it? I’ve danced around this topic before, but now I’m hitting it head on. Sure, some of the resistance to the idea of CER has been politically motivated. No one’s seriously talking about death panels or having the government get between you and your doctor to make medical decisions. But they are talking about finding out what works and what doesn’t. That’s information that, in many cases, we don’t have right now, although we have the tools we need to obtain it.
The problem is that there are four groups of stakeholders around this issue, and they need to get on the same page. Folks like me who do health services research are interested in finding out the answers to what works and what doesn’t. Some of us are more concerned with methodology and some of us are more concerned with translating our findings into practice, but the point is, group number one puts the research in comparative effectiveness research.
The second group consists of providers. They are one of the potential consumers of CER. The hope, after all, is that providers will start routinely using more effective treatments once the research has indicated which ones those are. Providers may also produce CER–either directly as investigators or in partnership with other researchers.
The third group consists of payers. They are another potential consumer of CER, and their focus is likely to be on paying for what works and not paying–or perhaps not paying as much–for what doesn’t work. I think there might be too much HMO-style backlash from patients if they felt their treatment options were being so overtly limited by their insurance company. That all remains to be seen.
The fourth, and final group, consists of the patients. Strangely, no one seems to talk about them in this conversation, but I believe that they are essential to the future of CER. If the public does not embrace the principles of CER, its use will remain limited. Of course, there’s no good reason for people not to want the best possible treatment–or the better of two treatment options. The thing is, right now, they’re being told that CER equals rationing, rather than smart decision making. Their toes are being stepped on by the concept, when it really should be seen as empowering them.
At the end of the day, health services researchers, providers, and payers all know the enormous potential CER has. It’s the patients who are left in the dark, misinformed, and scared that Uncle Sam will tell them that they can’t have their Lipitor anymore. We have to win over the hearts and minds of the people–show them how CER will help them rather than hurt them–before the potential of CER will ever be realized.
[The thoughts contained in this post were inspired by Dr. Kent Bottles whose post appeared on The Health Care Blog.]