Wednesday, May 6, 2009

Rationing - Yes, CER; The New England Journal of Medicine's Point of View

The American Reinvestment and Recovery Act gives comparative-effectiveness research (CER) a large boost in funding over the next 2 years. Despite a consensus that better information about the relative effectiveness of different medical interventions is needed to improve the quality and value of care, some view CER with skepticism.

Alan Gerber MD, PhD and Sean Tunis, MD, NEJM, May 7, 2009

The New England Journal of Medicine – well-written, well-edited, and well-researched – has a point of view. In the case of health care reform, it believes government reform, not market-based reform, will best solve America’s health care problems. The Journal tends to be dismissive of the other point of view – disruptive innovations from the market.

There is nothing wrong with this, as long as one is aware of how the Journal goes about selecting its content and its contributors. Every publisher is entitled to its point of view, which defines its identity. The Journal is foursquare behind the pillars of the Obama health reform initiatives - a national interlocking interoperative electronic health system, a public health plan competing with private plans, and a comparative effective research institute.

This bias – this point of view – is most evident in the May 7 edition in its Perspective and book review section.

The three Perspective pieces are:

1. “Does Comparative-Effectiveness Research Threaten Personalized Medicine?” The two authors, who serve on the Institute of Medicine’s Committee on Priorities for Comparative Effectiveness Research, conclude “CER is not a panacea, but it is key to individualized care and innovation, not a threat.”

2. “Debate about Funding Comparative-Effectiveness Research. “ Here Dr. Jerry Avorn, professor at Harvard Medical School, “ says, among other things, “The campaign to gut this funding ultimately failed, and the resonance of the oppositions’ in both lay and policy circles reveal much about the issues that will surround such research and its application in the coming years….Fortunately Congress did not let warnings of a dystopian scientific police state undercut the nation’s need to learn what works best in medicine.”

3. “The Neglected Purpose of Comparative-Effectiveness Research.” Two academics from Texas, have this to say, “This comparative-effectiveness research (CER) initiative has generated considerable controversy. Industry and free-market advocates have expressed concerns about the role of cost-effectiveness within CER and subsequent government intrusion into doctor-patient decisions… the primary goal of CER is to enhance the translation of new medical discoveries into safe and high-quality health care for all Americans.

In the book review section, a reviewer of The Innovator’s Prescription: A Disruptive Solution for Health Care, quotes Arnold Relman, MD, former editor-in-chief of the Journal, “We in America have allowed ourselves to believe that health –care is just another industry, that the provision of medical care is a business, and the medical services are an economic commodity that is best distributed by market forces.”

“Their prescription: let people choose the health care they need and use health savings accounts, coupled with high deductible insurance, to pay for it. “
The Journal disapproves of this approach. It does not fit their point of view.

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