Healthy Skepticism Library item: 15924

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Goozner M.
Priorities for Comparative Effectiveness Research
GoozNews 2009 Jun 30
http://www.gooznews.com/node/2986

Full text:

The Institute of Medicine today released its “top 100” list of priority comparative effectiveness research (CER) projects. The stimulus legislation called on the IOM to recommend how $400 million controlled by the secretary of the Health and Human Services department ought to be used.

Here’s a sleeper near the top of the list:

Compare the effectiveness of dissemination and translation techniques to facilitate the use of CER by patients, clinicians, payers, and others.
Given that Congress will probably insert language in health care reform legislation stipulating no one should ever be bound to actually use the findings of comparative effectiveness research (why that’s like EVIL BIG GOVERNMENT coming between YOU and YOUR DOCTOR), it’s probably a good idea for someone to study how to “disseminate and translate” this information so that parts of the health care system might actually put it to use.

Okay, now that I have that off my chest, here’s some of the more interesting proposals near the top of the IOM list:

Compare the effectiveness of management strategies for localized prostate cancer (e.g., active surveillance, radical prostatectomy [conventional, robotic, and laparoscopic], and radiotherapy [conformal, brachytherapy, proton-beam, and intensity-modulated radiotherapy]) on survival, recurrence, side effects, quality of life, and costs.
Establish a prospective registry to compare the effectiveness of treatment strategies for low back pain without neurological deficit or spinal deformity.
Compare the effectiveness of school-based interventions involving meal programs, vending machines, and physical education, at different levels of intensity, in preventing and treating overweight and obesity in children and adolescents.
Compare the effectiveness of imaging technologies in diagnosing, staging, and monitoring patients with cancer including positron emission tomography (PET), magnetic resonance imaging (MRI), and computed tomography (CT).
And near the bottom?

Compare the effectiveness of different treatment strategies (e.g., psychotherapy, antidepressants, combination treatment with case management) for depression after myocardial infarction on medication adherence, cardiovascular events, hospitalization, and death.
Compare the effectiveness of different long-term treatments for acne.
Three cheers for Dr. Harold Sox and the committee. They weren’t afraid to elevate some of the toughest issues in medicine — the ones where entrenched special interests earn lots of money practicing lack-of-evidence-based medicine and oppose efforts to know what works best. It remains to be seen if HHS Secretary Kathleen Sebelius and whomever the president chooses to run the Center for Medicare and Medicaid Services adheres to this well-thought-out priority list.