With a little more than $1 billion of the $787 billion stimulus legislation devoted to comparative effectiveness (CE) research, President Obama has made it clear that he believes government should have a role in aiding patient diagnoses. But what exactly does “aiding” mean? If clinicians are increasingly paid by tax dollars through a government-run plan, will CE lead to rationing and/or mandating certain kinds of treatment?

The American Medical Association (AMA) has gone on record supporting CE research, while also making it clear that results should only lend a helping hand, and not lead to government mandates.

Recent high-profile stories on NPR and other media outlets report that Democrats and Republicans are wary of using CE to “limit coverage or reimbursements.” Despite the reassurances, clinicians from across the health care continuum have strong opinions. Some fear government-generated data will inevitably lead to rationed medical care that could restrict options. Still others see a harmless, and ultimately beneficial, contribution to the medical body of knowledge.

Audiologist Cynde Parker, AuD, president and owner of Seaford Audiology, Seaford, Del, said in a statement that she believes CE could have a role in determining medications, but she also balks at the idea of turning over final decisions to computers. What is the point of educating doctors if we are just going to put an algorithm in a computer that tells them what to do? she said. Comparative effectiveness research may have a place when it comes to determining which drug may provide the best results at the least cost, but I don’t think the human body and its response to treatment should be dictated by an algorithm, she added. There is a need to control costs and everyone can agree on that, but I don’t think you control costs by denying or limiting treatment with no regard to the specific patients’ circumstances and health status, she said.

The slippery slope argument is an integral concept on both sides of the debate, with proponents believing the rationing scenarios can be avoided with a thoughtful approach. Kenneth Hosack, director of provider relations at Craig Hospital, Denver, believes evidence-based medical treatment guidelines and transparency could reduce the variability of practice in medicine, and improve overall care. He said in a statement that much of the grades of evidence in medicine and rehabilitation at this point in our research history is expert consensus-based, without randomized, controlled, double-blind research evidence. Guidelines should be used as guidelines, not rigid protocols or inflexible clinical pathways—they should be sufficiently flexible to allow physicians and health care providers to treat individual patients with individualized care, so they can practice the art of medicine, and most effectively treat their patients, he added.

[Source: Greg Thompson]