MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'comparative effectiveness'. Sat, 03 Sep 2011 02:05:26 +0100 http://www.medworm.com/index.php?rid=5181736&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F09%2F01%2Fberwick-to-keynote-health-affairs-briefing%2F Don Berwick, the Administrator of the Centers for Medicare and Medicaid Services, will keynote Health Affairs’ September 8 briefing on controlling health care costs. At the briefing, Health Affairs will release its September 2011 issue, “The New Urgency To Lower Costs.” Topics to be discussed include chronic disease costs and opportunities for savings through prevention; who bears [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=5181736 Thu, 01 Sep 2011 14:09:50 +0100 5181736 http://www.medworm.com/index.php?rid=4997503&cid=t_196392_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F07%2Fblogscan-forensic-statistics.html Several interesting points are raised in the newsletter of the American Association of Physicians and Surgeons (AAPS) in a post entitled "Forensic Statistics" in their July 2011 newsletter headlined "Numbers." Healthcare Renewal is cited:Forensic StatisticsWhile claims from RCTs fail to replicate about 20% of the time, the problem with epidemiology is so bad as to constitute a crisis, writes S. Stanley Young (“Everything Is Dangerous: a Controversy,” National Institute of Statistical Sciences, June 2008, www.niss.org). Fewer than 20% of nonrandomized trials [e.g., observational studies - ed.] replicate; i.e. 80%-90% of epidemiologists’ claims are false.More than $1 billion in grant/tax money flows to institutions with reproducibility problems, Young states. A fundamental flaw in the... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4997503 Sun, 03 Jul 2011 14:13:00 +0100 4997503 http://www.medworm.com/index.php?rid=4992681&cid=t_196392_87_f&fid=38368&url=http%3A%2F%2Fwww.changehealthcare.com%2Fdownloads%2Fhcti%2FHCTI_Q42010.pdf My mama told me you’d better shop around, as Smokey Robinson also told us. We now know it pays to shop the prices for digital imaging. The price of an MRI of the brain ranges from a low of $825 to a high of $3,600 within the Southeast region of the U.S. In the Northeast, the low is $1,540 and the high, $3,500. There are similar price “spreads” in other regions of the country for the same imaging study, and across other imaging modalities such as PET and CT. The greatest regional variances by service type are for MRI scans of the brain, varying 747% between a low price of $425 in the Southwest to a high of $3,600 in the Southeast, based on an analysis from change: healthcare‘s Q2 2011 Healthcare Transparency Index. USA Today reported on this study on June 30, 2011. Christopher Park... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=4992681 Fri, 01 Jul 2011 15:47:47 +0100 4992681 http://www.medworm.com/index.php?rid=4893368&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F06%2F03%2Fpost-on-health-reform-and-medicare-tops-mays-ha-blog-most-read-list%2F Thomas Saving’s and John Goodman’s post on the implications of the Affordable Care Act for Medicare leads the list of most-read Health Affairs Blog posts for May. On the list as well are posts on the hazards of ignoring the lessons of the Clinton years; the opportunities offered by clinical registries; and the implications of [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4893368 Fri, 03 Jun 2011 15:40:41 +0100 4893368 http://www.medworm.com/index.php?rid=4813229&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F05%2F11%2Fclinical-registries-the-opportunity-for-the-nation%2F In the early 1970s, the Cystic Fibrosis Foundation began tracking the health of patients with cystic fibrosis.  What began as a modest data collection effort is today a comprehensive clinical registry of 26,000 patients.  Caregivers and researchers use the registry to identify new trends in outcomes; recognize the most effective treatments; and design clinical trials [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4813229 Wed, 11 May 2011 16:22:36 +0100 4813229 http://www.medworm.com/index.php?rid=4813232&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F05%2F10%2Fhow-to-make-comparative-effectiveness-work%2F Comparative effectiveness research has been the target of recurrent criticism in some political circles, with opponents claiming it’s the “gateway to rationing” or it encourages “cookbook medicine.” But the conversation on Capitol Hill needs to evolve beyond the rhetoric so it can address the reality of medical care today: doctors and patients lack access to [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4813232 Tue, 10 May 2011 13:53:37 +0100 4813232 http://www.medworm.com/index.php?rid=4794833&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F05%2F06%2Fnew-answers-on-macular-degeneration-important-questions-for-comparative-effectiveness-research%2F On April 28th, the New England Journal of Medicine published the results of a study that compared two drugs head-to-head for the treatment of age-related macular degeneration (AMD), the leading cause of legal blindness in the United States.  The two drugs, Ranibizumab (Lucentis) and Bevacizumab (Avastin), are very similar molecules and are both meant to [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4794833 Fri, 06 May 2011 15:45:32 +0100 4794833 http://www.medworm.com/index.php?rid=4780485&cid=t_196392_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2FU_8pduWA8bk%2F How soon might comparative effectiveness offer significant change? And which entities will guide these changes when they begin? Inside the nation’s capitol, CER has become something of a mantra among those hoping to drive down health care costs. But beyond the Beltway, CER appears not to be nearly as potent a concept, for now anyway. To gauge the extent to which CER is perceived, the National Pharmaceutical Council, a policy and research organization supported by pharma, surveyed 111 people from federal agencies, consumer and trade groups, insurers and academics, among others. And NPC found nearly 60 percent are “very familiar” with CER, but only 30 percent believe CER will lead to moderate improvements in health care decision-making in the next year. One reason for the lack... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=4780485 Tue, 03 May 2011 13:36:25 +0100 4780485 http://www.medworm.com/index.php?rid=4723782&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F04%2F18%2Fcomparative-effectiveness-research-how-can-it-change-practice%2F The Patient Protection and Affordable Care Act (ACA)  is designed to increase the number of U. S. citizens with access to health insurance.  Along with augmented access to health insurance and hopefully health care for millions of the currently uninsured, as well as some degree of overall health care cost containment,  the ultimate success of [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4723782 Mon, 18 Apr 2011 13:59:19 +0100 4723782 http://www.medworm.com/index.php?rid=4642566&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F03%2F28%2Fmedicares-embedded-ethics-the-challenge-of-cost-control-in-an-aging-society%2F The challenge of reining in the rising costs of the Medicare Program is particularly thorny because it confronts a recalcitrant societal tension between the necessity for cost control and the value of open-ended technology use for life extension in the later years. That tension is becoming more deeply entrenched because a growing number of older [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4642566 Mon, 28 Mar 2011 20:02:43 +0100 4642566 http://www.medworm.com/index.php?rid=4626886&cid=t_196392_113_f&fid=34625&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FNeilVerselsHealthcareItBlog%2F%7E3%2FuP93TL-iZGE%2F The slams on Dr. Donald Berwick, frankly, are getting pathetic. Today, Fox News medical contributor Dr. Marc Siegel dismissed Berwick as a “basically a policy wonk” who “hasn’t really practiced since 1989.” Siegel tried to score points with sound bites. “This guy has more quotes than Yogi Berra, and let me tell you something, these quotes are an indictment on people that want clinicians to make decisions,” Siegel said on Fox this afternoon. Watch the latest video at video.foxnews.com According to Siegel, comparative effectiveness “doesn’t work in the real world.” Well, sure, that’s the point of clinical decision support. Best practices are for common conditions, and clinical decision support is to help physicians either foll... Neil Versel's Healthcare IT Blog blogs http://www.medworm.com/rss/comments.php?id=4626886 Wed, 23 Mar 2011 22:11:49 +0100 4626886 http://www.medworm.com/index.php?rid=4622245&cid=t_196392_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fbreast-cancer-breakthrough-less-is-more%2F2011.03.21 Recently, every newspaper in the country reported on a landmark development in breast cancer treatment. It is now clear that certain breast cancer women do not need to undergo removal of lymph nodes from the armpit as part of their treatment. This would spare them from the risk and discomfort of an unnecessary procedure. It is welcome news, particularly for those of us who argue that in medicine, less is more. This is an example of the benefit of comparative effectiveness research, a tool that can separate what patients truly need from what the medical profession believes they must have. Let’s hope that breast cancer breakthrough metastasizes across the medical profession. Here’s what it accomplished. It spares women from unnecessary surgery. It saves money. It demonstrates that physi... Better Health blogs http://www.medworm.com/rss/comments.php?id=4622245 Mon, 21 Mar 2011 20:00:00 +0100 4622245 http://www.medworm.com/index.php?rid=4560251&cid=t_196392_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FLizuL3o0-Bs%2F By Michael F. CannonIn a column for Kaiser Health News, Michael L. Millenson, President of Health Quality Advisors LLC, laments that conservatives in the U.S. House are approaching ObamaCare like, well, conservatives.  He cites comments by unnamed House GOP staffers at a recent conference: The Innovation Center at the Centers for Medicare & Medicaid Services? "An innovation center at CMS is an oxymoron," responded a  Republican aide..."Though it's great for PhDs who come to Washington on the government tab." There was also no reason the government should pay for "so-called comparative effectiveness research," another said. "Everything's on the chopping block," said yet another. No government-funded comparative-effectiveness research?  The horror!  For my money, those staffers (and... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=4560251 Mon, 07 Mar 2011 15:26:48 +0100 4560251 http://www.medworm.com/index.php?rid=4477684&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F02%2F14%2Fa-valentine-to-shared-decision-making%2F Shared decision making is hot right now. Research.  Surveys.  Tools.  Training.  Conferences.  Policies. The current model of shared decision making consists of providing patients with evidence that allows them to compare the risks and side effects of different treatments or preventive services when more than one option is available. After studying the evidence, the theory [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4477684 Mon, 14 Feb 2011 16:38:29 +0100 4477684 http://www.medworm.com/index.php?rid=4428980&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F02%2F02%2Fcomparative-effectiveness-research-and-medicare-gail-wilenskys-view%2F Editor’s Note: In the October issue of Health Affairs, Steven Pearson and Peter Bach proposed a new Medicare payment model incorporating comparative effectiveness research. Under the model, services offering greater health benefits than an existing alternative would receive cost-based reimbursement, but services offering benefits only comparable to an existing alternative would receive a “reference price” equal to [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4428980 Wed, 02 Feb 2011 19:25:15 +0100 4428980 http://www.medworm.com/index.php?rid=4428981&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F02%2F02%2Fcomparative-effectiveness-research-and-medicare-sean-tunis-view%2F Editor’s Note: In the October issue of Health Affairs, Steven Pearson and Peter Bach proposed a new Medicare payment model incorporating comparative effectiveness research. Under the model, services offering greater health benefits than an existing alternative would receive cost-based reimbursement, but services offering benefits only comparable to an existing alternative would receive a “reference price” equal to [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4428981 Wed, 02 Feb 2011 19:23:27 +0100 4428981 http://www.medworm.com/index.php?rid=4428982&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F02%2F02%2Fcomparative-effectiveness-research-and-medicare-kathy-butos-view%2F Editor’s Note: In the October issue of Health Affairs, Steven Pearson and Peter Bach proposed a new Medicare payment model incorporating comparative effectiveness research. Under the model, services offering greater health benefits than an existing alternative would receive cost-based reimbursement, but services offering benefits only comparable to an existing alternative would receive a “reference price” equal to the reimbursement [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4428982 Wed, 02 Feb 2011 19:20:28 +0100 4428982 http://www.medworm.com/index.php?rid=4382734&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2011%2F01%2F21%2Femployers-as-doctors%2F If you don’t keep up with the latest twists and turns in healthy policy, you probably don’t know what value-based health insurance benefits are. A Health Affairs article takes a focused look at it. Here is my layman’s summary: If you are like most people, you are not a very good consumer of health care. [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4382734 Fri, 21 Jan 2011 13:12:00 +0100 4382734 http://www.medworm.com/index.php?rid=4318331&cid=t_196392_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcomparative-effectiveness-research-more-can-be-less%2F2011.01.06 Discussion About Comparative Effectiveness Research When the public turns its attention to medical effectiveness research, a discussion often follows about how this research might restrict access to new medical innovations. But this focus obscures the vital role that effectiveness research will play in evaluating current medical and surgical care. I am now slogging through chemotherapy for stomach cancer, probably the result of high doses of radiation for Hodgkin lymphoma in the early 1970s, which was the standard treatment until long-term side effects (heart problems, additional cancers) emerged in the late 80s. So I am especially attuned to the need for research that tracks the short and long-term effectiveness — and dangers — of treatments.  Choosing a surgeon this Septembe... Better Health blogs http://www.medworm.com/rss/comments.php?id=4318331 Thu, 06 Jan 2011 22:00:53 +0100 4318331 http://www.medworm.com/index.php?rid=4245257&cid=t_196392_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F12%2Fmore-can-also-be-less-we-need-a-more-complete-public-discussion-about-comparative-effectiveness-rese.html By JESSIE GRUMAN, PhD Media coverage of the government’s new investment in comparative effectiveness research leans heavily toward the effects of such research on new drugs and technologies: Will such evaluations lead to restricted access to the latest innovations? Will... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=4245257 Thu, 09 Dec 2010 00:00:00 +0100 4245257 http://www.medworm.com/index.php?rid=4230157&cid=t_196392_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpatient-centered-outcomes-research-will-patients-be-involved%2F2010.12.05 A year ago Gangadhar Sulkunte shared his story here about how he and his wife became e-patients of necessity, and succeeded, resolving a significant issue through empowered, engaged research. As today’s guest post shows, he’s now actively engaged in thinking about healthcare at the level of national policy, as well – and he calls for all patients to speak up about this new issue. – Dave I recently came across a Pauline Chen piece in the New York Times, “Listening to Patients Living With Illness.” It refers to a paper by Dr. Wu et al, ”Adding The Patient Perspective To Comparative Effectiveness Research.” According to the paper and the NY Times article, Dr. Wu and his co-authors propose: Making patient-reported outcomes a more routine part of clinical studi... Better Health blogs http://www.medworm.com/rss/comments.php?id=4230157 Sun, 05 Dec 2010 19:00:34 +0100 4230157 http://www.medworm.com/index.php?rid=4200548&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2010%2F11%2F24%2Fthoughtful-purchasing-at-cms%2F Recent press reports on Medicare’s decision to evaluate coverage policy for the new cancer therapy Provenge were highly critical of the Centers for Medicare and Medicaid Services (CMS) and its role in examining the evidence behind FDA-approved products.  Let’s take a step back. In fact, this is exactly what CMS should be doing – carefully [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4200548 Wed, 24 Nov 2010 14:21:49 +0100 4200548 http://www.medworm.com/index.php?rid=4190149&cid=t_196392_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-federal-coordinating-council-for-comparative-effectiveness-research-what-is-it%2F2010.11.22 What is the Federal Coordinating Council for Comparative Effectiveness Research?  The mission of the Federal Coordinating Council for Comparative Effectiveness Research will be to decide on best practices and most cost effective practices. The council will recommend cost effective treatments for diseases to the National Coordinator for Health Information Technology (NCFHIT). The NCFHIT will determine treatment at the time and place of care. It is charged with deciding the course of treatment for the diagnosis given by the doctor.  The U.S. Department of Health and Human Services (HHS) announced the formation and membership of the Federal Coordinating Council for Comparative Effectiveness Research that will be funded by President Obama’s stimulus program the American Recovery and Reinv... Better Health blogs http://www.medworm.com/rss/comments.php?id=4190149 Mon, 22 Nov 2010 23:00:58 +0100 4190149 http://www.medworm.com/index.php?rid=4151691&cid=t_196392_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F11%2Fhit-trends-summary-for-october-2010.html By MICHAEL LAKE This is a summary of the HIT Trends Report for October 2010. You can get the current issue or subscribe here. The evolving health information exchange market. The HIE segment was center-stage this month with a game-changing... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=4151691 Wed, 10 Nov 2010 00:00:00 +0100 4151691 http://www.medworm.com/index.php?rid=4151733&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2010%2F11%2F08%2Fcomparing-treatments-judging-health-reform-top-ha-blog-most-read-list%2F A look at Health Affairs‘ October issue on comparative effectiveness research tops the list of most-read Health Affairs Blog posts for last month. Next on the list is Tim Jost’s look at the debate over the Affordable Care Act’s constitutionality, followed by John Goodman’s analysis of whether the new legislation will ”bend the cost curve.” Here’s the entire [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4151733 Mon, 08 Nov 2010 17:00:02 +0100 4151733 http://www.medworm.com/index.php?rid=4133647&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2010%2F11%2F02%2Fnew-health-affairs-issue-value-based-insurance-design%2F Having insurance coverage that requires consumers to pay less out of pocket for certain medications— for example, those they must take regularly to combat chronic illness— makes it more likely that they will adhere to their medication regimens.  But the jury is still out on whether this strategy will dramatically reduce the rate of growth [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4133647 Tue, 02 Nov 2010 11:34:09 +0100 4133647 http://www.medworm.com/index.php?rid=4119218&cid=t_196392_113_f&fid=39278&url=http%3A%2F%2Fblogsite.mdbuyline.com%2F%3Fp%3D75 I have been waiting patiently for the Comparative Effectiveness Research program to get into full swing.  Now, we are finally starting to see the first results of the $1.1 billion provided through The American Recovery and Reinvestment Act of 2009 (ARRA) for comparative effectiveness research, and what a wealth of knowledge! Technology is constantly evolving, and determining what is the most effective in terms of costs and outcomes can be a challenge.  Let me save you from reading the full 381-page MedPAC 2010 report to congress and summarize a portion of it for you.  According to the report, new technology is a primary factor causing the rising healthcare costs because it increases demand.  But, on the other hand, improved outcomes resulting from the new technologies can provide long-... MD Buyline blogs http://www.medworm.com/rss/comments.php?id=4119218 Fri, 29 Oct 2010 13:59:46 +0100 4119218 http://www.medworm.com/index.php?rid=4118856&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2010%2F10%2F28%2Freminder-health-affairs-briefing-on-value-based-insurance-design%2F On November 2, 2010, Health Affairs will welcome policy experts at a briefing to discuss key topics in value-based insurance design. VBID is the primary focus of the journal’s November issue, published with the support of the California HealthCare Foundation. Areas to be discussed will include: the evidence supporting the impact of value-based insurance design; the effectiveness of value-based insurance design in getting [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4118856 Thu, 28 Oct 2010 16:28:24 +0100 4118856 http://www.medworm.com/index.php?rid=4118804&cid=t_196392_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F10%2Fhow-come-comparative-effectiveness-research-is-all-the-rage.html By KENT BOTTLES, MD Comparative Effectiveness Research (CER) is suddenly a hot topic at all the health care conferences. How come? Everybody agrees that we have to decrease per-capita cost and increase quality. Why? Government programs like Medicare and Medicaid... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=4118804 Tue, 26 Oct 2010 23:00:00 +0100 4118804 http://www.medworm.com/index.php?rid=4118859&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2010%2F10%2F26%2Fsimpson-to-take-reins-at-academyhealth%2F AcademyHealth, a professional society for health services researchers and health policy analysts, today announced that Lisa Simpson would be the new president and CEO of the organization and its advocacy arm, the Coalition for Health Services Research. Simpson is currently the director of the Child Policy Research Center at Cincinnati Children’s Hospital Medical Center and [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4118859 Tue, 26 Oct 2010 17:19:21 +0100 4118859 http://www.medworm.com/index.php?rid=4086243&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2010%2F10%2F20%2Fhealth-affairs-briefing-value-based-insurance-design%2F The November issue of Health Affairs,with the support of the California HealthCare Foundation, focuses on the growing interest in and adoption of value-based insurance design.  Value-based insurance design is based on the simple concept that incentives matter – and if insurance coverage is an obvious set of incentives for both provider and patient, it should be [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4086243 Wed, 20 Oct 2010 15:52:28 +0100 4086243 http://www.medworm.com/index.php?rid=4082053&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2010%2F10%2F19%2Fwatch-health-affairs-comparative-effectiveness-briefing%2F The Affordable Care Act and last year’s economic stimulus legislation have launched a major new initiative in comparative effectiveness research, the topic of Health Affairs‘ October issue and the journal’s October 5 briefing at the National Press Club. You can watch the briefing and download speaker materials on the Health Affairs web site. Among the [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4082053 Tue, 19 Oct 2010 16:31:47 +0100 4082053 http://www.medworm.com/index.php?rid=4077245&cid=t_196392_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedicare-should-it-pay-less-for-less-effective-care%2F2010.10.18 From its inception, Medicare has been agnostic about the effectiveness of different treatments when it sets payment rates. Once a treatment is found to be “reasonable and necessary,” Medicare establishes a payment rate that takes into account complexity and other “inputs” that go into delivering the service. But it is prohibited by law from varying payments based on how well an intervention works. This would change under a “dynamic pricing” approach proposed by two experts in this month’s issue of Health Affairs. The article itself is available only to Health Affairs subscribers, but the Wall Street Journal health blog has a good summary. The researchers propose that Medicare pay more for therapies with “superior” results and the same f... Better Health blogs http://www.medworm.com/rss/comments.php?id=4077245 Mon, 18 Oct 2010 13:00:00 +0100 4077245 http://www.medworm.com/index.php?rid=4065460&cid=t_196392_113_f&fid=39278&url=http%3A%2F%2Fblogsite.mdbuyline.com%2F%3Fp%3D58 At about the time when the when the Wright brothers first flew, advanced medical technology consisted of a microscope, an X-ray machine, and a sterilizer.  Now, providers purchase almost $70 Billion worth in high tech Lab, patient monitoring, imaging, IT, radiation therapy, and robotic technology each year.  While gathering background information for one of my papers, I found a common concern facing administrators with the capital budget process, which can be summed up by a comment from Ms. Kim Capps, CFO of Green-Breach Memorial Hospital in Charlotte, MI.  She stated, “Most of the time, we have more requests than we have capital; therefore, we have to set priorities, but how we set priorities varies from year to year.”  Hospitals are then left wondering if there is a more effectiv... MD Buyline blogs http://www.medworm.com/rss/comments.php?id=4065460 Wed, 13 Oct 2010 14:15:30 +0100 4065460 http://www.medworm.com/index.php?rid=4036612&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2010%2F10%2F06%2Fmore-from-health-affairs-on-comparative-effectiveness%2F Health Affairs this week released a Health Policy Brief and two Web First articles about comparative effectiveness research, to complement the information in its October edition,     The Health Policy Brief, produced in conjunction with the Robert Wood Johnson Foundation (RWJF), examines some of the key issues concerning comparative effectiveness research. This area of scientific inquiry, which has been carried out [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4036612 Wed, 06 Oct 2010 16:10:57 +0100 4036612 http://www.medworm.com/index.php?rid=4031203&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2010%2F10%2F05%2Fnew-health-affairs-issue-comparative-effectiveness-research%2F A national push on comparative effectiveness research is under way as a result of federal stimulus and health reform legislation.  The research, which is aimed at answering critical questions about what works—and what doesn’t—in health care, is the subject of the October issue of Health Affairs.  The issue explores the myriad challenges inherent in making [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4031203 Tue, 05 Oct 2010 11:36:08 +0100 4031203 http://www.medworm.com/index.php?rid=4027161&cid=t_196392_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fbias-in-clinical-research-is-inevitable%2F2010.10.03 DrRich has said many times that clinical science is among the least exact of the sciences, and therefore, the results of clinical research are particularly susceptible to “spinning” by various interested parties, in order to yield the kind of results they would prefer to see. Until recent times in American medicine, the parties who have been most interested in spinning clinical research have been the people who run drug companies and medical device companies (who need clinical research which supports the use of their products), and the medical specialists (who are more likely to be paid for performing medical procedures that are supported by clinical research). In writing about such data-spinning abuses, DrRich has particularly targeted his own Cardiology Guild, but only because he kno... Better Health blogs http://www.medworm.com/rss/comments.php?id=4027161 Sun, 03 Oct 2010 12:00:16 +0100 4027161 http://www.medworm.com/index.php?rid=4022884&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2010%2F10%2F01%2Freminder-health-affairs-briefing-on-comparative-effectiveness-research%2F The October issue of Health Affairs focuses on comparative effectiveness research. On October 5, Health Affairs will hold a release briefing for the issue. WHEN:   Tuesday, October 5, 2010, 8:30 a.m. – 2:00 p.m. WHERE:       Hyatt Regency Capitol Hill, 400 New Jersey Avenue, NW [Union Station], Washington, D.C. 20001 RSVP:     RSVP for [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=4022884 Fri, 01 Oct 2010 13:20:25 +0100 4022884 http://www.medworm.com/index.php?rid=4003216&cid=t_196392_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F09%2Fconsumer-groups-shut-out-of-comparative-effectiveness-board.html By MERRILL GOOZNER The Government Accountability Office last week appointed two “faster cures” patient advocates and a former insurance company executive now on the AARP board to the three slots reserved for patient and consumer representatives on the Patient-Centered Outcomes... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=4003216 Sun, 26 Sep 2010 23:00:00 +0100 4003216 http://www.medworm.com/index.php?rid=3987026&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2010%2F09%2F20%2Fhealth-affairs-briefing-comparative-effectiveness-research%2F A major new national initiative in comparative effectiveness research is under way, thanks to the Affordable Care Act and 2009 stimulus legislation. The research is aimed at giving patients, health care providers and those paying the bill for health care far better information than ever on which to base health care decisions, as well as [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=3987026 Mon, 20 Sep 2010 19:13:55 +0100 3987026 http://www.medworm.com/index.php?rid=3976487&cid=t_196392_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2F-Sb79C4_7uY%2F By Michael F. CannonI must be losing my touch. I’ve let nearly two months pass without responding to Ezra Klein’s defense of RomneyCare, ObamaCare, and other centrally planned health care systems.  (For those who want to get up to speed: his original post, my reply, and his response.)  So here goes. Klein notes that he and I had each used flawed measures of RomneyCare’s impact on health insurance premiums in Massachusetts.  Fair enough.  But Klein ignores the study I cited by John Cogan, Glenn Hubbard, and Dan Kessler, which estimates that RomneyCare increased premiums in Massachusetts by 6 percent.  The CHK study has limitations, but it is the best estimate available.  I hope Klein addresses it. Klein’s fallback position is that even if RomneyCare increases p... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=3976487 Thu, 16 Sep 2010 15:50:05 +0100 3976487 http://www.medworm.com/index.php?rid=3885312&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2010%2F08%2F19%2Fconference-comparative-effectiveness-and-personalized-medicine%2F Susan Dentzer, Health Affairs editor-in-chief, will lead a discussion with speakers and audience in the opening session of ECRI Institute’s 17th annual conference, entitled “Comparative Effectiveness and Personalized Medicine: An Essential Interface.” The conference will be held on the campus of the National Institutes of Health, in Bethesda, MD, October 19 and 20, 2010. Health [...] (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=3885312 Thu, 19 Aug 2010 17:55:30 +0100 3885312 http://www.medworm.com/index.php?rid=3740583&cid=t_196392_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FgrmO7Lh-tHQ%2F By Michael F. CannonI just came across this doozy in a 2009 report by MedPAC, the government agency that advises Congress on how to adjust Medicare’s price and exchange controls: In broad terms, we must … invest in better information on the effectiveness of treatment options so it might guide the decisions of patients, health care providers, and public and private insurers.  Our nation spends over $2 trillion on health care, yet we know far too little about the comparative effectiveness of alternative treatments.  Such information is a public good, which has not—and will not—be [sic] spontaneously produced by the private market. Except: the private market has spontaneously produced comparative-effectiveness information, as I documented in this study released one m... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=3740583 Fri, 09 Jul 2010 19:58:01 +0100 3740583 http://www.medworm.com/index.php?rid=3714139&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2010%2F06%2F30%2Fis-the-impact-of-comparative-effective-reports-being-evaluated%2F Conclusion In this study we were unable to document a single instance where the impact of a traditional evidence review was evaluated and made publicly available.  Additionally, no known systematic effort has been made to document whether such evaluations have occurred; thus this study can serve as a call for such efforts to take place.  The scope of this study was to determine whether impact evaluations existed in the public domain.  A useful next step might be to conduct research that surveys plans and providers for how they use and/or implement evidence reviews, such as those conducted by AHRQ and the Drug Effectiveness Review Project, the BCBS TEC, and other private and public organizations. Comparative effectiveness research remains a cornerstone of public policy efforts to improve... Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=3714139 Wed, 30 Jun 2010 14:34:51 +0100 3714139 http://www.medworm.com/index.php?rid=3710528&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2010%2F06%2F29%2Frapid-learning-cancer-care-getting-serious-about-implementation%2F Editor’s Note: Below, Amy Abernethy discusses the potential of a rapid learning system to improve the quality and efficiency of cancer care. Lynn Etheredge also addresses this subject in a another Health Affairs Blog post published today. With respect to rapid learning healthcare, it’s time to get serious about implementation.  National entities, such as the Institute of Medicine and the Robert Wood Johnson Foundation, have helped shape a growing consensus that this new model can help bridge the chasm between research and clinical care, and have convened thought leaders to define it. As a practicing oncologist and clinical researcher, I see rapid learning healthcare as starting from patient care itself, which is provided individually, patient-by-patient. In the rapid learning... Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=3710528 Tue, 29 Jun 2010 14:29:12 +0100 3710528 http://www.medworm.com/index.php?rid=3710529&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2010%2F06%2F29%2Frapid-learning-and-cancer-care-time-to-move-forward%2F Editor’s Note: Below, Lynn Etheredge discusses the potential of a rapid learning system to improve the quality and efficiency of cancer care. Amy Abernethy also addresses this subject in another Health Affairs Blog post published today. Cancer is among the most complicated group of diseases to research and treat. The progress in the federal government’s “war on cancer” launched in the 1970s has been frustratingly slow. A rapid-learning (RL) cancer system is now possible — using the potential of “in silico” research. Traditional health research has relied on “in vitro” and “in vivo” methods – bench science and experiments. In silico research would add large computerized registries and databases, with many millions of records, Internet-connected research netwo... Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=3710529 Tue, 29 Jun 2010 14:26:25 +0100 3710529 http://www.medworm.com/index.php?rid=3706623&cid=t_196392_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F06%2Fcomparative-effectiveness-research-removing-the-barriers.html By DAVID E. WILLIAMS Writing in the New England Journal of Medicine (Identifying and Eliminating the Roadblocks to Comparative-Effectiveness Research) three authors share their experience in running a head-to-head trial of Avastin (bevacizumab) versus Lucentis (ranibizumab) for wet age-related macular... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3706623 Sun, 27 Jun 2010 23:00:00 +0100 3706623 http://www.medworm.com/index.php?rid=3699703&cid=t_196392_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2FqmL_7AMPh1Q%2F This may be a bad break for drugmakers. Wellpoint is using comparative effectiveness to make it more difficult for its members to use the Boniva osteoporosis drug after its own research found greater fractures, lower compliance and higher costs than other meds, according to Dow Jones. The insurer studied 26,000 members on osteo meds, comparing Boniva, which is marketed by Roche and GlaxoSmithKline with Actonel, which is sold by Sanofi-Aventis and Warner Chilcott, and Merck’s Fosamax. Although randomized clinical trials suggest the drugs should be equivalent, WellPoint data found differences. Now, WellPoint other drugs must be tried before Boniva is approved. The drug remains where on Tier 3, or non-preferred level, on the formulary. WellPoint actually made the change last year, Dow J... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=3699703 Fri, 25 Jun 2010 13:57:57 +0100 3699703 http://www.medworm.com/index.php?rid=3607500&cid=t_196392_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhave-we-killed-clinical-research%2F2010.05.27 “…I have always depended on the kindness of strangers.”  — Blanche DuBois in Tennessee Williams’ play A Streetcar Named Desire Years ago when I began my medical training, I recall enrolling patients for clinical research. In cardiology, there were a myriad of questions that needed to be answered, especially in the area of defining which medications were best to limit the damage caused by a heart attack. Patients routinely participated in large, multi-center prospective randomized trials to answer these questions. It was routine for them not to charged for participating in the trial — the drug(s) and additional testing would be funded by the company whose drug was being studied. Patients enrolled willingly, eager to help advance science and perhaps, in s... Better Health blogs http://www.medworm.com/rss/comments.php?id=3607500 Thu, 27 May 2010 16:00:00 +0100 3607500 http://www.medworm.com/index.php?rid=3573718&cid=t_196392_105_f&fid=38964&url=http%3A%2F%2Fdrwes.blogspot.com%2F2010%2F05%2Fhow-weve-killed-clinical-research.html "I have always relied on the company of strangers."- Blanche DuBois in Tennessee William's play, A Streetcar Named DesireYears ago when I began my medical training, I recall enrolling patients for clinical research. In cardiology, there were a myriad of questions that needed to be answered, especially in the area of defining which medications were best to limit the damage caused by a heart attack. Patients routinely participated in large, multi-center prospective randomized trials to answer these questions. It was routine for them not to charged for participating in the trial: the drug(s) and additional testing would be funded by the company whose drug was being studied. Patients enrolled willingly, eager to help advance science and perhaps, in some small way, their fellow man.It never daw... Dr. Wes blogs http://www.medworm.com/rss/comments.php?id=3573718 Tue, 18 May 2010 10:14:00 +0100 3573718 http://www.medworm.com/index.php?rid=3560498&cid=t_196392_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2F6PUQzXUi6TE%2F Pontificators are having a field day deciphering healthcare reform and PricewaterhouseCoopers is no exception. The consulting firm has just released a report concluding that, despite expanded coverage that will increase revenue, overall drug sales will decline by 4.3 percent from what they would have been otherwise between 2010 and 2019. The bill increases Medicaid rebates, expands discounts to 340b hospitals, requires Medicare Part D discounts and adds a big fees over 10 years. Specifially, a typical big pharma should see a 4 percent drop in revenue, and a large generic drugmaker should see a 2 percent boost. Meanwhile, a medium-size drugmaker with low government sales should expect only a 1 percent decline, but a large drugmaker with lots of government sales can expect a 7 percent drop. ... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=3560498 Thu, 13 May 2010 11:16:46 +0100 3560498 http://www.medworm.com/index.php?rid=3468021&cid=t_196392_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2Fx5kKBxgumFg%2F Top of the morning to you. Another shiny day here on the Pharmalot corporate campus and our spirits are high. And why not? Once again, we would like to share a favorite saying of the Morning Mayor: ‘Every brand new day should be unwrapped like a precious gift.’ So go ahead and tug on the ribbon. Meanwhile, here are a few items to help you along. Have a great day, everyone… Buy Bullish Dendreon Options Says Analyst (Bloomberg News) Canada Made ‘Value Judgment’ In Dropping HIV Plant (InPharmaTechnologist) Harvard’s Avorn Hires Faculty To Test Comparative Effectiveness (Bloomberg News) Orexigen Revises Obesity Drug Data (Reuters) Sanofi-Aventis Shifts PR Chief To Global Responsibility Role (PR Week) Teva Strikes Deal For Mersana Cancer Drug (PharmaTimes) Me... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=3468021 Wed, 14 Apr 2010 11:14:44 +0100 3468021 http://www.medworm.com/index.php?rid=3443981&cid=t_196392_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2F2paLZUJkPhc%2F The cost-per-QALY (Quality-Adjusted Life years) pricing model is a trick used by drugmakers to raise prices, and as a pricing instrument it is “going completely the wrong way,” because the benefits to patients cannot be quantified, according to a German health insurance expert, PharmaTimes writes. Drugmakers, instead, need to demonstrate why prices are so high, Thomas Mueller, head of the pharmaceuticals department at the Federal Joint Committee (G-BA) - the lead decision-making body of Germany’s statutory health insurance system – told a conference in London. “Give us a dossier which justifies the price,” he said, noting that studies submitted to the G-BA is at a very low rate. “We have communicated our frustration about this to the government. You cannot have a free market... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=3443981 Wed, 07 Apr 2010 12:16:46 +0100 3443981 http://www.medworm.com/index.php?rid=3424811&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2010%2F03%2F30%2Fmoving-toward-a-robust-comparative-effectiveness-research-enterprise%2F Editor’s Note: Most health policy analysts believe that better evidence about quality and value, obtained through comparative effectiveness research (CER), can drive better clinical decision making and could potentially slow the rate of growth in health care spending.  But the success of any national CER initiatives will depend on how evidence is developed, whether it is trusted, and how is used by patients, providers, and payers. Last fall,  the Health Industry Forum of Brandeis University hosted a roundtable in Washington DC, bringing together policymakers from HHS, AHRQ, NIH, and CMS with representatives from the Health Industry Forum’s Advisory Board to discuss how public and private investments in CER can be focused to achieve maximum value. Chaired by Professor Stuart Altman,... Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=3424811 Tue, 30 Mar 2010 18:48:26 +0100 3424811 http://www.medworm.com/index.php?rid=3403828&cid=t_196392_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F03%2Fhealth-care-reform-bill-and-health-care.html I have not written much about the seemingly endless health care reform debate in the US, because much of it has not been relevant to the issues we discuss on Health Care Renewal.  Now that the current phase of the debate is done, and legislation has been passed, let me offer my opinions on the few aspects that do seem relevant to this blog.The Sunshine ActFor Health Care Renewal readers, the most important part of the legislation is that containing the provisions of the Sunshine Act, championed by Senators Grassley and Kohl.  (See this summary on Postscript, the Prescription Project blog.)  The act requires that all drug, device, biologic, and medical supply manufacturers report essentially all payments to physicians or teaching hospitals to the goverment, and on the in... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3403828 Wed, 24 Mar 2010 21:42:00 +0100 3403828 http://www.medworm.com/index.php?rid=3366137&cid=t_196392_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2010%2F03%2F15%2Fjournal-of-the-american-medical-association-2010-vol-303-no-10%2F This article examines the characteristics of recently published CE studies evaluating medications. An NHS Athens password is required to access this article. Filed under: Current Awareness, E-Journals Tagged: Comparative Effectiveness, Medication, Research (Source: Fade Library) Fade Library blogs http://www.medworm.com/rss/comments.php?id=3366137 Mon, 15 Mar 2010 13:51:29 +0100 3366137 http://www.medworm.com/index.php?rid=3359213&cid=t_196392_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2FORFn2VZ8BVg%2F An analysis of comparative effectiveness studies finds that only 32 percent, which were published in leading medical journals, compared the effectiveness of existing drugs. Instead, few compared meds with non-pharmacologic interventions, while only 19 percent examined safety and 2 percent eyed cost effectiveness, according to the study in this week’s Journal of the American Medical Association (here is the abstract). The analysis examined 328 studies, of which 104 were CE studies, and discoved that only 11 percent compared existing drugs with existing therapies not involving drugs, such as surgery or lifestyle changes. Also worth noting - 87 percent were funded by nonprofit or government institutions, not drugmakers. And of the 212 randomized trials analyzed, 46 percent used an acti... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=3359213 Fri, 12 Mar 2010 13:41:25 +0100 3359213 http://www.medworm.com/index.php?rid=3350270&cid=t_196392_87_f&fid=38368&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDisruptiveWomenInHealthCare%2F%7E3%2FORzKd2YOkW0%2F Editor’s note: The Disruptive Women in Health Care blog recently compiled an ebook exploring the issue of Comparative Effectiveness Research (CER) from a variety of viewpoints and perspective. We invite you to download the ebook or read the original posts. By Liz Scherer. Comparative effectiveness research (CER): it’s the buzzword of the new decade.  In fact, Congress recently passed legislation to provide more than $1B to support CER  in hopes of improving utilization of existing therapies while simultaneously holding down healthcare costs. The ultimate goal of CER goes even further and paints a rosy vision of patient-centered care and personalized medicine. However, perhaps these goals are loftier than originally imagined.  Newly- published data appearing in this week’s JAMA... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=3350270 Wed, 10 Mar 2010 13:31:25 +0100 3350270 http://www.medworm.com/index.php?rid=3185296&cid=t_196392_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F01%2Fnot-just-american-disease.html We have written about attacks on rigorous evidence-based medicine, and particularly on comparative effectiveness research from those with vested interests in having clinical research come out a certain way (e.g., see this most recent relevant post). Those who see such research primarily as a marketing opportunity tend to be offended by the notion of rigorous, unbiased research that may not be so easily turned to marketing purposes. Since I, like the other current Health Care Renewal bloggers, am based in the US, we tend to focus on local examples. But it turns out that the American malady described above has spread to Germany.From the Science blog, ScienceInsider:A long-running feud between pharmaceutical companies and the German institute that evaluates the effectiveness of medical treatm... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3185296 Mon, 18 Jan 2010 21:05:00 +0100 3185296 http://www.medworm.com/index.php?rid=3167083&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2010%2F01%2F12%2Fthe-mammograpy-guidelines-and-evidence-based-medicine%2F As someone who has spent the last several years promoting the development of a comparativeness effectiveness center that would encourage the production of more objective information about what works medically, for whom, and under what circumstances, it is hard not to feel discouraged by the reaction to the breast cancer screening guidelines recently announced by the U.S. Preventive Services Task Force.  To be sure, there are a variety of lessons that should be learned from this experience about how to present to the public information that goes against current “conventional wisdom, ” how to explain why current recommendations may differ from past recommendations or current practice, how to reach out to the media, and how to handle issues of  timing, task force composition and so fort... Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=3167083 Tue, 12 Jan 2010 18:45:29 +0100 3167083 http://www.medworm.com/index.php?rid=3100767&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F12%2F17%2Fhealth-care-costs-and-imaging-technology-adoption%2F Conclusion In summary, close examination of the two papers suggests that adoption and use of high-tech imaging is probably more rational than the papers describe it to be, particularly for acquisition of 64-slice CT.  On the other hand, one wonders about MRI, for the U.S. has 26 MRI machines per million population and keeps these units fairly busy, while the typical OECD country has 5-10 MRIs per million (OECD, Health Data 2009). Copyright © 2009 Health Affairs Blog. This Feed is for personal non-commercial use only. All material published on Health Affairs blog, excluding links, is covered under a Creative Commons Attribution - NonCommercial - No Derivs 2.5 license.Plugin by Taragana (Source: Health Affairs Blog) Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=3100767 Thu, 17 Dec 2009 18:14:55 +0100 3100767 http://www.medworm.com/index.php?rid=3052113&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F12%2F02%2Forszag-on-health-reform-at-health-affairs-breakfast%2F At a Health Affairs reporters breakfast this morning, White House Office of Management and Budget Director Peter Orszag defended the ability of the health reform bill being debated in the Senate to “bend the cost curve” of health care costs. “The bill that is currently on the Senate floor contains more cost-containment and delivery system reforms, in its current form, than any bill that’s ever been considered on the Senate floor, period,” he said. Orszag said the Senate bill meets the four pillars of cost control laid out in a recent letter to President Obama by 23 noted economists: no increases in federal government deficits; an excise tax on high-cost health plans; a Medicare commission to ensure continuing flexibility and reform; and delivery system reforms such as inc... Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=3052113 Wed, 02 Dec 2009 18:28:32 +0100 3052113 http://www.medworm.com/index.php?rid=3026636&cid=t_196392_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F11%2Fno-free-speech-for-comparative.html We have repeatedly argued why comparative effectiveness research, under ideal circumstances, would be a good idea.  As I said before:Physicians spend a lot of time trying to figure out the best treatments for particular patients' problems. Doing so is often hard. In many situations, there are many plausible treatments, but the trick is picking the one most likely to do the most good and least harm for a particular patient. Ideally, this is where evidence based medicine comes in. But the biggest problem with using the EBM approach is that often the best available evidence does not help much. In particular, for many clinical problems, and for many sorts of patients, no one has ever done a good quality study that compares the plausible treatments for those problems and those patients. Wh... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3026636 Tue, 24 Nov 2009 22:22:00 +0100 3026636 http://www.medworm.com/index.php?rid=3023236&cid=t_196392_113_f&fid=35746&url=http%3A%2F%2Fblog.criticalmassconsulting.com%2F%3Fp%3D15 Check out this WSJ piece on the falloff of participation in Wikipedia: http://online.wsj.com/article/SB125893981183759969.html?mod=WSJ_hps_MIDDLESecondNews.   Since a medical- and health-oriented wiki would advance the democratization of care, the notion of such a crowd-sourced compendium of relevant knowledge is appealing, at least in principle.  But now I’m thinking the odds are stacked against the idea, for at least four reasons:   ·         Lack of first-mover advantage.  The original Wikipedia benefitted enormously from sheer originality, which led to its having little or no competition in its formative years.  The situation of medical and healthcare wikis seems quite different.  Today, if you Google healthcare wiki, you get roughly 19 million hits.  Medica... Critical blogs http://www.medworm.com/rss/comments.php?id=3023236 Tue, 24 Nov 2009 02:02:51 +0100 3023236 http://www.medworm.com/index.php?rid=3023118&cid=t_196392_87_f&fid=38368&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDisruptiveWomenInHealthCare%2F%7E3%2F9BgVPJIVN08%2F The following post represents my personal opinion and not that of any groups or organizations with which I am affiliated. Okay, it’s enough already! Why is it that women are always the target? First it’s abortions, then mammograms, pap smears following closely, behind and now cosmetic surgery (although that’s not only women!) It looks like the Congress is desperate to find any savings anywhere. Why not tell it like it is, it’s raising taxes. Whether it is through so called elective procedures or levying taxes on devices and diagnostics, to be passed on to the patients, it’s a tax. Instead of rewriting the rules on mammograms which will cost lives, maybe not that many, but if it is your life that’s all that matters and focusing on false positives and unnecessary screening, ... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=3023118 Mon, 23 Nov 2009 18:05:21 +0100 3023118 http://www.medworm.com/index.php?rid=3012345&cid=t_196392_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F11%2Fso-much-for-comparative-effectiveness.html By MERRILL GOOZNER The Obama administration's commitment to cost control in health care can now be summed up in four words: Not on our watch. Health and Human Services Secretary Kathleen Sebelius told American women this week that they have... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3012345 Fri, 20 Nov 2009 00:00:00 +0100 3012345 http://www.medworm.com/index.php?rid=3003716&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F11%2F17%2Fthe-battle-over-rewarding-efficient-providers%2F Editor’s Note: In the post below, John Wennberg and Shannon Brownlee discuss the controversy over a proposed study of regional variations in Medicare spending. Wennberg and Brownlee rebut claims that spending and utilization variations among academic medical centers are due to differences in patient income, race, and health status. In another post coming next week, Wennberg and Brownlee will rebut claims that academic medical centers with higher utilization and spending produce better outcomes. To the casual observer of health care reform legislation, the reaction from several prominent medical centers to a modest provision in the House health reform bill might seem perplexing. The bill provides funding for a two-year study by the Institute of Medicine (IOM) looking at regional vari... Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=3003716 Tue, 17 Nov 2009 22:39:02 +0100 3003716 http://www.medworm.com/index.php?rid=2970240&cid=t_196392_105_f&fid=38964&url=http%3A%2F%2Fdrwes.blogspot.com%2F2009%2F11%2Freading-fine-print-of-government-run.html This week, the New England Journal of Medicine published the comparative effectiveness research trial "ROOBY" comparing conventional cardiac bypass surgery to off-pump bypass surgery. The study was conducted at VA medical centers and randomly enrolled 2203 patients between conventional bypass and off-pump bypass surgeries. The study concluded "At 1 year of follow-up, patients in the off-pump group had worse composite outcomes and poorer graft patency than did patients in the on-pump group. No significant differences between the techniques were found in neuropsychological outcomes or use of major resources." Excellent reviews of the trial (with associated surgeon commentary) are provided at theHeart.org and at MedPageToday.com.What I found interesting was the fact that over half of the oper... Dr. Wes blogs http://www.medworm.com/rss/comments.php?id=2970240 Fri, 06 Nov 2009 18:08:00 +0100 2970240 http://www.medworm.com/index.php?rid=2934738&cid=t_196392_105_f&fid=38964&url=http%3A%2F%2Fdrwes.blogspot.com%2F2009%2F10%2Fdefibrillators-and-video-pill.html A radiofrequency interference myth debunked:A new Mayo Clinic study suggests that video capsule endoscopy (CE), a procedure that uses wireless technology in diagnosing intestinal disease, is safe for patients with heart devices. Wireless electrical gadgets, such as cell phones, have been shown to interfere with implanted heart devices, including pacemakers and defibrillators. This risk has led medical experts to speculate that capsule endoscopy could similarly cause heart devices to fail. As a result, the noninvasive procedure has been contraindicated by the U.S. Food and Drug Administration (FDA) for patients with cardiac devices. Contraindication means an increased risk may be involved.Generally, the topic has remained in the subject of speculation, although several small studies have fo... Dr. Wes blogs http://www.medworm.com/rss/comments.php?id=2934738 Tue, 27 Oct 2009 21:24:00 +0100 2934738 http://www.medworm.com/index.php?rid=2930930&cid=t_196392_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F10%2Fwho-should-sponsor-comparative.html We have tried to argue why comparative effectiveness research is a good idea. To cut and paste what I wrote in a previous post,Physicians spend a lot of time trying to figure out the best treatments for particular patients' problems. Doing so is often hard. In many situations, there are many plausible treatments, but the trick is picking the one most likely to do the most good and least harm for a particular patient. Ideally, this is where evidence based medicine comes in. But the biggest problem with using the EBM approach is that often the best available evidence does not help much. In particular, for many clinical problems, and for many sorts of patients, no one has ever done a good quality study that compares the plausible treatments for those problems and those patients. When the only... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2930930 Mon, 26 Oct 2009 18:34:00 +0100 2930930 http://www.medworm.com/index.php?rid=2857430&cid=t_196392_105_f&fid=38964&url=http%3A%2F%2Fdrwes.blogspot.com%2F2009%2F10%2Four-new-era-of-comparative.html I just finished our first day at the Principle Investigator Meeting for the launch of the Catheter Ablation Versus Anti-arrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial in Philadelphia today. The trial is a 3000-patient patient trial performed at 140 centers around the world and jointly sponsored by the National Heart, Lung, and Blood Institute (NHLBI), a component of the National Institutes of Health (NIH), and industry (St. Jude Medical and Biosense Webster). The trial will randomize 3000 previously untreated or incompletely treated patients at high risk of cardiovascular complications in the trial to two arms: 1500 patients to catheter ablation as primary therapy of atrial fibrillation and the other 1500 patients to conventional medical therapy with rate control or rhythm ... Dr. Wes blogs http://www.medworm.com/rss/comments.php?id=2857430 Sat, 03 Oct 2009 02:21:00 +0100 2857430 http://www.medworm.com/index.php?rid=2695389&cid=t_196392_99_f&fid=35344&url=http%3A%2F%2Fzackarysholemberger.blogspot.com%2F2009%2F08%2Fsaving-money-while-improving-care.html At the Health Care Blog, George Lundberg picks the following sources of savings, where comparative effectiveness research can help save money while guiding us to the most effective treatment. His confidence that screening mammography doesn't improve mortality seems misplaced (the data isn't clear, and the studies are difficult), and his jab at oncologists is impolitic, but otherwise this is a worthwhile list. Intensive medical therapy should be substituted for coronary artery bypass grafting (currently around 500,000 procedures annually) for many patients with established coronary artery disease, saving many billions of dollars annually. The same for invasive angioplasty and stenting (currently around 1,000,000 procedures per year) saving tens of billions of dollars annually.Most non-indic... Zackary Sholem Berger blogs http://www.medworm.com/rss/comments.php?id=2695389 Thu, 13 Aug 2009 10:34:00 +0100 2695389 http://www.medworm.com/index.php?rid=2667427&cid=t_196392_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F08%2Fsenate-healthcare-bill-amendment-allocates-your-tax-dollars-to-quacks.html By DR. VAL With healthcare costs spiraling out of control, and major rationing efforts under consideration - can we really afford to allow purveyors of pseudoscience to use up scarce Medicare/Medicaid resources? It’s hard to imagine that Obama’s administration would... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2667427 Mon, 03 Aug 2009 23:00:00 +0100 2667427 http://www.medworm.com/index.php?rid=2648996&cid=t_196392_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F07%2Fexplaining-runaway-healthcare-costs-on-lunch-clubs-and-lap-choleys-.html By BOB WACHTER Have you found yourself ‘splaining to friends and family why the healthcare system is so damn expensive? I’ve been teaching health policy for a couple of decades, and I’m surprised that my two favorite stories haven’t yet... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2648996 Mon, 27 Jul 2009 23:00:00 +0100 2648996 http://www.medworm.com/index.php?rid=2645294&cid=t_196392_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F07%2Fexplaining-runaway-healthcare-costs-on-lunch-clubs-and-lap-choleys-.html By BOB WACHTER Have you found yourself ‘splaining to friends and family why the healthcare system is so damn expensive? I’ve been teaching health policy for a couple of decades, and I’m surprised that my two favorite stories haven’t yet... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2645294 Sun, 26 Jul 2009 23:00:00 +0100 2645294 http://www.medworm.com/index.php?rid=2634334&cid=t_196392_87_f&fid=38368&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDisruptiveWomenInHealthCare%2F%7E3%2FM6f2saN00_A%2F At the end of June 2009, Disruptive Women in Health Care ran a series of posts that explored the issue of Comparative Effectiveness Research (CER) from a variety of viewpoints and perspectives: Patients Providers Innovators Caregivers Policymakers Rare Diseases Minorities Gender While there is tremendous potential in the power of CER, there remain a number of troubling issues and difficult questions.  The promise and the pitfalls are reflected in the new CER ebook we put together, which encapsulates each of the posts.  To download a free copy, please click here. (Source: Disruptive Women in Health Care) Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=2634334 Thu, 23 Jul 2009 13:26:50 +0100 2634334 http://www.medworm.com/index.php?rid=2594431&cid=t_196392_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F07%2Fby-rahul-parikh-md---when-i-was-a-kid-growing-up-in-los-angeles-there-was-this-local-tv-show-my-dad-used-to-enjoy-watching-c.html By RAHUL PARIKH MD When I was a kid growing up in Los Angeles, there was this local TV show my dad used to enjoy watching called “Fight Back with David Horowitz.” Basically, Horowitz, a TV reporter and consumer advocate,... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2594431 Sun, 12 Jul 2009 23:00:00 +0100 2594431 http://www.medworm.com/index.php?rid=2588173&cid=t_196392_87_f&fid=38368&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDisruptiveWomenInHealthCare%2F%7E3%2FlVMpUf3cD5U%2F The following guest post on Comparative Effectiveness Research comes from Maria L Kirzecky, R.Ph., MBA, who founded The Kirzecky Group, LLC – a strategic healthcare consultancy specializing in leading organizations to enhance their market position through market-focused business direction, innovative strategies, and sound science-based communications. Why aren’t we as health care professionals clamoring for CER? Why shouldn’t we encourage health care policy makers and industries to align themselves to how we make clinical decisions? Perhaps we haven’t taken the time to fully understand the benefits of CER, how it could directly improve our ability to positively affect the lives of our patients, or we see it as something far-off and impossibly complex to implement. If w... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=2588173 Thu, 09 Jul 2009 15:00:25 +0100 2588173 http://www.medworm.com/index.php?rid=2570453&cid=t_196392_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2009%2F07%2Fcreative-thinking-about-the-cer-agenda.html By JOSHUA SEIDMAN This week the Institute of Medicine (IOM) released its list of the top 100 topics that should be addressed in comparative effectiveness research (CER) now — thanks to $1.1 billion in the American Recovery & Reinvestment Act... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=2570453 Thu, 02 Jul 2009 23:00:00 +0100 2570453 http://www.medworm.com/index.php?rid=2570354&cid=t_196392_86_f&fid=34445&url=http%3A%2F%2Fwomenshealthnews.wordpress.com%2F2009%2F07%2F02%2Fat-our-bodies-our-blog-research-priorities-and-more-bs-posturing-on-womens-health-for-political-gain%2F Yesterday at Our Bodies Our Blog, I posted about the list of priorities for comparative effectiveness research compiled in an Institute of Medicine report as part of the process for allocating funds for this research from the stimulus package. It’s really more interesting than that sentence makes it sound. Several women’s health and childbirth-related topics made the list. Check it out. Christine has something more urgent today, Trading Women’s Health for Votes: Legislators Call for Excluding Abortion Services from Government Health Plan. Apparently “Nineteen House members sent a letter to House Speaker Nancy Pelosi stating that they will not vote for health care reform legislation ‘unless it explicitly excludes abortion funding from the scope of any government-d... Women's Health News blogs http://www.medworm.com/rss/comments.php?id=2570354 Thu, 02 Jul 2009 21:24:27 +0100 2570354 http://www.medworm.com/index.php?rid=2570357&cid=t_196392_87_f&fid=38368&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDisruptiveWomenInHealthCare%2F%7E3%2FoUfyubZxxAQ%2F Today’s guest post by Julie Murchinson, Executive Director, Health 2.0 Accelerator, is the final installment in the Disruptive Women Comparative Effectiveness Research smackdown. Stay Tuned: We will be creating and widely distributing a CER e-book. The HHS Federal Coordinating Council for CER research posted its report to Congress and the President on Monday describing federal activities on CER. Another report with actual priority suggestions is due to Congress by the end of July. On Tuesday, the Institute of Medicine released their sage advice about the top 100 priorities as well as a report on CER. I found one line, in particular, of extreme importance from the report to Congress: “National Institutes of Health (NIH) diabetes prevention trial demonstrated that lifestyle change ... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=2570357 Wed, 01 Jul 2009 14:28:21 +0100 2570357 http://www.medworm.com/index.php?rid=2561196&cid=t_196392_87_f&fid=38368&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDisruptiveWomenInHealthCare%2F%7E3%2FoUfyubZxxAQ%2F Today’s guest post by Julie Murchinson, Executive Director, Health 2.0 Accelerator, is the final installment in the Disruptive Women Comparative Effectiveness Research smackdown. Stay Tuned: We will be creating and widely distributing a CER e-book. The HHS Federal Coordinating Council for CER research posted its report to Congress and the President on Monday describing federal activities on CER. Another report with actual priority suggestions is due to Congress by the end of July. On Tuesday, the Institute of Medicine released their sage advice about the top 100 priorities as well as a report on CER. I found one line, in particular, of extreme importance from the report to Congress: “National Institutes of Health (NIH) diabetes prevention trial demonstrated that lifestyle change w... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=2561196 Wed, 01 Jul 2009 14:28:21 +0100 2561196 http://www.medworm.com/index.php?rid=2556069&cid=t_196392_87_f&fid=38368&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDisruptiveWomenInHealthCare%2F%7E3%2Fct_05V7h5lY%2F I don’t think we in health policy really understand how complex our systems are and what manner of challenges – some of which we created – present themselves in clinical care. It was Dr. Christine Sinsky who enlightened me. She said that just five years ago, a patient with a 143/82 blood pressure, 1.4 creatinin, 128 fasting blood sugar and 189 cholesterol was advised to exercise and lose weight. Today, that same person has hypertension, stage 3 kidney disease, diabetes, hyperlipidemia and is a candidate for four medications and ongoing monitoring. Citing data from the New England Journal of Medicine, she added that a Medicare patient with diabetes, hypertension and depression with a complaint of headaches is subject to 56 different quality measures. The complexity of those – and ot... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=2556069 Tue, 30 Jun 2009 12:02:44 +0100 2556069 http://www.medworm.com/index.php?rid=2553000&cid=t_196392_87_f&fid=38368&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDisruptiveWomenInHealthCare%2F%7E3%2FJvZlJEPNyj8%2F I’ve been tasked with presenting the genetic and rare disease perspective on comparative effectiveness. I’ll dispense with ‘rare’ right away.  If by rare, we mean single gene disorders, then perhaps it is a useful designation. If by rare, we just mean the equivalent of the US definition of orphan disease, i.e., less than 200,000 people in the US, then we should ask a few questions. In the old model of test and drug development, the ‘block buster, body count’, model, rare was a useful designation.  In a system built for BIG, then rare needed a boost.  In the new age of personalized medicine, all conditions are rare. In fact, they are usually an N of 1 after factoring in the myriad of genes involved, epigenetics, environment and so on.  As we enter new... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=2553000 Sun, 28 Jun 2009 19:14:59 +0100 2553000 http://www.medworm.com/index.php?rid=2522819&cid=t_196392_87_f&fid=38368&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDisruptiveWomenInHealthCare%2F%7E3%2FPXIMAhh8eyM%2F The Top headline of FDA News Device Daily today read, “Comparative Effectiveness Research has Benefits, Risks Experts Say”. Why would Device Daily consider comparative effectiveness to be risky? Many obvious concerns come to mind. There are distinct risks that the process imposed on the device industry may stifle growth. Worries abound related to the direction policy makers may employ such as when studies will be required (e.g., at the early stages of development, or later in the cycle of real-world experience), how studies will be conducted (e.g., by the government or a public/private entity), who will determine the type, scope, design and rationale for conducting such studies, what the studies will be used for (e.g., to restrict coverage, to control access). The medical device indus... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=2522819 Fri, 26 Jun 2009 14:02:33 +0100 2522819 http://www.medworm.com/index.php?rid=2515170&cid=t_196392_87_f&fid=38368&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDisruptiveWomenInHealthCare%2F%7E3%2F43WhriHtG7M%2F Caregivers need all the help we can get in navigating the confusing and often conflicting health, medical, and financial decisions required to support a family member with severe or chronic health conditions. My husband, Paul Berger, suffered a severe stroke from a ruptured aneurysm at the young age of 36. Our insurance covered his acute medical needs—brain surgery, hospital care, and even some rehabilitation services. Reimbursement ended when he was discharged from the rehab unit of the hospital, but he still needed—and could benefit from—long term speech, occupational and physical therapy. The first decision was how to continue care. Should we try to coordinate outpatient care through the hospital, or through independent practitioners? Should we sacrifice our savings by spending a ... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=2515170 Thu, 25 Jun 2009 15:00:26 +0100 2515170 http://www.medworm.com/index.php?rid=2510202&cid=t_196392_87_f&fid=38368&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDisruptiveWomenInHealthCare%2F%7E3%2FLlDHWQOUAhM%2F My organization, the National Hispanic Medical Association, is committed to improving the health of Hispanics and other underserved. We support policies that will reform public health and medical services to decrease health care disparities and improve the health status of vulnerable groups. The National Disparities Report by the Agency for Healthcare Research and Quality found that our community has the worst access and quality care compared to non-Hispanics in the nation. Evidence-based public health and medicine strategies are necessary to decrease variation of service delivery that impacts and rations care to Latinos, especially in our poor neighborhoods. Medical treatment should be based on comparative effectiveness value of treatment strategies that produce the greatest benefit for t... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=2510202 Wed, 24 Jun 2009 15:32:09 +0100 2510202 http://www.medworm.com/index.php?rid=2510203&cid=t_196392_87_f&fid=38368&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDisruptiveWomenInHealthCare%2F%7E3%2FjVUwvJSdZlU%2F “$2.5 Billion spent: no alternative medicine cures” screamed the headline two weeks ago. “You expect scientific thinking” one expert was quoted as saying, claiming that it’s become “politically correct to investigate nonsense.” So what’s the real issue here? Better yet, is there a way to bridge the gap between Western and Eastern philosophies so that the constituent that matters most in this paradigm — the patient — wins? I believe that when it comes to comparative effectiveness research (CER, i.e. the efficacy/superiority of one drug or modality compared to another), the heart of the West vs. East battle is two-fold and until we find ways to overcome philosophical barriers, never the twain shall meet. First, we must examine the funding factor. Notably, most Wes... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=2510203 Tue, 23 Jun 2009 11:59:19 +0100 2510203 http://www.medworm.com/index.php?rid=2510204&cid=t_196392_87_f&fid=38368&url=http%3A%2F%2Fwww.amplifypublicaffairs.net%2Fharkin-society-letter-on-ce.pdf With all the chatter and perhaps now “ twitter” about health care reform, one area has gotten a lot of attention and it is an issue that is near and dear to the Society for Women’s Health Research—that is comparative effectiveness research (CER). Since it is accepted knowledge that women and minorities were not, and are still not, to the degree they should be, included in clinical trials, there is much we are learning and still do not know about sex and ethnic differences in terms of prevention, diagnosis and treatment. My concern with CER, therefore, is how differences in effectiveness and treatment will be determined. Several genetic, hormonal, environmental factors influence health and disease in particularly different ways in women and men. Because of that, CER must study both ... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=2510204 Mon, 22 Jun 2009 11:52:48 +0100 2510204 http://www.medworm.com/index.php?rid=2510436&cid=t_196392_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F06%2Fclear-headed-defense-of-comparative.html We have tried to argue why comparative effectiveness research is a good idea. To cut and paste what I wrote in a previous post,Physicians spend a lot of time trying to figure out the best treatments for particular patients' problems. Doing so is often hard. In many situations, there are many plausible treatments, but the trick is picking the one most likely to do the most good and least harm for a particular patient. Ideally, this is where evidence based medicine comes in. But the biggest problem with using the EBM approach is that often the best available evidence does not help much. In particular, for many clinical problems, and for many sorts of patients, no one has ever done a good quality study that compares the plausible treatments for those problems and those patients. When the only... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2510436 Wed, 17 Jun 2009 21:18:00 +0100 2510436 http://www.medworm.com/index.php?rid=2441164&cid=t_196392_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2Fbz5bpMFLQqA%2F Sen. Edward Kennedy (D-Mass.) has begun circulating drafts of his proposed health care reform legislation. Initial reports, including an op-ed in the Boston Globe by Kennedy himself, suggest that the bill will contain every one of the bad ideas that I outlined in my recent Policy Analysis on what to expect from Obamacare. Among other things, the Kennedy bill will call for: An employer mandate; An individual mandate; A so-called “Public Option,” a Medicare-like plan that will compete with private insurance; The use of comparative-effectiveness/cost-effectiveness research to restrain costs; Subsidies for families earning as much as 500% of the poverty level ($110,250 for a family of four). Insurance regulation, including guaranteed issue and community rating. (He would also establish a... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=2441164 Fri, 29 May 2009 18:39:29 +0100 2441164 http://www.medworm.com/index.php?rid=2441286&cid=t_196392_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F05%2Fblogscan-comparative-effectiveness.html On the Hooked: Ethics, Medicine and Pharma blog, Dr Howard Brody dissected a campaign to redirect comparative effectiveness research by making it responsible to a new governing board that would include "insurance" and "industry" members. And surprise, surprise, the campaign is run by the Partnership to Improve Patient Care, a group that seems to have multiple connections to PhRMA, the pharmaceutical industry trade organization. More stealth health policy advocacy? (Source: Health Care Renewal) Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2441286 Sun, 24 May 2009 15:46:00 +0100 2441286 http://www.medworm.com/index.php?rid=2424392&cid=t_196392_134_f&fid=35187&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDiabetesDaily%2F%7E3%2FVvaZVoE1zs0%2Fwhy-perform-comparative-effectiveness-research.php Comparative Effectiveness Research (CER) answers basic questions about drugs and treatments. Is Treatment A better than Treatment B? Which one costs more over time? Answers to these questions can help doctors and patients choose cheaper and more effective treatments. What Exactly Is Comparative Effectiveness Research? In the latest issue of the New England Journal of Medicine, Jerry Avorn clearly explains why CER is so important. "The contested provisions were designed... (Source: Diabetes Daily) Diabetes Daily blogs http://www.medworm.com/rss/comments.php?id=2424392 Wed, 20 May 2009 16:00:00 +0100 2424392 http://www.medworm.com/index.php?rid=2416842&cid=t_196392_87_f&fid=34816&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHonestMedicine%2F%7E3%2F1eebeTBS4D0%2Fguest-columns-by-daphne-white-about-comparative-effectiveness-research-reprinted-from-theintegratorb.html When I first learned of the Obama Administration’s commitment to implementing Comparative Effectiveness Research (CER) as a way of determining which treatments are effective and which ones are not, I was very hopeful. I thought that, done right, CER would assure that the best of conventional and the best of alternative medicine would finally be used together to give American patients the best results. In my enthusiasm, I decided to write articles for HonestMedicine.com on the topic of combining both medical worlds to assure the best patient care, and how CER could help to make this happen. While doing my research, I discovered that another health writer, Daphne White, CHTP, was addressing the same topic. Her slant, very similar to mine, was the importance of including CAM (Complementar... HONEST MEDICINE: My Dream for the Future blogs http://www.medworm.com/rss/comments.php?id=2416842 Mon, 18 May 2009 04:40:27 +0100 2416842 http://www.medworm.com/index.php?rid=2416843&cid=t_196392_87_f&fid=34816&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHonestMedicine%2F%7E3%2FksWbpfU77yA%2Fthe-kabuki-play-of-monied-interests-around-the-11billion-comparative-effectiveness-research-initiati.html (This column was first published by John Weeks on TheIntegratorBlog.com.) John Weeks’ Introduction: In this section of a two-part series, Integrator contributor Daphne White, CHTP focuses on the political-economic dynamics behind the $1.1 billion "clinical effectiveness research" (CER) initiative. White examines what she calls the "Kabuki play" - intense dynamics as the medical industry seeks to gut the value of the initiative, while not appearing to do so. Would you assume that this initiative would look at cost or would inform the care people receive? As White points out, Congress appears to already have caved in on key aspects of apparent value. One wonders if CER can be the point of leverage for reform which White House Budget Director Philip Orzack thinks it can be. And if Orzack c... HONEST MEDICINE: My Dream for the Future blogs http://www.medworm.com/rss/comments.php?id=2416843 Mon, 18 May 2009 04:16:29 +0100 2416843 http://www.medworm.com/index.php?rid=2416844&cid=t_196392_87_f&fid=34816&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHonestMedicine%2F%7E3%2FGpyLendIlGQ%2Fcam-and-comparative-effectiveness-research-are-we-going-to-play-by-daphne-white-chtp.html (This column was first published by John Weeks on TheIntegratorBlog.com.) John Weeks’ Introduction: The idea of "comparative effectiveness research" (CER), the new $1.1 billion economic stimulus program, strikes a happy chord for many in the integrative practice community. Isn't this the appropriate research terrain for showing value of integrative care?  In this first of two part Integrator series, reporter and regular Integrator contributor Daphne White, CHTP, shares how she attended the "listening session" of the government's CER advisory board to understand what was going on and see if the integrative practice community was showing up. White ended up taking off her journalist hat and testifying. She shares her perspectives on why and how the integrative practice community should b... HONEST MEDICINE: My Dream for the Future blogs http://www.medworm.com/rss/comments.php?id=2416844 Mon, 18 May 2009 03:35:18 +0100 2416844 http://www.medworm.com/index.php?rid=2398613&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F05%2F07%2Fmental-health-is-focus-of-new-health-affairs-issue%2F Many more people are using mental health services and U.S. mental health spending rose 65 percent in the past decade, but there is still a disturbingly large gap between access to care and quality of mental health care received. These are some of the findings discussed in the May/June issue of Health Affairs — Mental Health Care: Better, Not Best – released on Tuesday, May 5. The issue explores key aspects of U.S. mental health care including the latest mental health care trends, comparative effectiveness research in mental health treatment, barriers facing veterans in need of mental health services, and supported employment as a means of helping Social Security disability program recipients with psychiatric disabilities earn incomes. Highlights of the issue, funded by a grant... Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=2398613 Fri, 08 May 2009 13:56:55 +0100 2398613 http://www.medworm.com/index.php?rid=2389693&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F05%2F04%2Fhealth-affairs-blog-top-10-posts-for-april%2F Health reform tops the most-read list for April on the Health Affairs Blog. A series of posts on health IT looked at building the new technology into the delivery system, effect on patient-physician relationships, and more. Additional commenting is always welcome. No Direction Home: A Primary Care Physician Questions The Medical Home Model by Caroline Poplin Health Reform: Show Us The Money! by Jeff Goldsmith Propaganda and Prejudice Distort The Health Reform Debate by Merton Bernstein Oberlander: Health Reform Likely To Depend On Budget Reconciliation by John K. Iglehart and Chris Fleming Building Health 2.0 Into the Delivery System by John Halamka Payment Reform Should Drive Delivery System Reform by Francois de Brantes and Lawton Burns Indiana: Health Care Reform Amidst Colliding Value... Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=2389693 Tue, 05 May 2009 15:01:29 +0100 2389693 http://www.medworm.com/index.php?rid=2354017&cid=t_196392_134_f&fid=35187&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDiabetesDaily%2F%7E3%2FAxIhr0WvBUA%2F5-ways-to-control-the-cost-of-diabetes.php Let's continue our discussion of health care costs by looking at diabetes in particular. Here are five practical suggestions for lowering the total cost of having a lifetime of diabetes. Get rid of the term "pre-diabetes". Delete this word from the dictionary because it does more harm than good. If someone has started down the path towards insulin resistance, there is no going back. It may be controlled by weight... (Source: Diabetes Daily) Diabetes Daily blogs http://www.medworm.com/rss/comments.php?id=2354017 Tue, 21 Apr 2009 17:04:07 +0100 2354017 http://www.medworm.com/index.php?rid=2347946&cid=t_196392_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F04%2Fhave-we-suffered-complete-breakdown-in.html Have we suffered a complete breakdown in the scientific method with regard to EHR and other clinical IT?I read announcements like this with trepidation:http://govhealthit.com/articles/2009/03/31/sebelius-confirmation.aspx “The goal,” Sebelius said, “is to provide every American with a safe, secure electronic health record by 2014." The nominee also endorsed efforts to use data gleaned from electronic medical records to conduct “comparative effectiveness research" (CER) to provide information on the relative strengths and weaknesses of alternative medical interventions to health providers and consumers.” Recovery Act funds have been allocated to NIH specifically for comparative effectiveness research. NIH has further specified the definition of CER as:"[A] rigorous evaluation of t... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2347946 Thu, 09 Apr 2009 16:25:00 +0100 2347946 http://www.medworm.com/index.php?rid=2325195&cid=t_196392_134_f&fid=34841&url=http%3A%2F%2Fwww.diabetesmine.com%2F2009%2F04%2Fdrug-ads-comparative-research-adding-value-or-wasting-cash.html As patients, we all know that millions (billions?) of dollars get thrown around in the Pharma and healthcare industries that may not ever touch us directly.  Are all those dollars spent on marketing and research really providing the value they propose?  Two related posts/discussions by industry insiders caught my eye lately:   The Downside (and Upside) of [...] (Source: Diabetes Mine) Diabetes Mine blogs http://www.medworm.com/rss/comments.php?id=2325195 Tue, 07 Apr 2009 13:00:36 +0100 2325195 http://www.medworm.com/index.php?rid=2306719&cid=t_196392_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FagjKN5tr-So%2F My colleague, Michael Cannon, makes several good points about comparative effectiveness research (CER), both in his letter to USA Today and in his excellent paper on the subject. I strongly agree with him that we should not reflexively oppose CER—much of health care spending is wasteful or unnecessary, and it makes sense, therefore, to test and develop information on the effectiveness of various treatments and technology, giving consumers tools to evaluate the value of the care they receive. There is also a case for the use of CER in taxpayer-funded programs like Medicare and Medicaid. Taxpayers should not have to subsidize health care that has not proven effective, nor can Medicare and Medicaid pay for every possible treatment regardless of cost-effectiveness. However, I am more skeptic... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=2306719 Mon, 06 Apr 2009 16:38:23 +0100 2306719 http://www.medworm.com/index.php?rid=2306722&cid=t_196392_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FJSZCM-K0EfY%2F I’ve got a letter to the editor in today’s The USA Today on comparative-effectiveness research: Commentary writer Kevin Pho misrepresented my views on comparative-effectiveness research (CER), which is the analysis of which medical treatments work best (”Unbiased research for doctors is good medicine,” The Forum, March 26). Pho wrote that “drug companies, medical device makers and think tanks such as the libertarian Cato Institute have expressed concerns that health care rationing and denial of certain treatments or drugs would follow” taxpayer-funded CER. In the Cato Institute study linked to in the piece, I write that rationing is the intent behind such research, but I do not express concern that it will lead to rationing. Indeed, I express the opposit... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=2306722 Mon, 06 Apr 2009 13:38:21 +0100 2306722 http://www.medworm.com/index.php?rid=2279759&cid=t_196392_150_f&fid=34889&url=http%3A%2F%2Fpharmamkting.blogspot.com%2F2009%2F03%2Fprotracted-decline-in-us-rx-sales.html "We ration care in the US today using one of the most capricious and inequitable means possible -- ability to pay," says Kim Slocum, former Director, Strategic Planning & Business Development at AstraZeneca, in an article to be published in the March 2009 issue of Pharma Marketing News. "As cost shifting to consumers has accelerated over the past decade, we've seen the effects of this as year-on-year sales growth for prescription products has dropped on more or less a straight line since 2000."To support his thesis, Slocum sent me the chart above, which shows the percent change in dollar sales for US prescription products from 1990 through 2008. The original source of this data is the IMS National Sales Perspective, January 2006, 2007, 2008, 2009."There's plenty of evidence to show tha... Pharma Marketing Blog blogs http://www.medworm.com/rss/comments.php?id=2279759 Fri, 20 Mar 2009 12:22:00 +0100 2279759 http://www.medworm.com/index.php?rid=2270324&cid=t_196392_87_f&fid=34816&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHonestMedicine%2F%7E3%2FmoaYnPDLJdA%2Fjulia-schopicks-comment-on-the-institute-of-medicines-proposed-panel-comparative-effective-research-.html I just posted the comment below to the Institute of Medicine (IOM), recommending that they include people with knowledge of integrative medicine on their panel that will be comparing the effectiveness of medical treatments. Click here to leave your own suggestions/comments about the composition of the proposed panel. (Comments will be accepted until March 23, 2009.) At the end of this posting, I'll give links to other websites with relevant information about this issue. I urge you to access the above link and offer your own input to the IOM about this very important issue. TO: The Institute of Medicine I would like to thank the Institute of Medicine (IOM) for giving me this opportunity to submit my comments and recommendations concerning this panel, which has been slated to mak... HONEST MEDICINE: My Dream for the Future blogs http://www.medworm.com/rss/comments.php?id=2270324 Tue, 17 Mar 2009 03:17:22 +0100 2270324 http://www.medworm.com/index.php?rid=2269055&cid=t_196392_150_f&fid=34889&url=http%3A%2F%2Fpharmamkting.blogspot.com%2F2009%2F03%2Fwhats-cause-of-drug-industrys-bad.html (Source: Pharma Marketing Blog) Pharma Marketing Blog blogs http://www.medworm.com/rss/comments.php?id=2269055 Mon, 16 Mar 2009 13:25:00 +0100 2269055 http://www.medworm.com/index.php?rid=2263775&cid=t_196392_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FTMZHd6fyPWI%2F In “A Better Way to Generate and Use Comparative-Effectiveness Research,” I predicted that taxpayer-funded research on which medical treatments work best would ultimately be defunded at the behest of those who make a living providing the less-effective treatments. Because, well, that’s what always happens. Well, it turns out those folks have gone and formed themselves a coalition and launched a media campaign to ensure that comparative-effectiveness research doesn’t put a dent in their incomes. According to the Associated Press: People’s lives and plenty of money are at stake when it comes to determining which medical treatments work best. So some prominent health industry and patient advocacy groups are trying to reframe the debate over how such decisions are... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=2263775 Fri, 13 Mar 2009 20:45:06 +0100 2263775 http://www.medworm.com/index.php?rid=2255995&cid=t_196392_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2F4Dfrn3Nfldo%2F Jason Shafrin agrees with me that the public-goods case for government-funded comparative-effectiveness research is weak, though he argues that political constraints make my proposed solutions difficult. (Source: Cato-at-liberty) Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=2255995 Tue, 10 Mar 2009 00:41:17 +0100 2255995 http://www.medworm.com/index.php?rid=2260915&cid=t_196392_150_f&fid=34889&url=http%3A%2F%2Fpharmamkting.blogspot.com%2F2009%2F03%2Fas-innovation-shifts-to-small-companies.html (Source: Pharma Marketing Blog) Pharma Marketing Blog blogs http://www.medworm.com/rss/comments.php?id=2260915 Mon, 09 Mar 2009 11:32:00 +0100 2260915 http://www.medworm.com/index.php?rid=2233695&cid=t_196392_87_f&fid=35747&url=http%3A%2F%2Fhealthaffairs.org%2Fblog%2F2009%2F03%2F04%2Fthe-attack-on-health-it-and-comparative-effectiveness-research-a-warning-for-what-lies-ahead%2F Few of us could have predicted (or were ready for) the firestorm of opposition that provisions in the stimulus bill related to electronic health information or comparative effectiveness research created a few weeks ago. Oh, we might have thought that privacy issues related to electronic health records (EHRs) might be of concern. Or the fact that electronic health information systems or comparative effectiveness research were not as “job creating” as money for road building (even though they are predicted to create 200,000 or more jobs). But did we anticipate adequately that these two provisions would be so commingled, misunderstood, or hysterically misrepresented in the media as they were? The tactics used to attempt to defeat these two provisions are instructive, because they will b... Health Affairs Blog blogs http://www.medworm.com/rss/comments.php?id=2233695 Thu, 05 Mar 2009 02:51:44 +0100 2233695 http://www.medworm.com/index.php?rid=2182483&cid=t_196392_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F02%2Fattack-on-government-funded-comparative.html A provision in the massive US stimulus bill passed by the US Senate to fund comparative effectiveness research has generated considerable criticism. As Alicia Mundy, reporting in the Wall Street Journal, wrote:The drug and medical-device industries are mobilizing to gut a provision in the stimulus bill that would spend $1.1 billion on research comparing medical treatments, portraying it as the first step to government rationing.The $1.1 billion in research funding would be doled out to the National Institutes of Health and other government bodies. 'We should focus on producing the best unbiased science possible,' said Rep. Henry Waxman (D., Calif.), a strong proponent of the House language.Mr. Obama supported research into comparative effectiveness during his campaign. Administration offic... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2182483 Wed, 11 Feb 2009 21:58:00 +0100 2182483 http://www.medworm.com/index.php?rid=2177585&cid=t_196392_99_f&fid=35344&url=http%3A%2F%2Fzackarysholemberger.blogspot.com%2F2009%2F02%2Fcan-health-care-act-as-economic.html I'm scholar Googling and can't find anything. I don't know what the Obama Administration's argument is supporting their inclusion of comparative effectiveness research in the stimulus bill. Obviously I think CER is great a priori, as are EHRs, but neither save money in the short run. Do they stimulate the economy? Beats me - not my field - but I suppose in the sense of creating jobs, sure. (Funding research supports researchers, who buy bread, gasoline, and electricity just like everyone else.)Note that this is separate from whether prevention and CER give good value for the dollar. Stephen Woolf claims unsurprisingly that they do, writing recently in JAMA. But the real point of his article is this: if you're going to ask whether prevention is worth the cost, you have to ask also whether (... Zackary Sholem Berger blogs http://www.medworm.com/rss/comments.php?id=2177585 Tue, 10 Feb 2009 20:48:00 +0100 2177585 http://www.medworm.com/index.php?rid=2163795&cid=t_196392_113_f&fid=35746&url=http%3A%2F%2Fblog.criticalmassconsulting.com%2F%3Fp%3D10 On Feb. 2nd and 3rd I schlepped down to DC for the annual National Health Policy Conference sponsored by AcademyHealth and Health Affairs.  We 700-odd people in the audience (up a bit from 2008, organizers tell me) heard from Members of the House and Senate, their staff people, and Jeanne Lambrew, now Deputy Director of President Obama’s White House Office of Health Reform.  Much of the talk was guarded, even cryptic – some combination of hold-your-cards-close-to-the-vest and haven’t-a-clue-how-this-will-turn-out.  Still, the meeting was useful, not to mention just full – bigger than last year’s.  I came away with a better sense of the players and the likely nature and timing of some Obama Administration initiatives:  ·    Lambrew is a sophisticated thinker about health ... Critical blogs http://www.medworm.com/rss/comments.php?id=2163795 Thu, 05 Feb 2009 15:46:44 +0100 2163795 http://www.medworm.com/index.php?rid=2144664&cid=t_196392_99_f&fid=35344&url=http%3A%2F%2Fzackarysholemberger.blogspot.com%2F2009%2F01%2Fgood-things-in-stimulus-package-come-in.html Look what Barack Claus brought down the chimney - the Federal Coordinating Council for Comparative Effectiveness Research! This is wonderful news. And I'll even try and convince the skeptics at some point. (Source: Zackary Sholem Berger) Zackary Sholem Berger blogs http://www.medworm.com/rss/comments.php?id=2144664 Thu, 29 Jan 2009 14:00:00 +0100 2144664 http://www.medworm.com/index.php?rid=1991565&cid=t_196392_150_f&fid=35777&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FPharmalot%2F%7E3%2F465025988%2F Sylvia Syvenky went for a routine dental appointment in early October, expecting to have two caps on her teeth replaced, but something went terribly wrong. She was rushed by ambulance to University Hospital near her home in Edmonton, Alberta, where doctors placed a mask on her face and forced air into her lungs, The New York Times writes. They told her she had heart failure. And after her condition improved, they asked her to sign up for a study of a new drug to help with breathing. Syvenky is like many with heart failure who arrive at hospitals, unable to breathe. Yet she is the last person who would normally be asked to join a research study, the Times notes, adding that, at age 70, she was much older than typical study participants and her symptoms were too complex. But now there is a ... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=1991565 Tue, 25 Nov 2008 13:22:35 +0100 1991565 http://www.medworm.com/index.php?rid=1686526&cid=t_196392_150_f&fid=35777&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FPharmalot%2F%7E3%2F357424885%2F A new bill was introduced late last week that would create a hub for clinical research in order to evaluate clinical research – for drugs, devices and surgical procedures - in a bid to lower health care costs. The non-profit Health Care Comparative Effectiveness Research Institute would conduct research into which treatments work and which don’t. Its board would include representatives from the HHS, AHRQ and NIH, as well as drug and device makers, and patients and doctors, although the institute would operate independently from government. Public and private payers, such as Medicare and private insurers, would provide annual funding, which is expected to exceed $300 million after five years. “Doctors and patients need reliable, unbiased information about the effectiveness of... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=1686526 Wed, 06 Aug 2008 13:56:45 +0100 1686526 http://www.medworm.com/index.php?rid=1682942&cid=t_196392_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F08%2Fblogscan-proposed-comparative.html On the Health Beat Blog, Maggie Mahar discussed a bill in the US Senate proposing the formation of a comparative effectiveness institute. It has one striking drawback. The board of the proposed institute, which would include representatives of "private payers; [and] pharmaceutical, device and technology companies." Both groups have financial interests favoring comparative effectiveness studies with particular groups. Private payers make more money when they can avoid paying for expensive tests, treatments, and other forms of care. They would prefer to see comparative effectiveness studies that find that more expensive tests, treatments, etc do not work so well. Pharmaceutical, biotechnology, and device companies would prefer to see comparative effectiveness studies that find their products... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1682942 Tue, 05 Aug 2008 20:32:00 +0100 1682942 http://www.medworm.com/index.php?rid=1142372&cid=t_196392_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F01%2Fhealth-care-renewal-bloggers-to-present.html Health Care Renewal bloggers are scheduled to make some presentations this spring.First, I will be participating in a special symposium on comparative effectiveness research at the Society for General Internal Medicine (SGIM) annual meeting in Pittsburgh, PA, USA. The session will be on Friday, April 11, 2008 from 10:30 AM - Noon, co-sponsored by the Sydenham Society, entitled, "Comparative Effectiveness: What, How, and Who?" I will be emphasizing the importance of transparency and avoiding conflicts of interest.Second, Dr Wally R Smith and I will be presenting a short course on challenges and threats to evidence-based practice at the European meeting of the Society for Medicine Decision Making (SMDM) in Engleberg, Switzerland. The session will be on Sunday, June 1, 2008, and is entitled, ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1142372 Thu, 10 Jan 2008 16:28:00 +0100 1142372 http://www.medworm.com/index.php?rid=961629&cid=t_196392_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F10%2Fwhose-opinions-did-new-york-times.html The New York Times today included an op-ed piece by Peter Pitts which raised the alarm about comparative effectiveness research on one of the world's most prominent opinion pages. Pitts was identified as President of the Center for Medicine in the Public Interest, "a nonprofit organization that receives financing from the pharmaceutical industry."If Congress overrides President Bush’s veto of the State Children’s Health Insurance Program, a little-known provision of the original House bill could be revived.As written, the provision would allocate $300 million to create a Center for Comparative Effectiveness that would test whether newer, more expensive drugs work better than their older and cheaper counterparts. Medicare would use the center’s findings to help decide which drugs to c... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=961629 Thu, 18 Oct 2007 20:13:00 +0100 961629 http://www.medworm.com/index.php?rid=927835&cid=t_196392_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F10%2Fmain-stream-may-be-little-wider-than-we.html I just attended a health policy session on addressing rising health care costs. The four speakers emphasized these points, in order:We need to better address not just patients with chronic disease, but those with complex and/or multiple chronic diseases. We need to provide the practitioners who care for such patients the time and resources do so well.One reason for ever rising health care costs is that the current system often very generously reimburses particular services, treatments, and tests without any evidence that the services do very much good for patients. Instead, we need to make reimbursement proportionate to the value (presumably benefits/ harms) patients accrue.Unfortunately, we do not often actually know what the benefits and harms of services, treatments and tests are for pa... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=927835 Thu, 04 Oct 2007 22:17:00 +0100 927835