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 'effectiveness research'. Sat, 03 Sep 2011 02:06:13 +0100 http://www.medworm.com/index.php?rid=4997503&cid=t_229999_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_229999_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=4780485&cid=t_229999_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=4560251&cid=t_229999_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=4318331&cid=t_229999_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_229999_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_229999_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=4190149&cid=t_229999_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_229999_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=4119218&cid=t_229999_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=4118804&cid=t_229999_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=4077245&cid=t_229999_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=4027161&cid=t_229999_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=4003216&cid=t_229999_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=3976487&cid=t_229999_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=3757852&cid=t_229999_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FsaYXyH9Fags%2F By Michael F. CannonChristopher Weaver of Kaiser Health News has an excellent article in today’s Washington Post on the various government agencies that will now be deciding what health insurance coverage you must purchase, and how many of those decisions will ultimately fall to lobbyists and politicians: For years, an obscure federal task force sifted through medical literature on colonoscopies, prostate-cancer screening and fluoride treatments, ferreting out the best evidence for doctors to use in caring for their patients. But now its recommendations have financial implications, raising the stakes for patients, doctors and others in the health-care industry. Under the new health-care overhaul law, health insurers will be required to pay fully for services that get an A or B recomm... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=3757852 Thu, 15 Jul 2010 15:32:20 +0100 3757852 http://www.medworm.com/index.php?rid=3706623&cid=t_229999_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=3648474&cid=t_229999_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FFjc9Jk-ceC4%2F By Michael F. CannonOver at CongressDaily, Julie Rovner has a great piece on the difficulties involved in generating and using comparative-effectiveness research (read: evidence that can improve the quality and reduce the cost of medical care). Rovner cites a recent New England Journal of Medicine article about the obstacles to conducting CER, and a recent article from Health Affairs that finds consumers tend to trust their doctor’s judgment more than evidence-based treatment guidelines. In a paper titled, “A Better Way to Generate and Use Comparative-Effectiveness Research,” I explain how a string of government interventions — from state licensing of medical professionals and health insurance, to the tax preference for job-based health insurance, to Medicare and Me... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=3648474 Thu, 10 Jun 2010 14:27:03 +0100 3648474 http://www.medworm.com/index.php?rid=3607500&cid=t_229999_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_229999_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=3403828&cid=t_229999_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=3350270&cid=t_229999_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_229999_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=3026636&cid=t_229999_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=3012345&cid=t_229999_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=2934738&cid=t_229999_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_229999_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=2908581&cid=t_229999_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FF4OyERJiqJM%2F If the goal is to improve health, then the answer is clearly no. Ironically, even though universal coverage is presumably about helping the sick, the Democrats’ pursuit of universal coverage demonstrates not how much, but how little they care about their neighbors’ health. Economists Helen Levy and David Meltzer explain, in a book published by the Urban Institute, “There is no evidence at this time that money aimed at improving health would be better spent on expanding insurance coverage than on…other possibilities,” such as clinics, hypertension screening, nutrition campaigns, or even education.  In the Annual Review of Public Health, they explain further: The central question of how health insurance affects health, for whom it matters, and how much, remains largely unanswered ... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=2908581 Mon, 19 Oct 2009 15:47:15 +0100 2908581 http://www.medworm.com/index.php?rid=2857430&cid=t_229999_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_229999_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_229999_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_229999_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_229999_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_229999_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_229999_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_229999_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_229999_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=2570357&cid=t_229999_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_229999_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_229999_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_229999_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_229999_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_229999_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_229999_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_229999_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_229999_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_229999_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_229999_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=2441178&cid=t_229999_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2Fpp5du9uDC64%2F The New Republic’s Jonathan Cohn accuses Americans for Prosperity (AFP) of “lies” for running an ad that claims “Washington wants to bring Canadian-style healthcare to the U.S.” AFP’s ad is more defensible than Cohn’s criticisms of it. Cohn elides the question of whether Shana Holmes (the woman featured in the ad) was almost killed by Canada’s Medicare system.  For a supporter of single-payer like Cohn, that is tantamount to admitting that, yeah, socialized medicine sometimes kills people. Cohn argues that the ad is unfair because Canada has many advantages over the U.S. health care sector.  That may be true, but the ad doesn’t appear to defend American health care.  It merely says, “government should never come in between your family and your doctor” and “Don’... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=2441178 Thu, 28 May 2009 12:43:07 +0100 2441178 http://www.medworm.com/index.php?rid=2441286&cid=t_229999_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_229999_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=2354017&cid=t_229999_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_229999_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_229999_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_229999_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_229999_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_229999_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=2269055&cid=t_229999_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_229999_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_229999_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_229999_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=2182483&cid=t_229999_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_229999_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=2144664&cid=t_229999_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_229999_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=1682942&cid=t_229999_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_229999_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_229999_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_229999_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