Why the US Needs Comparative Effectiveness Research for Medical Care

Reading this well-written piece by Sharon Begley got me thinking. One of the mysteries of the practice of medicine in high income countries is the fact that US spends a substantially larger proportion of GDP on medical care and yet the conventional outcomes place it below France and Canada. Both these countries have some form of publicly-funded medical care through a national health insurance plan.

One of the planks of president Obama's campaign promises was not only to enact legislation to provide health insurance for all US citizens, but to also institute a the Comparative Effectiveness Research (CER) mechanism which Begley argues for in the article. Understandably, the failure or reluctance of doctors to monitor the relative effects of treatments results in too much treatment with the incentives being misaligned with patient interests. She suggests strongly that doctors are driven by a cultural tendency that is not itself informed by any science and that this results in regional disparities in approaches that are evidently wasteful.

The need for the Comparative Effectiveness Research to compare the relative merits of treatment options makes both economic and medical sense. However, while the article suggests that there is no comparable mechanism, this Kevinmd blog post refers to a study carried out on a similar system that measures the summary of a study that compared hospitals with different electronic clinical knowledge databases. The result of that study is that there is better performance on the part of hospitals that use the electronic reference facility uptoDate.

Since all I have read is the summary, which also has a number of caveats, I cannot tell to what extent uptoDate is a comprehensive CER mechanism. still, i am glad that one exists and perhaps the review of its performance should be made with a view to expanding its use as an alternative to the CER that will be set. Unlike Dr. Kevin Pho MD, I have no problem with establishing competing mechanisms for ensuring CER provided it is capable of ensuring that the expensive tests are not called for in vain.