IOM: Comparative Effectivenes Recommendations – Top Down Bureaucracy at Its Best
In the midst of all the chaos surrounding the economic downfall, Americans overlooked a key component of the American Recovery and Reinvestment Act (ARRA): the Comparative Effectiveness Research Council.
The purpose of the Council is to determine what drugs are more/less effective than similar drugs.
One of the provisions of ARRA was for the Institute of Medicine to recommend a list of priority topics to be the initial focus of a new national investment in comparative effectiveness research. As a result, the Institutes of Medicine recently published a report titled: Initial National Priorities for Comparative Effectiveness Research.
The report was supported by funds from the Agency on Healthcare Research and Quality, the National Academies President’s Fund, and the Robert Wood Johnson Foundation.
The IOM committee identified three report objectives: 1) establish a working definition of CER, 2) develop a priority list of research topics to be undertaken with ARRA funding using broad stakeholder input, and 3) identify the necessary requirements to support a robust and sustainable CER enterprise.
The report also outlines 100 Initial Priority Topics for Comparative Effectiveness Research. Within the list the topics are listed by quartile (groups of 25), with the first quartile having the highest priority.
The 100 topics were selected from some 2,600 suggestions, with 17 suggestions coming from device companies and 11 from pharmaceutical/biotechnology firms. Some of the comparative effectiveness research projects in the first quartile are:
– hearing loss in children and adults; upper endoscopy utilization; care coordination programs, such as the medical home; Crohn’s disease, ulcerative colitis, rheumatoid arthritis, and psoriatic arthritis; health care associated infections (HAI); prostate cancer.
Some of the more disturbing suggestions from IOM include prioritizing lower back pain; yoga; homeless care; and even acne ahead of or at the same level as pediatric cancer.
Is this really what the government is going to use or is this just a suggestion to them from the IOM?
Does the government really assume that the higher priority is to save money and produce better outcomes researching low back pain versus pediatric cancer?
In addition, the new report, offers recommendations for the $400 million given to the Department of Health and Human Services from ARRA, according to the Wall Street Journal. Conversely, the Institute of Medicine stated it did not consider cost in its assessment of priorities.
Dr. Harold Sox, editor of the Annals of Internal Medicine and co-chairman of the committee that picked the priorities noted that committee did no include cost because it was "a very big topic, and one that we knew we didn't have sufficient time to deal with. Others noted that "the focus of comparative effectiveness research is that it leads to better care, not cheaper care."
Accordingly, research on these and future topics will not yield real improvements unless the results are adopted by health care providers and organizations and integrated into clinical practice. Dr. Cox further said that:
“Conducting high-quality research and implementing the results pose major challenges, and thus "it is going to take awhile" before the impact of the research is seen in hospitals and doctors' offices.
Ultimately, comparative effectiveness research is an “ongoing process to accommodate new treatments and changes in practice. As a result some people believe that as comparative research develops, this council will make decisions based on cost, especially since IOM did not consider cost.
How can Congress and IOM consider whether medicine is going to be more effective when the results from this research will make care unaffordable to Americans, and degrade the health care system further?
Top down recommendations always favor the elite vs. the needy. Would it not be better to randomly survey a select group of healthcare providers and patients to come up with what is needed as opposed to Washington bureaucrats deciding what is best for patients.
IOM and Congress need to realize one crucial factor when determining their priorities for comparative effectiveness research: although recommendations can and should be made, flexibility is essential for the individual physician to prescribe what he or she feels best for the individual patient.
Witness Testimony from Stakeholder Meeting