Two Republican Senators, John Kyl and Mitch McConnell, have now introduced a bill to essentially gut federal funding for or use of comparative effectiveness research, continuing a Republican attack on the proposed expansion of such research for the purpose of controlling costs; an attack which several Democrats have joined. The primary objection appears to be that such research will be used to “ration care”.
These concerns are either misplaced or intended to mislead. Comparative effectiveness research is eminently sensible and unobjectionable. The whole point of such studies is to gather information about what works in health care. No one seems to seriously suggest that we have adequate evidence about the best methods to treat various conditions and illnesses. It is entirely consistent with creating the best possible quality in our health care system to want to base care delivery on solid research findings. It is not rationing care to have science-based guidelines developed and used to promote best practices. Why would we want physicians and other providers to be free to deliver what appears to be substandard care? Undoubtedly some drug and device makers will find their products disfavored, but if that occurs as a result of valid studies, why would we want to pay for a product that is not as good as another method of treatment?
What will be more controversial is introducing cost-benefit notions into the research. Making such measurements is often highly subjective, particularly when attaching a value to human life or functional status. It would be best if comparative effectiveness research largely confines itself to care outcomes. Another appropriate concern about these studies would be whether they are used by regulatory agencies as a method to delay introduction on new, potentially expensive, products and techniques. One could imagine, for example, that the FDA by requiring comparative effectiveness studies for all new drugs or devices would add significantly to the time and expense to bring a product to market, which would discourage funding of innovation and would potentially harm patients by delaying the availability of products which might improve their health outcomes. A balance needs to be struck which encourages continued development and speed-to-market for products which do provide better outcomes while ensuring that there is research that verifies claims of those better outcomes. Effectively banning comparative effectiveness research seems like a very poor solution.