A nice piece on comparative effectiveness by Ceci Connolly of the Washington Post. No pun intended. Nice in that it underscores the limits of comparative effectiveness and it's link to consumer choice rather than top down directives.
However, there are limits that Connolly's piece did not discuss and which likely will be silence by the IOM panel which is stacked with people who believe that the one size fits all, literature review, take it or leave approach of comparative effectiveness is the key to universal coverage. This (with some rare and sensible exceptions) is a panel of patronage appointees intended to suppress responsible, science based alternatives to evaluating treatment effects. I will have much, much more on this subject in a forthcoming post. But for instance, don't expect the IOM panel, which is stacked to simply implement an AHRQ agenda that they have developed and receive millions from to address the following issues:
Which drug or treatment works best for an individual based on a variety of factors including genetic variation, co-morbidity, life style preference, stage of life?
Moreover, will comparative effectiveness force additional studies before a product is paid for? If so, that will inevitably delay access, raise prices or reduce rates of innovation. And if trials have to be randomized for each subpopulation the cost goes higher still.
The drug effectiveness review studies conducted by DERP fail to control for subpopulations and the literature they look at themselves exclude adjustments for severity of illness, genetic variation, etc. So most "studies" show no difference in drugs for a particular illness when in fact there are substantial variations, particularly in the areas of depression, schizophrenia, hypertension.
Therefore, shouldn't money be spent on tools for personalized medicine instead of one-size fits all guidelines?
However, there are limits that Connolly's piece did not discuss and which likely will be silence by the IOM panel which is stacked with people who believe that the one size fits all, literature review, take it or leave approach of comparative effectiveness is the key to universal coverage. This (with some rare and sensible exceptions) is a panel of patronage appointees intended to suppress responsible, science based alternatives to evaluating treatment effects. I will have much, much more on this subject in a forthcoming post. But for instance, don't expect the IOM panel, which is stacked to simply implement an AHRQ agenda that they have developed and receive millions from to address the following issues:
Which drug or treatment works best for an individual based on a variety of factors including genetic variation, co-morbidity, life style preference, stage of life?
Moreover, will comparative effectiveness force additional studies before a product is paid for? If so, that will inevitably delay access, raise prices or reduce rates of innovation. And if trials have to be randomized for each subpopulation the cost goes higher still.
The drug effectiveness review studies conducted by DERP fail to control for subpopulations and the literature they look at themselves exclude adjustments for severity of illness, genetic variation, etc. So most "studies" show no difference in drugs for a particular illness when in fact there are substantial variations, particularly in the areas of depression, schizophrenia, hypertension.
Therefore, shouldn't money be spent on tools for personalized medicine instead of one-size fits all guidelines?
