Unfinished Business Over Comparative Effectiveness

  • by: |
  • 10/19/2007
Drugwonks has been attacked over it's views on comparative effectiveness. The attacks break down into two lines of "thinking".

1. We receive funding from drug companies.
2. We receive funding from drug companies.

Apparently if we supported comparative effectiveness as a wonderful tool for achieving optimal prescribing and reimbursement decisions our funding from drug companies would not be an issue. But because we criticize it and offer the collection of patient-centered data to support improved outcomes and productivity, our views are both wrong and tainted. I guess taking money from George Soros, trial attorneys and left wing foundations or just hating drug companies -- which some bloggers do -- in no way biases the views of others. So people who receive pharmaceutical firm support are tainted but everyone else is objective. Yeah, right.

Indeed, the biomarker and patient-centric approach we support is now being attacked as..no surprise... as another venue for industry to enrich itself. See our previous posts regarding the unwarranted attack on the Reagan Udall Institute.

Follow this logic. Big Pharma used the FDA to push through me-too drugs of limited efficacy so it could market blockbuster drugs to an unthinking public. Critics clamored that companies should invest in breakthroughs based on new genetic research that targeted important diseases and developed drugs that really advanced care.

So now companies are doing just that or trying. They are now being criticized for investing in efforts to develop targeted medicines using new science. Instead, critics want "hard" evidence that people are actually cured or better before a drug is approved though the predictive accuracy of genetic markers is precisely what is revolutionizing health care.

When someone keeps changing the standards and the goalposts it tells you that what they dislike is not the goal but the target of their criticism. Comparative effectiveness, as applied in every health system, is used to control costs and limit access to new medicines. Meanwhile studies show new medicines improve productivity and extend life.

Those who support comparative effectiveness have yet to show me one study they support they demonstrates the better value of new medicines. That's because for the most part they are design by government agencies and others with a bias towards cost containment and against medical innovation. That goes for the ALLHAT and CATIE studies.

And as for the ALLHAT study, Health Care Renewal does not want to accept the fact that the ALLHAT design was bizarre and structured to produce excess mortality in blacks. Don't believe me, believe Michael Weber who was one of the investigators....

"The reality of ALLHAT – it was poorly designed, the interpretations were disingenuous, it violated appropriate scientific reporting, and most frightening, it did something that was so unethical that if a pharmaceutical company had done it or any of us as individual academics had done it, we would not only be thrown out of our jobs, we would be pilloried and maybe even be facing criminal charges: They exposed African-American patients for several years to treatments they knew would not be effective in controlling their blood pressure.

And one thing that did show up in favor of diuretics, the fact that they cause fewer strokes than one of the other drug classes, was driven entirely by a 40% excess stroke rate in black patients that was predictable before the study began. And they used that as their reason to claim superiority of the diuretic."

I want to know if Health Care Renewal would treat his African American patients with high blood pressure and congestive heart failure without using BiDil and according to the ALLHAT guidelines?


Some proponents of comparative effectiveness might because they are ideologues. And that's the difference. For a lot of people and policymakers comparative effectiveness analysis -- from the design of studies right down to the reimbursement -- it's political and a way to wound drug companies.

Finally, I apologize to all who have tried to post comments and have not been able to. It was not intentional. We are making a technical fix to clear this problem up.

Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

Blog Roll

Alliance for Patient Access Alternative Health Practice
Better Health
Biotech Blog
CA Medicine man
Cafe Pharma
Campaign for Modern Medicines
Carlat Psychiatry Blog
Clinical Psychology and Psychiatry: A Closer Look
Conservative's Forum
Club For Growth
Diabetes Mine
Disruptive Women
Doctors For Patient Care
Dr. Gov
Drug Channels
DTC Perspectives
Envisioning 2.0
FDA Law Blog
Fierce Pharma
Fresh Air Fund
Furious Seasons
Gel Health News
Hands Off My Health
Health Business Blog
Health Care BS
Health Care for All
Healthy Skepticism
Hooked: Ethics, Medicine, and Pharma
Hugh Hewitt
In the Pipeline
In Vivo
Internet Drug News
Jaz'd Healthcare
Jaz'd Pharmaceutical Industry
Jim Edwards' NRx
Kaus Files
Laffer Health Care Report
Little Green Footballs
Med Buzz
Media Research Center
More than Medicine
National Review
Neuroethics & Law
Nurses For Reform
Nurses For Reform Blog
Opinion Journal
Orange Book
Peter Rost
Pharm Aid
Pharma Blog Review
Pharma Blogsphere
Pharma Marketing Blog
Pharmacology Corner
Pharmaceutical Business Review
Piper Report
Prescription for a Cure
Public Plan Facts
Real Clear Politics
Shark Report
Shearlings Got Plowed
Taking Back America
Terra Sigillata
The Cycle
The Catalyst
The Lonely Conservative
Town Hall
Washington Monthly
World of DTC Marketing
WSJ Health Blog