Roy Poses MD is one of the more intelligent and thoughtful commenters on the conflicts of interest that are rife in the world of healthcare. Roy’s latest discusses the issue of comparative effectiveness – evaluating and comparing different drugs to see which does a better job treating specific conditions.
Not surprisingly, big pharma is no fan.
Here’s the money quote from Roy’s piece:
“Research directly comparing plausible options has not been done for a large number of important clinical problems affecting many types of patients. Why not? Most research about drugs or devices is currently sponsored, that is, paid for by the companies that make them.”
The good doctor also observes that there is an active and rather effective PR campaign funded by, you guessed it, big pharma, apparently designed to denigrate the results of comparative effectiveness research.
I’m shocked.
If drug industry lobbyists prevent the government from establishing and financing an entity to perform comparative effectiveness research, perhaps insurers could pool their resources to finance the job, at least for the high volume drugs, devices and therapies. Based on the findings, they could establish sharply differentiated copays to maximize value and better control medical cost growth.
Good suggestion, Barry, but I’ll take it a step further. How about large purchasers of drugs — like large, self-insuring employers, the Leapfrog Group, the Business Roundtable, or whomever — form their own, privately-funded organization, free from the taint of lobbyist influence, to perform such comparative trials?
Now THAT would get some attention.
While comparative effectiveness research would be extremely useful, I’m not sure that having it done by any of the existing stakeholders would be seen as valid. Where pharma companies would be looking to push brand, employers and insurance companies are looking to hold down costs– and thus you have the potential for bias toward generics and older medications.
Whats more complicated is the hypotheses to be tested– progression against certain diseases are one thing, but side effect profiling and off-label usage would be a completely different ball of wax.
My sense is that a consumer reports or Morningstar structure is what you’d need to get more objective information, and several competing bodies would provide a better spectrum of answers due to slightly differing approaches.
Joe, perhaps you or commenters could point us to good examples from other countries where this research has taken place. Are there sucesssful models that could be borrowed from elsewhere? If not, why not?