By Ruth Faden and Jonathan D. Moreno, It’s a name only a policy wonk could love: comparative effectiveness research. But get ready to hear a lot about it; it could save your rights as a patient – and maybe even your life.
If opponents have their way, it could be the bogeyman that brings down health care reform.
Using false and misleading scare tactics, Conservatives for Patients Rights, a group opposed to comprehensive health care reform, announced last week a $1 million ad attacking comparative effectiveness.
However, an emerging consensus of strange bedfellows – from insurance companies to the Institute of Medicine to patients rights advocates – all support making a national investment in research to compare the effectiveness of drugs, devices and diagnostic procedures, and sharing the information that results with physicians and patients. The enthusiasm for comparative effectiveness research is also strong in the Obama administration and among health care leaders in Congress.
Comparative effectiveness research could have a profound, positive effect on how medical decisions are made. Currently, there are three main drivers in medical decision-making: advertising and promotion by drug and device companies; coverage decisions by insurance companies; and medical science and experience. The first two, as we all know, can work against the interests of patients. They are supposed to be balanced by the third driver – medical science and experience. The problem is that, for many important medical decisions, there is no medical evidence about which treatments or which diagnostic tests work best for which patients.
In those cases, because doctors and patients lack objective facts about what’s best, they often can’t challenge the other two powerful forces.
For instance, what kinds of patients with low back pain require back surgery and which recover with physical therapy alone? Which of the many drugs for high cholesterol or osteoporosis are best for whom? Definite answers to these questions could make a huge difference in peoples’ lives. For example, a recent comparative effectiveness study found that patients with multi-vessel coronary artery disease who had stents implanted did much better with blood flow tests and angiography than with angiography alone.
Comparative effectiveness would allow patients and doctors to make decisions together based on the best possible scientific evidence, giving patients real choices based on solid information. An uninformed choice is like no choice at all.
It would also improve the quality of the medical care that patients receive, not only by identifying what works best but also by identifying what doesn’t work at all – and even more importantly, what causes more harm than good. So comparing treatment effectiveness helps physicians to honor another moral value at the heart of medicine, along with that of informed choice: do no harm.
Critics charge that comparative effectiveness research will lead to “one-size-fits-all” guidelines that cater to a non-existent average patient for the sake of making the system more efficient. In fact, patients will be empowered by rigorous, evidence-based recommendations that are specific to the needs of particular patient groups. Research on comparative effectiveness would provide data to help each patient make the best possible choice with his or her doctor.
Patients want the right to make decisions with their doctors in order to pursue what is in their own best interests. Choosing blindly is an empty right; choosing with evidence respects patients’ rights and enhances quality. This is a case in which good ethics demands good facts.
Professor Ruth R. Faden is director of the Johns Hopkins Berman Institute of Bioethics at the Johns Hopkins Bloomberg School of Public Health. Jonathan D. Moreno is a professor of ethics and medical ethics at the
