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Show Me the Evidence: Comparative effectiveness research could aid treatment decisions

by Geri Aston •

Involvement in a clinical research network, such as Creating Healthcare Excellence through Education and Research (CHEER), is one way otolaryngologists could prepare for and participate in comparative effectiveness research, said Dr. Witsell, principle investigator of the National Institutes of Health-funded CHEER grant. The network focuses on practice-based clinical research in hearing and communicative sciences.

Some critics argue that comparative effectiveness findings will cause access trouble for groups of patients for whom the best treatment is typically less effective in the general public. The opposite is the case, Dr. Conway said. The goal is to include patient subgroups in studies and present differences in treatment effectiveness between patient populations in the findings, he said. The House and Senate health reform bills mandate that the research take into account patient subpopulations and communicate effectiveness differences in the findings.

“A treatment that works well for a small group of patients with identified characteristics would still be seen as an effective option,” Dr. Witsell said.

Alphabet Soup: The IOM

The Institute of Medicine (IOM) is an independent, nonprofit organization that works outside of government to provide “unbiased and authoritative advice” to policymakers and the public. Established in 1970, the IOM is an arm of the National Academy of Sciences, a nongovernmental advisory body established by congressional charter in 1863.

The IOM issues studies, many of which are mandates from Congress. Others are requested by federal agencies and independent organizations. Studies are conducted by committees made of experts with a variety of perspectives on the issue at hand.

Each committee’s task is developed in collaboration with the study’s sponsor. Once the task and budget are finalized, the panel works independently to come to consensus on the questions raised. All reports undergo review by a second, independent group of experts whose comments are provided anonymously to committee members.

Cookbook Medicine?

Some critics claim that comparative effectiveness research will lead to “cookbook” medicine or rationing of expensive care, notes a June 2009 letter to the Senate signed by 62 medical associations, including the AAO-HNS. “That is not its purpose,” the letter reads. “Its purpose is to help physicians and patients make smart choices based on the clinical value of varying treatments and interventions, the unique needs and preferences of individual patients and our societal commitment to reduce disparities in care.”

Controversy sparked in November 2009 by changes in U.S. Preventive Services Task Force recommendations regarding screening mammograms offers a cautionary tale for comparative effectiveness research. The task force dropped its recommendation of regular mammograms for women under 50 and stated that, for this group, the decision to begin regular screenings “should be an individual one and take patient context into account.” The shift caused an uproar among conservative political circles and some advocacy groups.