Reading About Comparative Effectiveness

Public service organizations that have an interest in health care are paying more attention to comparative effectiveness research. Some are even starting to put out publications that serve as good starting points for learning about comparative effectiveness. Fortunately, these publications generally are available online. For example, the US Chamber of Commerce published a "toolkit" on comparative effectiveness last winter. Their toolkit has a readable and concise background section and also includes links to several resources on comparative effectiveness. I recommend it, because it gives some good examples about how comparative effectiveness information can be applied to real decisions made by clinicians and patients. It is available here:

http://www.uschamber.com/NR/rdonlyres/enmanvvbpdock5hjkiqldpr57jja4e5hhy35xkoyyzuvj23xaeqky3gqnkco4cpjenzwh7eg5hfboskrf2fg3jsmdwe/HealthCareComparativeEffectivenessToolKit.pdf

The Friends of Cancer Research (FOCR) is an advocacy organization that lobbies for increased federal funding for cancer research. It recently released a booklet on comparative effectiveness:

http://focr.org/files/CER_REPORT_FINAL.pdf

This publication places emphasis on an issue that frequently comes up (and is often responsible for skepticism by clinicians about comparative effectiveness). The issue is that there is substantial individual variation among people with a particular disease. By this viewpoint, clinicians need to consider carefully each patient's characteristics and individualize treatment for that person. Because comparative effectiveness measures the "average" response to comparative treatments, some may argue that it does not account for this patient variation. To its credit, the FOCR publication argues gives a few examples about research that provides insight into the sources of patient variation. The FOCR booklet argues that the spectrum of comparative effectiveness research needs to include studies that aim to discover the important patient factors that affect response to a treatment. I think this is a very reasonable point of view. In any case, though, be careful about throwing out the baby with the bathwater. It is not appropriate to dismiss the findings of comparative effectiveness research altogether, just because that research may still be limited in elucidating the sources of patient variation.