The effort to strangle comparative effectiveness research in its cradle gets a timely rebuff in today's New England Journal of Medicine. Political efforts to either remove the $1.1 billion for CER from the stimulus package (Rush Limbaugh) or limit its use (a letter from industry-supported patient advocacy groups insisting on restrictive language in the bill) were addressed by Jerome Avorn of Harvard Medical School. He notes: 

At 1/20 of 1% of our $2 trillion annual health care expenditure, the CER funding amounts to a fraction of what any corporation would spend to find out whether it was getting its money's worth from its purchases. It represents one of the best investments we can make to edge the health care system away from the fiscal catastrophe it faces, since such studies will help to reduce spending on poorer clinical decisions and to spare resources for expenditures that will help patients most (and most affordably). This research is a public good, like highways and clean air. The private sector is no more likely to identify badly mispriced or potentially toxic treatments than it was to spot badly mispriced or potentially toxic products of the banking industry.

One of the chief arguments against CER -- that it creates "one-size-fits-all" medicine and will undermine nascent efforts to create more "personalized medicine" is skewered by Alan Garber of Stanford and Sean Tunis of the Center for Medical Technology Policy. In fact, CER properly conducted will promote faster adoption of personalized care, they write:

The very name "personalized medicine" suggests an approach to care that is based on individuals rather than groups. The term has been used to describe the consideration of characteristics such as age, coexisting conditions, preferences, and beliefs in crafting an individual management strategy; the use of advanced individual genomic information in choosing an expensive biologic agent; and the development of therapies biologically tailored to patient needs, such as customized monoclonal antibodies and vaccines. But far from impeding personalized medicine, CER offers a way to hasten the discovery of the best approaches to personalization, providing more and better information with which to craft a management strategy for each individual patient.

Looking beyond the political debate, another article argues that the time has come to develop effective strategies for making use of the CER that will be generated over the next few years. Aanand D. Naik and Laura A. Petersen, who are associated with the government-financed John M. Eisenberg Clinical Decisions and Communications Science Center at the Baylor College of Medicine, write:   

The creation of a CER initiative focused on developing and disseminating effectiveness reviews is an essential, but not a sufficient, step toward the routine provision of safe, high-quality health care to all Americans. We also need evidence-based methods for discovering and describing how the findings of clinical trials and CER can be efficiently implemented and incorporated into routine practice. Harnessing the promise of CER by ensuring the efficient and effective implementation of its findings into practice requires substantial investment and planning that will involve health care providers, patients, and other local stakeholders.

The Agency for Healthcare Quality and Research last year earmarked about $7 million over two years to Baylor's Eisenberg Center to develop effective ways for disseminating the results of CER. It will be interesting to see what they come up with. Will the most effective dissemination be through organized medicine and its professional societies? Through translation into clinical practice guidelines? Through patient advocacy and consumer groups? All of the above?

Whatever the answer (the authors call for making dissemination efforts evidence based), development and implementation of a dissemination strategy ought to be part of every grant given out under the $1.1 million CER program. The last thing most Americans (not the know-nothings who listen to Rush Limbaugh) want from this wise use of taxpayer funds is more published research gathering dust on library shelves.