Who's going to determine the research plan for the three agencies now involved in comparative effectiveness research? The drug industry wants a seat at the table, and, according to the Wall Street Journal, has launched a new patient advocacy group to ensure that it has one. The Partnership to Improve Patient Care, launched by former Congressman Tony Coelho with Pharmaceutical Research and Manufacturers Association funding, is backing a bill by Rep. Kurt Schrader (D-OR) that would give "health-care providers, physicians and industry" a say over what research gets done. Coelho told reporters that "patients and doctors should make treatment decisions" and "quality, rather than cost, should be the key factor."

Governance matters. Giving special interest groups a veto-power over what comparative research gets done will create a politicized environment where the agencies sponsoring the research will never get actionable information on critical questions. Is this generic in an older class just as good as the three brand name drugs in a new class? Put PhRMA at the table, and the research agency's response might be: "don't ask, don't tell."