â€¢ My opening question to the panel was whether or not comparative effectiveness (aka evidence-based medicine, aka healthcare technology assessment, aka rational use of medicine) was focusing on cost rather than care. Practice variation vs. patient variation.
â€¢Carolyn Clancy (Director of AHRQ) remarked that we need to capture clinical data from off-label prescribing.
â€¢ Scott Gottlieb pointed out that the value of studying Avastin vs. Erbitux or Actos vs. Januvia is of no value â€“ but that studying Avastin+ Erbitux and Actos + Januvia would yield important clinical information.
In short â€“ if you donâ€™t ask the right questions, you wonâ€™t necessarily get the wrong answers â€“ but you wonâ€™t get the answers that will help improve patient care on the clinical level.
There was much conversation about the relative benefits of RCTs vs real life epidemiological data (like off-label prescribing outcomes). Look at it this way â€“ consider each separate pieces of software designed for different purposes. Both are relevant to any discussion of comparative effectiveness â€“ but only one â€œsoftwareâ€ is used â€“ RCTs (by DERP, Consumers Union, etc.). We need to design a software interface that will allow these two data sets to â€œtalkâ€ with each other.
The time for puritanical allegiance to RCTs is coming to an end.
Panelists were also brutally honest when it came to the question of cost-over-care, the new health care realpolitk, agreeing that when it comes to Washington, DC â€“ cost containment will win out over patient care every time.
Unfortunately I agree â€“ thatâ€™s the way it is right now. But that has to change. As John Bridges (Johns Hopkins Bloomberg School of Public Health) commented, â€œThere is no health care without the patient.â€
When it comes to changing the short term, politically-driven cost-over-care debate to a long term, patient-focused right-care-for-the-right-patient at-the-right-time paradigm, yesterdayâ€™s debate wasnâ€™t the end, or even the beginning of the end but, hopefully, the end of the beginning.
And, when that day comes, it will indeed be health care's finest hour.