What Works Best?

I have already blogged a time or two about the concept of Comparative Effectiveness Research, which is abbreviated in the press as CER. This is research that compares medical treatments in an effort to determine which one works best and causes the least problems. I support this and am pleased that over a billion dollars has been included in the US stimulus package that was signed this passed February for these studies. I understand that what hasn't been addressed is how to deal with any issues related to cost of treatment by comparison. People fear that less effective treatments will be chosen because they are cheaper. I do not have this fear myself.

I am mentioning CER again today because there was a nice article in the New England Journal of Medicine on Wednesday related to it. It was written by K. Volpp and A. Das. It was a brief piece but the content was important and I dare say, I wish I had been the one to bring it up.

The authors note that over thirty percent of deaths in the country that are premature, are related to the behaviors that we adopt or choose. Our causes of death are related to things that we do or do not do, not something that happens TO US. Because that statement is true, I changed my career from social work to public health. I want us to get in front of the adverse outcomes because conditions like diabetes and heart disease are far easier, safer and cheaper to prevent then they are to treat.

Volpp and Das support CER and note that almost everyone does agree that the information will help the patient and the physician make better treatment decisions. What they add is that the research should not only compare medicines but also behavioral interventions. If, they say for example, an intervention leads to long lasting weight loss it can save a significant amount of money. I agree. Weight loss could prevent the need for medications, surgery, and assisted living and preserve disability dollars and the work force.

So the authors suggest that these types of interventions be included in the research. They gave an example of smoking cessation where the quitters were given incentives to quit, money. They compared those outcomes to outcomes from cessation medication. The range of success had the intervention at its lowest equal to stop smoking medicine Zyban and at its highest it was almost doubly effective. They point out also that the people given meds, whether NRT or non NRT, often relapse where the ones given the money at the end of the program did not. In other words, the expensive medications did not produce the outcome desired and the monetary payment wasn't given until after the outcome was achieved.

I agree that people's behaviors are key causes and key cures.. now.. where is the money for the education and systems change that will allow us to address it?

http://healthcarereform.nejm.org/?p=1004#printpreview