Partnership to Improve Patient Care

A recent op-ed in the Wall Street Journal by Dr. Leonard Zwelling, illustrates why treatment decisions must stay between a patient and their doctor and reinforces the importance of the comparative effectiveness research (CER) language included in the recently passed Patient Protection and Affordable Care Act.

Zwelling, an oncologist, explains the challenges of using CER to set rigid national policy requirements. He highlights how cancer care is continually evolving in that it allows doctors to better address the individual needs of cancer patients whose bodies react to their forms of cancers in different ways than those of other patients:

“Cancers that present in a similar fashion clinically and appear identical under the microscope may vary significantly in how they actually express cancer-related genes. These genetic differences alter both the patient's prognosis and the doctor's choice of the most effective therapy. Lung, colon and breast cancer treatments are already altered by such molecular findings, and it is likely that someday all cancers will undergo molecular analysis prior to the selection of appropriate treatments. This is what oncologists mean when they refer to ’personalized medicine’."

The “personalized medicine” that Dr. Zwelling discusses would be stymied by blunt, one-size-fits-all approaches to CER. Or, as Dr. Zwelling puts it:

“If decisions based on CER inhibit the progress of personalized medicine—or in any way interfere with a meaningful interaction between doctor and patient to individually tailor the most appropriate therapy—no one is helped.”

Fortunately, the CER provisions in the health reform law require the research to recognize patient differences, and include specific references to genetic differences in patients. If these provisions are implemented well -- and if policy-makers resist the temptation to use them in one-size-fits-all policies to cut costs -- CER can improve patient care and advance personalized medicine.