Partnership to Improve Patient Care

Agree or disagree with the recent changes to mammography guidelines by the U.S. Preventive Services Task Force (USPSTF), one thing is clear – two sets of highly qualified experts can come to very different conclusions when looking at the same evidence. This holds big implications for provisions of health care reform like comparative effectiveness research (CER).

Dr. Bernadine Healy, in a thoughtful commentary in U.S. News & World Report yesterday, underscored this point, and drew lessons for the debate over CER. “The breast-cancer screening saga points to the kind of struggles that will be rampant as comparative-effectiveness studies—whether of mammograms, testing for prostate cancer, or a new drug or procedure for heart failure -- are translated into medical decisions by Uncle Sam,” Dr. Healy said. “Most of these decisions will be clear, based on good science and a consensus of opinion, but some will struggle in the gray zone where legitimate disagreements can run hot.”

The American Cancer Society made a similar point in its statement on the new guidelines, saying, "When recommendations are based on judgments about the balance of risks and benefits, reasonable experts can look at the same data and reach different conclusions."

This underscores why it is so important to patients that we get CER right. As the mammography controversy has shown, a new CER program must include a diverse range of views and expertise, particularly from the patient and provider communities, in the management of a CER program.

It also underscores the dangers of giving a single set of experts or bureaucrats the power to issue national guidelines or coverage recommendations based on CER studies. In many instances, the experts will disagree, even when a lot of evidence is available – not to mention the times when there isn’t a lot of evidence available. In these situations, it will be easy for government experts to default to the options that are cheapest for Uncle Sam.

Only one version of reform legislation – the Senate bill (H.R. 3590) – avoids these dangers and achieves truly patient-centered CER that gives all health care stakeholders a voice at the table. The Senate bill also is the only one that ensures the program will focus on communicating results, not establishing national guidelines or coverage policies.  

Unfortunately, the House bill – H.R. 3962 – does not take this approach, and is likely to lead to many more controversies similar to the one caused by the USPSTF’s mammography recommendations.  This is not the right approach for patients.

As I’ve mentioned in many previous posts, PIPC is continuing to work to ensure that the Senate’s take on CER is included in any final health reform legislation. With the Senate’s CER language in a reform bill, patients nationwide will benefit from improved research data, and, more importantly, easy and immediate access to that important information.