There are undoubtedly many among us who consider last month's passage of the bitterly fought and historic health-care reform legislation to be the beginning of the end. Whether you accept that or not, it can certainly be described as the end of the beginning. It will be years before the full effect of the legislation becomes clear.

One of the lesser-publicized provisions of the bill  (at least in the consumer media) that survived the legislative process may eventually have as much impact on the practice of medicine as any part of the law—the creation of a non-profit institute charged with funding and overseeing studies to determine which drugs, devices and medical procedures are most effective. Such comparative effectiveness research is seen by many as one of the keys to reining in medical costs. Even more promising is that the institute will have secure funding that will eventually top $500 million a year.

There's a lot of ground between here and the ultimate goal of having more medical decisions be based on evidence rather than habit.

David Nexon, of the device-industry group AdvaMed, told Bloomberg News, "It takes about 17 years until a new technology is fully accepted as the dominant practice even for something that's new and better." AdvaMed and PhrMA, its drug-industry counterpart, supported the legislation. "If you have something that's really superior, having these studies validate that can really speed up the adoption."

Not everyone is convinced that the institute is starting on the right footing. In a New England Journal of Medicine article, Harry Selker, MD, of Tufts University, and Alastair Wood, MD, of Weill Cornell, question the wisdom of allowing industry representatives a place on the institute's governing board, and through it, potential influence on study methodology.1 "If health care reform does not promote CER that is free of the potential taint of commercial and political meddling," say the authors, "the public will have little confidence in the results of such research."

Shouldn't a really superior product be able to stand up to independent study? I guess that's what those lobbying dollars go for.


1. N Engl J Med. 2009 Dec 31;361(27):2595-7. Epub 2009 Nov 18.