The rising cost of health care in the United States has led policy-makers and researchers to call for more evidence-based medical practices. The recently enacted American Recovery and Reinvestment Act of 2009 commits $1.1 billion to increase efforts in collecting information of comparative clinical effectiveness—a rigorous evaluation of the impact of different treatment options for a particular set of patients. There have been intense disagreements, however, among key players as to what comparative effectiveness research means and how to pay for it. This article explores those disagreements, asking not only what comparative effectiveness research is, but also how it should be paid for and managed.
Internal medicine with its long history of leadership in evidence-based practice has much to contribute to the debate.
Because of the intense and combative nature of the debate with its variety of stakeholders, including physicians, drug companies, medical equipment manufacturers and others, the authors suggest an independent multi-stakeholder process with a prominent role for clinicians and patient advocates to identify the clinical questions that most Americans want answered. They also recommend a dedicated trust fund to support the work that is immune from political influence.