When the Sound Bite Doesn’t Tell the Full Story

Not long ago, President Obama was asked at a press conference about comparative effectiveness research (CER) and how it fits into the health care reform debate. He answered the question this way:

“If doctors and patients have the best information about what works and what doesn't, then they're going to want to pay for what works. If there's a blue pill and a red pill, and the blue pill is half the price of the red pill and works just as well, why not pay half price for the thing that's going to make you well? But the system right now doesn't incentivize that. Those are the changes that are going to be needed, that we're going to need to make inside the system.”1

I empathize with the President, who is trying to distill a complicated issue and make it understandable in a society driven by seven-second sound bites and 140-character tweets, but it doesn’t accurately reflect the complexity and science of the issue.

Let’s take a closer look. First, CER is more than simply one pill versus another pill. It encompasses comparisons among a full range of treatment options, such as drugs, medical devices, medical and surgical procedures, and diagnostics. The point of CER is to ensure that health care providers and patients have the best evidence, or information, available to them about those various treatment options. With that information in hand, the doctor and patient can discuss the best available and most appropriate treatments for the patient’s condition.

Second, by simplifying the issue, the President’s example ignores the important aspect of studying subpopulations. In testimony earlier this year, NPC urged the federal agencies charged with outlining and strategic framework and priorities for CER to take into account the needs of patient subgroups who may respond differently to therapeutic options based on demographic characteristics, genetic variation, and coexisting medical conditions. Such differences can have a big impact of the efficacy of a medicine. For example, through recent advances in pharmacogenomics, the field focused on learning how genetic profiles predict the body’s response to pharmacotherapy, researchers have been able to pre-identify patients with a high response rate to a particular therapy and low probability of an adverse drug event.

Third, the example does not take into account the potential for side effects. The blue pill might work well in some patients, but not all. Suppose the patient is allergic to blue pills, has a genetic condition that reacts poorly to the blue pills, or has any number of biological reasons for not responding well to the blue pill? Then simple cost comparisons won’t work for that patient.

Sound bites aside, it is a positive development for the president and health care stakeholders to be talking about the importance of CER in health care reform. And even more importantly, with $1.1 billion allocated for CER, the administration has been developing a framework that does deal with many of the aforementioned considerations. Now the ball is in Congress’ court to determine, through health care reform legislation, how CER will be conducted in the future.

There are few short answers to this complex debate. But it’s clear that when CER is conducted in a thoughtful manner, it can help health care providers and patients make informed decisions, thus better targeting the right treatments to the right patients. That in turn can help keep Americans healthier, improve their quality of life, and even increase productivity through fewer sick days and hospital stays.

1 Transcript: Obama’s Fifth News Conference, New York Times, July 22, 2009. http://www.nytimes.com/2009/07/22/us/politics/22obama.transcript.html, accessed September 14, 2009.