Comparative Effectiveness Research: Evidence, Medicine, and Policy

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For all its costs, flaws, and inequities, American health care is fundamentally rooted in a belief that treatment should be based on solid scientific research. To this end, between 2003 and 2010, three different federal laws were enacted, the most recent being the Affordable Care Act of 2010, that mandated new federal investments in a type of clinical research called comparative effectiveness research (CER) -- research into what works best in medical care. Comparative Effectiveness Research: Evidence, Medicine, and Policy provides the first complete account of how -- and why -- the federal government decided to make CER an important feature of health reform. Despite earlier legislative uptake of policy proposals on CER, support for federal mandates took dramatic twists and turns, with eventual compromises forged amid failing bipartisan alliances, special interests, and mobilized public opinion. Based on exhaustive research and first-hand interviews, the authors examine where CER fits in the production of scientific evidence about the benefits and harms of treatments for human diseases and conditions. Their work offers sobering confirmation that contemporary American medical care falls, not surprisingly, well short of the evidence-based ideal. Comparative Effectiveness Research demonstrates that dealing constructively with the vast uncertainties inherent to medical care requires policies to make the generation of high-quality evidence an inseparable part of routine health care.

Comparative Effectiveness Research: Evidence, Medicine, and Policy Review

With everyone talking about the quality and cost of health care in America, this book is a must-read. Not only is it written by two doctors who know the system intimately well, but it's also thoroughly researched from all angles. "Comparative Effectiveness Research" covers the role of government policies, drug and device manufacturers, insurers, politicians, patients, and physicians in shaping our current health care environment. The authors spent more than 3 years gathering information, and it shows -- I learned some surprising details, like the fact that less than 1% of "approved" medical devices were required to show their safety or effectiveness in human studies (Chapter 2, The Use of Evidence). I was also surprised to learn about the convoluted and often biased way that legislation is crafted in congress. If you've ever wondered about what really goes on behind closed doors, or what those 2,000-page legislative bills really contain (and why), I highly recommend this book!

Overall, Comparative Effectiveness Research looks at how we gather and use medical evidence, and how we can improve the current system. Everyone could benefit from the insights that Ashton and Wray provide, either in making their own treatment decisions or in taking a critical eye to ongoing healthcare reforms.

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