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What’s Wrong with “Comparative Effectiveness Research”?


Let’s set aside the issue of whether funding for a new “comparative effectiveness research” (CER) program belongs in a “stimulus” bill. Let’s instead ask: Is CER a good idea on the merits? 
In theory, CER is intended to ensure that medical decisions are grounded, whenever possible, in empirical evidence. The government would pay researchers to collect data and conduct experiments to determine what medical procedures actually improve patient health. That seems reasonable enough: Too often, patients receive care for which there is little evidence demonstrating effectiveness. 
But CER is only going to be beneficial to our health if the research is well-executed and put to good use. This raises a new question: Who is calling the shots, cost-conscious consumers or the government? 
In the hands of consumers, new evidence on efficacy, especially if comes from many sources, can be weighed against other concerns. That’s crucial, because as Scott Gottlieb demonstrates in this excellent piece, evidence from CER will rarely be definitive enough to mandate specific judgments on treatment options. 
By contrast, government bureaucracies don’t do nuance and subtlety very well. If the federal government is in charge, the tendency will be to take single studies and use them to make decisions for the entire population. 
That’s why Betsy McCaughey was right to say in this piece that the CER funding in the “stimulus” legislation is really the first installment of Obamacare. The president and his allies in Congress believe that the federal government is up to the task of managing the health sector. 
But evidence from around the world indicates that centralized government control always leads to price controls, under-funding of institutional care, arbitrary restrictions on access to new drugs and technology, and a drying up of investment in medical innovation. That’s certainly not “stimulus,” or the kind of health-care “change” the public wants.

—James C. Capretta is a Fellow at the Ethics and Public Policy Center and a health policy and research consultant.


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