The drumbeats have been pounding the message loud and clear.

America needs evidence on which to base our medical care treatment decisions—-rigorous studies of all treatments available to assess which ones really work and which ones don’t.

What doctors don’t have enough of is the evidence.

The Institute of Medicine has just issued a list of 100 priorities for evidence-based research, an impressive piece of work, which could benefit the nation.

The Institute of Medicine is part of the National Academy of Sciences. The IOM does not have any regulatory authority but it is highly influential among government officials, academic researchers and other interest groups who advocate for patients.

This list includes a broad range of broad projects, divided into four quartiles. Within those four, however, the placement of a topic on the list is not intended to be a ranking. The IOM report considers all topics in a quartile equally important.

Many IOM reports, valuable as they are, recommend the ideal, not unlike the Harvard Business Review for corporations. To those down in the trenches of health care, these recommendations may seem, at times, to come from the academic ivory tower.  (”It would be great if this happened, but…how?”)

This is not going to be that kind of report.

There may be disagreements, as there always are in health care, about the priority given a research topic. (”My research is far, far, far more important than yours.”) For example, the assessment of hearing treatments in children and adults is in the first grouping. No one who has watched another person struggle to hear could quarrel with its importance as a research topic. These patients need all of the help they can get. On the other hand, in the second grouping, a topic focuses on how to get patients to take medicines properly. That affects everyone who swallows a pill. The IOM does nothing casually. The authors of the report had good reasons for their groupings. This is an example, however, of how people will debate what is in which grouping, which misses the point. They are all important.

No reasonable person could look at this list of 100 priorities and say that that research topic would not be extremely valuable to patients and to those who pay for care—-which includes patients, again.

The story below mentions some nervousness about this kind of research being used as a tool to advance treatment decisions based only on price. This does not appear to be justified, based on the IOM’s mission. The IOM  would surely violate its commitment to rigorous research—–which takes researchers wherever it takes them.  If an approach saves money, to be sure, researchers likely will report that, but that is not their purpose. It is their purpose to find out which treatments do the most good for the most people and why.

Other activities on the evidence-based medicine front continue.  The Agency for Health Care Research and Quality also does this kind of research, but the topics for which work has been completed totals nine, for example.

Other, on-going studies from all medical specialties may compare effectiveness of treatments, but these studies usually are more narrowly than the IOM’s list of topics. In cardiology, there is a continuing examination of which treatments work and why, for instance.

You never know who will benefit from these studies but, in the end, everyone does.

Kaiser Health News

“An Institute of Medicine panel released a list of 100 priorities for comparing the effectiveness of medical treatments as part of a $1.1 billion, stimulus-funded research program on Tuesday, the Associated Press reports. The recommendations – which are not official, but will likely influence government decisions – include comparing treatments for atrial fibrillation, an irregular heartbeat, prostate cancer, age-related hearing loss, attention deficit hyperactivity disorder and lower back pain. Also, the panel suggested comparing strategies for reducing hospital-acquired infections and unwanted pregnancies (Neergaard, 6/30).

“The report is one of the first concrete steps in a broad effort by administration officials and health experts to shift the focus of medical practice toward scientific evidence — rather than a physician’s personal views or treatments promoted by medical product companies,” the New York Times reports. “Supporters of comparative effectiveness reviews include many medical researchers, consumer groups, unions and insurers. They say such studies are essential to curbing the widespread use of ineffective treatments and to helping control health care costs, which totaled $2.2 trillion in 2007, or 16 percent of the nation’s gross domestic product.” Meanwhile, a co-chairman of the panel said the response of medical product companies, often among the critics of this form of research, was “muted.” (Meier, 6/30).  (Emphasis added)

“In addition, patient rights groups have said the research could limit their choices. “Some worry that comparative research will ultimately lead to treatment decisions based on price. In the U.K., the National Institute for Health and Clinical Excellence has denied rheumatoid arthritis patients access to Bristol-Myers Squibb’s Orencia because the health-care agency decided it was too costly,” the Wall Street Journal reports. “Proponents say that isn’t the plan in the U.S.” (Yao, 6/30).  (Emphasis added)

“The recommendations do, however, target specific drugs in some cases, such as a type of arthritis drug produced by major pharmaceutical makers. Bloomberg reports, “studies should compare the effectiveness of the drugs, including Remicade from J&J, and Enbrel, marketed by Wyeth and Amgen, in a family of medicines linked to cancer.” (Rapaport, 7/1).

Source: Kaiser Health News, June 1, 2009

Sources Quoted: Associated Press, June 30, 2009; New York Times, June 30, 2009; Wall Street Journal, June 30, 2009; and Bloomberg News, July 1, 2009