• Known unknowns in comparative effectiveness

    Stuff like the following no longer shocks me, but it really should. It just seems like we ought to know more about comparative effectiveness (CE) studies given what we spend on health care and how important it is. Patrick Conway and Carolyn Clancy wrote in JAMA (March 2010):

    The Institute of Medicine (IOM) committee commissioned by the US Congress to identify priorities for CE research relied on broad stakeholder input and expert judgment regarding important clinical topics, but had no clear inventory of published studies or research in progress to inform their deliberations. [Emphasis added.]

    Yikes! Can we at least establish such an inventory?

    The short-term goal should be that an inventory […] be readily accessible by researchers, clinicians, patients, and others. The US Department of Health and Human Services will establish such an inventory and it will be essential for a CE research inventory to build on current mechanisms to capture studies (eg, tagging of published results via PubMed). The inventory also will need to be a dynamic system that allows for entities and individuals to contribute CE research findings and these studies should be vetted for inclusion and categorized. In addition, the inventory must include both private sector and non–private sector CE research and therefore incentives for participation will be critical. In addition, an effective inventory should include categorization of studies and searching mechanisms so clinicians and patients can locate summaries of evidence and studies of interest. [Emphasis added.]

    What’s the state of this inventory-building goal? Anything happening? As important as it is, it actually sounds rather hard. Who will do the vetting? How do you get researchers to submit? It’s tempting to say this is a perfect candidate for a wiki-like project, but I’m not sure very many academics and subject-matter experts will want to spend their time working on it, uncompensated.

    Putting effort into this type of thing ought to be rewarded, if not in dollars than in recognition that is valuable for promotion. We get too little value out of research as it is, and far less return for our investment in it and in health care. If you’re like me, you’re shaking your head at the sorry state of things and thinking, “We must do better!” But, I, like you, will turn my attention to the next thing on my to-do list after I write these words. See how easy it is to ignore what should be very important? I don’t blame you. But you’ll do it because it is not your job. Watch yourself as you do it right now. Me too!

    AF

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