Thursday, March 11, 2010

Comparative effectiveness

Comparative effectiveness research (CER) is the latest buzzword in my field, in large part because Obama has promoted it as an important component of healthcare reform and included $1 billion of funding for it in the stimulus bill. This Reuters article discusses a new study by Hochman  and McCormick finding that only 32% of drug studies published in top medical journals compare the effectiveness of existing treatments. Most of the time, studies compare the new drug to placebo because that's what the FDA requires. In other countries, such as the UK, health technology assessments are required that compare the new drug to the standard of care.

The study is published in this week's issue of JAMA - here's a link to the abstract.

Couple of thoughts:
  • They only looked at articles in the six top-ranked general medicine and internal medicine journals. If I were going to try to publish a comparative effectiveness study, I would think it probably wouldn't get in to a top-ranked general journal (JAMA, NEJM, etc.), so I'd probably target it to a specialty journal. 
  • Pharma company-sponsored research often seems to be less favorably reviewed than academia-sponsored research, plus companies are often in a hurry and don't want to go through the excruciatingly long review processes at the top journals.
  • They point out the lack of cost-effectiveness (CE) studies. Again, if I were going to try to publish a CE study, JAMA and NEJM would be my last choice for a target journal unless I thought I had a real blockbuster... they just don't publish many CE studies.
In short, I think this study is majorly confounded by the conventions of the medical publishing world.

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