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Stakeholders weigh in on comparative effectiveness research

Patient advocates, researchers, medical insurers, and clinicians had no shortage of advice today for the Patient-Centered Outcomes Research Institute (PCORI) — an organization created by the 2010 US health-care reform act to spur research on the effectiveness of clinical therapies and services (see Opponents battle health care research).

At a public hearing held at the National Press Club in Washington DC, the PCORI’s Board of Governors took comments on the draft of the institute’s research agenda, released last month. That document, which is open for public comment until 15 March, carved out five areas of focus including the assessment of prevention and treatment options, and efforts to eradicate health-care disparities among patient populations. But the research agenda was sparse on detail, leaving plenty of room for the public to weigh in before May, when the PCORI is expected to release a presumably more-specific call for grant applications.

Today the PCORI gathered recommendations spanning the gamut from broad topics, such as research into improving access to health care, to specific health-care needs, such as tackling schizophrenia and the conditions that often accompany it.  Several participants urged the PCORI to prioritize studies of treatments for common, high-cost conditions, such as heart failure or stroke, and prevention efforts to fight obesity and sedentary lifestyles. These approaches, they said, would allow the PCORI to quickly make a large impact on the nation’s health-care system.

But Otis Brawley, chief medical officer of the American Cancer Society, based in Atlanta, Georgia, cautioned that the PCORI’s biggest challenge would probably be to persuade patients and physicians to accept the results of its studies. Brawley gave a series of recent examples in which patients and physicians rejected scientific evidence when it ran counter to present practice, including the angry reaction when a panel of physicians recently determined that a form of prostate-cancer screening does more harm than good for many patients (see The PSA position).

The present health-care system isn’t rational, he said, and is addled by a poor understanding of the scientific process. As a result, the PCORI will need to maintain its focus on public relations. “Those of us in medicine tend to confuse what we believe with what we know,” he said. “The problem for PCORI is getting people to believe the scientific findings that you come up with.”

Image:  takacsi75 via Flickr

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