On Comparative Effectiveness Research, Why Do So Many Bloggers Get the Facts Wrong?

Here is an example of poor quality blogging on the topic of comparative effectiveness research in medicine. Dozens and perhaps hundreds of blogs have addressed this topic in the past several months, and many of them keep repeating the same simple errors.

The blog I point you to at the top of this post, for instance, misses key facts about CER, including the definition of CER. According to the Congressional Budget Office (scroll to page 3), CER is "a rigorous evaluation of the impact of different options that are available for treating a given medical condition for a particular set of patients." Other definitions taken from the  recently passed legislation (see page 1620, "PURPOSE"), the Institute of Medicine (scroll to bottom of page 1) and the now terminated Federal Coordinating Council on Comparative Effectiveness Research all point to this same idea - that CER is designed improve information about which treatments work best for which patients and under what circumstances.

Comparative effectivenes research is therefore meant to replace current practice in which summary results from clinical trials are applied to every patient, with a better practice in which patient-specific evidence from clinical research and real-world practice settings is applied to patients on a case-by-case basis.

It is clearly spelled out in every Federal document that describes the role of CER: this research is designed to make comparisons between treatments and apply the results to individuals, not to whole populations.

A second major gaffe in this blog suggests that the information will be used by some invisible hand (read: government) that stops the use of certain medical interventions. This blogger writes: "Comparative effectiveness research is the process of comparing the costs and the results of various treatments to decide whether the more expensive treatments actually yield better results. And of course if the answer is no, the more expensive treatments stop being used (for the most part)."

I'm not sure what "(for the most part)" is supposed to mean. This claim is false. It can be contrasted with the newly passed law, which actually states:

"The [CER] Institute shall ensure that the research findings ...  not be construed as mandates for practice guidelines, coverage recommendations, payment, or policy recommendations" (pages 1634-35)

and further on:

"COVERAGE.—Nothing in this section shall be construed to permit the Institute to mandate coverage, reimbursement, or other policies for any public or private payer" (pages 1647-48)

and still further on:

"The Secretary shall not use evidence or findings from comparative clinical effectiveness research conducted under section 1181 in determining coverage, reimbursement, or incentive programs under title XVIII in a manner that treats extending the life of an elderly, disabled, or terminally ill individual as of lower value than extending the life of an individual who is younger, nondisabled, or not terminally ill.” (pages 1652-53)‏

So, why do so many bloggers get the facts wrong on CER?  I'm pretty sure they are taking shortcuts. I'm sure it is easier to work from political talking points than to obtain verifiable source material and report on it. In the case of comparative effectiveness research, the source material is available and verifiable, but it is buried under a mountain of low quality blogging.