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Observations Yankee Doodling

How to waste a billion dollars

BMJ 2009; 338 doi: (Published 15 June 2009) Cite this as: BMJ 2009;338:b2432
  1. Douglas Kamerow, chief scientist, RTI International, and associate editor, BMJ
  1. dkamerow{at}

    The currently fashionable “comparative effectiveness research” risks ineffectiveness if industry opposition to it succeeds

    Comparative effectiveness research (CER) is all the rage in the United States right now. It seems that everywhere you turn a conference or meeting or briefing on CER is being conducted. I knew it had got ridiculous when I saw an advertisement (and a website) for an upcoming “national summit” on CER sponsored by a for-profit medical conference company, “featuring a comparative effectiveness boot camp.” (Let’s see now, calculating quality adjusted life years while wearing olive drab fatigues?) I am not making this up.

    The term “comparative effectiveness research” seems to be a relatively recent US coinage, but the concept has been around for ever. It is usually called technology assessment. The idea is to figure out which drug, device, treatment, or diagnostic test works best for a given condition in a given population. And you do that by comparing active interventions with each other, not with placebos, to produce conclusions that are useful in real world settings.

    We have well documented geographical variation in care in the …

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