On July 31, 2008, Senators Max Baucus (D, Mont) and Kent Conrad (D, ND) introduced the Comparative Effectiveness (CE) Research Act of 2008. The bill authorizes the establishment of a private, nonprofit corporation to be known as the Health Care Comparative Effectiveness Research Institute which will aim “to improve health care in the U.S. by advancing evidence concerning the manner in which diseases, disorders, and other health conditions can best be prevented, diagnosed, treated, and managed through research, evidence synthesis, and dissemination of findings, with respect to relative outcomes, effectiveness, and appropriateness of health care strategies.” (Full text: S 3408)

In the stimulus package, $1.1 billion has been set aside for supporting CE research. Proponents of CE believe that it has the potential to reduce healthcare costs while improving quality of care by discouraging practices that are deemed too expensive or ineffective, especially where cheaper alternative exist. The critics warn that such research may result in a one-treatment-fits-all strategy, making the government an intrusive third party in the medical decision making process. Some also fear that insurance companies will abuse the data to deny appropriate care to patients.

Both sides have valid arguments.

Thomas Sydenham (1624 – 1689), the father of English Medicine, pioneered the concept of separating the disease from the patient. Prior to that, doctors focused mostly on addressing symptoms. Sydenham recognized that the disease process behaves almost the same in most individuals and that the “phenomenon that you would observe in the sickness of a Socrates you would observe in the sickness of a simpleton.”

The separation of the disease from the person made treating it more uniform and rational but it also caused physicians to start speaking a different language from patients. Symptoms of a disease (headache, runny nose) are easy to relate to and  understand. On the other hand, characterizing a disease (subarachnoid hemorrhage, allergic rhinitis) is in the domain of the scientist physician.

The art of medicine is most visible when physicians attempt to bridge the gap between scientific facts and individual human needs. The outcomes of CE research may widen this gap as the focus shifts more towards aggregated evidence and farther from patients’ individual needs and preference.

The scientist-artist duality seems to be an enduring reality for the modern physician.

Filed under: Health Policy