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Finding What Works in Health Care

By William C. Weldon
Thursday, July 2, 2009

Congress took an important step for health care when it provided $1.1 billion to fund "comparative effectiveness research" as part of the stimulus legislation this year.

This research promises to help America's doctors better target treatments to patients who can benefit from them as well as cut unnecessary health-care spending. It's also good that lawmakers recognized that research comparing one therapy to another should take into account that patients respond to treatments differently.

As Congress begins to enact health-care reforms, advancing understanding of which treatments work for which patients is critical. To that end, Congress should move swiftly to make our stimulus investment sustainable with a permanent comparative effectiveness institute.

Many patient groups, physicians and developers of treatments fear that comparative effectiveness research will be used to restrict access to a broad range of treatments, some of which may be precisely what particular patients need. As the head of Johnson & Johnson, a global pharmaceutical and device company, I have seen technology assessments make it more difficult for patients to access some lifesaving treatments.

But that doesn't have to be what happens here. By carefully allotting the stimulus funding, the federal government can lay the groundwork for how a permanent institute devoted to comparing treatments could work.

Achieving this goal involves addressing the concerns of those who worry about the impact of this research on access to treatment. What's needed is a public-private entity focused on improving the evidence for treating individual patients. The institute should have open, transparent processes and consider the input of patients, consumers, physicians and other providers. It should focus on clinical effectiveness, not cost effectiveness.

Because government funding is likely to be scarce, life-science companies should be encouraged to be part of the effort. Tapping into the considerable expertise of their researchers could also dramatically increase the number and quality of studies.

Of course, comparative effectiveness research is not a silver bullet. It won't address all the drivers of health-care costs. Undiagnosed or unmanaged chronic conditions, too little focus on prevention and wellness, inefficient processes and reimbursement that rewards volume, not outcomes, also push up our rising medical expenses.

Yet comparative effectiveness research is essential to improving the value of health care. The nonprofit Institute of Medicine released a report on initial national priorities yesterday, laying out 100 research topics that it suggested policymakers consult as they determine how to spend on comparing the effectiveness of various health services. As we consider these ideas and other issues, such as those being raised before the Federal Coordinating Council for Comparative Effectiveness Research, we must also consider how best to sustain health-care innovation that will serve tomorrow's patients.

We stand at an important crossroads in health-care reform. We must reduce costs, but in a way that does not harm the care of individual patients. A well-designed public-private comparative effectiveness institute, supported with sustainable funding and broad input, is essential for real reform. It's within our reach this year. Congress should not let this opportunity slip by.

The writer is chairman and chief executive officer of Johnson & Johnson.

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