Oregon Public Broadcasting

In two weeks, Congress will be back in session, and working on pending health care bills. Some Oregon representatives have been involved in a proposal that hasn’t made headlines, but that might bring substantial  change. April Baer reports.

Comparative Effectiveness Research.  Pretty clunky name,right? But it isn’t really hard to understand.

It’s research that helps doctors wade through the ocean of clinical studies out there, narrowing down which treatments are proven most effective, and which haven’t been well-explored.  

Sean Jones is a primary care doctor with Kaiser Permanente in Portland.

Sean Jones “So I usually get five to eight emails from patients. Let’s see what I got today”

This afternoon, one longtime patient has a question. He’s in his seventies, in reasonably good health, except for high cholesterol. Dr. Jones and the patient tried to control the problem with diet and exercise, but some recent tests don’t look  good.

Sean Jones  “And so he wrote back and asked if we had a particular drug called Vytorin.”

Maybe the patient heard about the drug from a friend, or  saw one of the commercials aimed at people in his age group.

Dr. Jones knows about the drug through Kaiser’s CER-- or comparative effectiveness research  on the subject. Vytorin, he explains, is a combination of statin and other medicines.

Sean Jones “There’s evidence that that combination does more effectively lower your blood leve of cholestrol, however  there’ s no evidence that lowers risk of serious complications of heart attack or stroke.”

Dr. Jones isn’t telling the patient he can’t have Vytorin. But he is able to offer what he considers better advice than if he relied on drug company data alone.

Sean Jones “So I’m going to explain to him, that Vytorin is a combination drug, one half of which we know a great deal about, the  other half is relatively unknown.”

This process, which happens every day at Kaiser, is something medical experts would like to graft onto the American Health care system.

Kurt Schrader   “What could be more important than having good information about your health care options?”

Oregon Congressman Kurt Schrader has written an amendment to the House health care bill that calls for the creation of a new national non-profit Comparative Effectiveness Research institute, with a board of governors to collect available research, and make it  digestible

Kurt Schrader:  “Good information you know has been peer-reviewed, not just some glossy advertisement for a product.”

Schrader says  it’s in everybody’s interests to get the right treatments prescribed the first time. That could help contain health care costs, and it's good for health care effectiveness.

Schrader’s amendment is one of many fighting for a place in the House health care bill. It might be subject to change, but even opponents think it’s going to end up in the final version one way or the other.

Tony Coelho   “What we’re talking about is who’s at the table in the decision-making process.”

Former Congressman Tony Coehlo now works for the Partnership for Patient Care. It’s funded by the Pharmaceutical Research and Manufacturers of America. The pharmaceutical group  declined to comment for this story, but referred us to Coelho, who  has guarded praise for the amendment.

Tony Coelho   “Right now, a lot of this research is written up in a way that doctors, nurses, and even we patients can’t even understand.”

His also says drug makers deserve to be involved, too. Schrader’s bill does propose three seats on the institute’s board for patient groups and another three seats for pharmaceutical makers, along with government reps, non-profits, and doctors.

If all this is starting to sound familiar, it should. Oregon has been home to some comparative effectiveness studies, most famously for the  painkiller  drug Vioxx, that were way ahead of their time. 

And the state pioneered the practice of using Comparative Effectiveness Research. to guide drug benefits offered under the Oregon Health Plan.  

Mark Gibson was Chief of Staff to then-Governor John Kitzhaber when those projects got started.

Mark Gibson  “The idea was to get the best value forthe pharmaceutical dollar the state was spending.”

Gibson is now deputy director at Center for Evidence-Based Policy in Portland. While he’d love to see Comparative Effectiveness Research included in the national health care system, he has concerns about the amendment.

He notes Schrader’s bill would give pharmaceutical and medical device companies a seat at the table, along with others who have a financial stake in medical products.

Mark Gibson  “There is good solid evidence out there that when folks with a economic conflict of  interest participate in the decisions around research, there’s a much higher likelihood the research will favor their given product.”

Schrader says getting all parties involved is necessary to keep the amendment viable – and that means cutting the medical industries in.  

One thing Schrader’s bill won’t do, is tell doctors or patients what to do with the research. That would be a debate for another Congress, in another year.