In an editorial published the New York Times, a strong argument was made for studying the relative effectiveness of screening colonoscopy and sigmoidoscopy. Based on a review in JAMA of three studies conducted outside the US that showed no difference in colon cancer mortality or incidence when the two procedures were compared, the Times proposed a US study to answer this question.
Comparative effectiveness (CE) research, a relatively new concept in the lexicon of US medicine, pushed to the forefront by health care reform, appeals to the data-driven orientation of oncologists but could put the rapid pace of progress in cancer therapy at some risk. Research to compare similar treatments could “use up” thousands of patients who might otherwise be considered for participation in studies of newly developing therapies. In addition, the energy and resources that are currently devoted to developing studies that test the efficacy of new drugs and technologies are not limitless and might be taxed by CE research.
For example, although answering the question about colonoscopy and sigmoidoscopy is worthwhile, is it as important as finding out if new molecular screening methods for colon cancer and precancerous changes could minimize or replace invasive screening? Although these studies could be done simultaneously on the same patients, this type of coordination will take new levels of cooperation between academia, industry and government.
If we are not careful, we will find the answer to the question, which of our current treatments is most effective, when we should be applying our energy, imagination and resources to answering the question, how can we significantly improve on current treatments. As hard as it is to believe today with the high short term costs of new anti-cancer therapies and technologies, ultimately, better treatments and technologies will improve quality and drive down cost of care. If we focus on cost reduction as the primary goal, we may miss out on or delay the benefits of future improvements.
Richard Leff is Chief Medical Officer of Conisus.
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