COSTS: What's Not to Like About A Cheaper Diuretic?

The latest installment of the New York Times "The Evidence Gap" series ran over the holiday weekend and looked at why doctors by and large kept prescribing expensive brand name blood pressure drugs years after a huge $130 million government-funded clinical trial known as Allhat showed that older generic diuretics worked better for far less money.

As the Wall Street Journal's Health Blog put it, "Study Found Cheap Blood Pressure Meds Are Best. No One Cared."

On one level, the Times article provided an illuminating look at how the losers in this study—name-brand drug companies—sowed doubt about the accuracy and reliability of the Allhat study as they increased efforts to market their drugs.

But another subtler aspect of the story reminds us that comparative effectiveness research—which we strongly support—is not easy. By the time one data set is analyzed and interpreted, new drugs have come on the market and others become available as generics. The target is always moving. The paper quoted Dr. Sean Tunis, a former chief medical officer for Medicare, as saying that while he supports comparative-effectiveness studies "they are hard to do, expensive to do and provoke a lot of political pushback." Dr. Tunis who now runs the nonprofit Center for Medical Technology Policy added, "There's a lot of magical thinking that it will all be science and won't be politics."

Dr. Carolyn Clancy, director of the federal Agency for Healthcare Research and Quality, noted that traditional clinical trials aren't the only way to gather data about comparative effectiveness on patients in the real world. Her agency has been using insurance records, for instance. Other data could become available to researchers if the U.S. finally got its electronic health records and health IT act together. As Merrill Goozner notes in his blog, patient outcome registries can cause their own debates, but that was how scientists uncovered the Vioxx problems.