Like millions of other Americans, I have a bad back. My personal experience with "degenerative disc disease" is why I am so enthusiastic about comparative effectiveness research, or "CER," a key piece of health care reform. It is also why I get so frustrated when people claim that reform will lead to the government "rationing" care and interfering with the relationship between patient and doctor.

CER is the scientific examination of which medical treatments are the most effective for individual patients. The federal government invested over $1 billion in such research as a part of the stimulus package. Public funds must generously support this activity because private funding frequently biases medical research in favor of prematurely approving new treatments that will harm patients or waste money.  A proposal by the New Democratic Coalition would place responsibility for disseminating this research with an independent board rather than within government.

Opponents of CER say that it will lead to the rationing care, but these medical rationing arguments are irrational. We stand to gain enormously from a system in which medical decisions are grounded in evidence as to which treatments are the most effective. Having access to better information will support shared decision-making between doctors and patients.

To understand why all of this is the case, you need to know more about bad backs.

When I was twenty-nine, I ended up temporarily paralyzed on the floor of my bedroom in excruciating pain. The doctor who examined me at the emergency room aggravated my condition by yanking up on my leg. I left several hours later with a generous allotment of narcotic painkillers but no more information about my condition or how to control it. 

When I went to see my primary care physician, he added Celebrex and Neurontin to my pharmaceutical regimen. He then recommended I see a spine surgeon and a licensed physical therapist. The spine surgeon spent eight minutes with me and asked one question, "should I cut you open?" Thankfully, the answer was "no."  He did recommend, however, that I get an MRI scan. 

At this point, I began to ask some questions. The answers I received made me increasingly concerned. I managed to extract from my spine surgeon that the MRI was not medically necessary and would probably not give him more information than a standard X-Ray. I was also disturbed to learn that the two drugs I had been prescribed were of questionable value, perhaps even harmful, in cases like mine. And I had felt the direct effects of the harm of my trip to the emergency room.

I did enjoy my time with the physical therapist. But I learned from him that the most effective treatment for degenerative disc disease, in the vast majority of cases, is self-directed exercise. Not surgery. Not drugs. Not even professional physical therapy. In fact, after going through all the therapy and taking the drugs, the incidents continued until I began exercising regularly.

CER is about just that: effectiveness. Self-directed exercise happens to be less costly than surgery. But sometimes the most effective treatment is more expensive. CER will promote effective new treatments, regardless of cost, to help ensure that Americans are getting value for their health care dollars.

A good deal of information about effective medical care already exists. Federal funding will help build channels to get reliable information into the hands of doctors and patients so that they can work together to make high-value treatment decisions. Yet, not everyone is in favor of providing transparent access to this information. In fact, the last federal agency charged with comparative effectiveness research actually pointed out that exercise rather than spine surgery should be the first line of therapy for this condition. However, the public dissemination of this consensus conclusion was effectively quashed by a single group of spine surgeons, and the agency that made the recommendations was nearly eliminated.

We cannot allow misleading rhetoric and self-interested lobbyists to get in the way of research that is vital to our health and the health of our nation. Without it, we'll all end up flat on our backs. 

And trust me. I've been there. It's not comfortable.