Wednesday, February 2, 2011

Advocating for Comparative Effectiveness Research


Comparative Effectiveness Research is guided by the goal of creating information capacities regarding the best comparative evidence base on treatment effectiveness, side effects, and benefits of different treatment options. The CER process is one that attempts to de-center the shroud of secrecy and scientific legitimacy that the medical industry (pharmaceuticals, physicians etc.) rely on. What is most important about the CER process is the implicit acknowledgement that is built into it: that the culture of medicine operates often under a great deal of uncertainty, misinformation, and lack of solid information. The CER process therefore seeks to a) foster a scientific evidence base for comparing different treatments, and b) de-center the blindfolded legitimacy patients put in physicians by seeking to put information in the hands of patients.

It is precisely in this backdrop that I have witnessed resistance from physicians about CER in one-on-one interactions with them. That the transparency of information in CER threatens the privilege that many physicians enjoy in the status quo (based on the fundamentalism of science) does not come as a surprise. What however does come as a surprise is the argument that is being used by physicians and several lobbies funded by physicians: that patients don't know what is good for them, and medical decisions are best left in the hands of physicians.

Consider the hypocrisy of the argument that uses the language of science to make the very processes of science invisible to local communities. Part of the medical establishment is up in arms about CER precisely because physicians are scared about what this means for their practices and profts.

Personally, I am excited about what the CER processes promise to bring into medicine in the US, perhaps an opportunity for culture change, one that moves medicine from this hollow relic of sacredness that it occupies to a practice that is constituted in relationships, through struggles, and through the practices of healing and curing that work in the intimate spaces of phsyician-patient relationships, working together to heal the marks of disease and illness.

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