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"Medical decision-making is rarely black-and-white," adds the NIH's heart chief Dr. Elizabeth Nabel. "We see certainly helping to provide additional evidence that really guides physicians and individuals in sorting through the shades of gray."
The bypass-versus-stent question for severe heart disease is a good example. Last week's New England Journal of Medicine published a comparison suggesting bypass recipients fare slightly better. But Nabel notes that in fact the study found tradeoffs that mean people may legitimately choose the easier recovery of a stent.
A bigger question is how to ensure that patients get the opportunity to consider such findings. AHRQ has begun translating its jargon-filled comparisons into easy-to-understand consumer brochures.
But the most-used comparative effectiveness research may come from a unique program in Oregon called the "Drug Effectiveness Review Project" that evaluates the evidence behind competing drugs.
One example: Two years before the painkiller Vioxx was pulled off the market because of heart side effects, the project declared it riskier than its equally effective cousins, says project director Mark Gibson at Oregon Health and Science University.
The reports don't weigh drug costs but they are used primarily by the Medicaid directors of 14 states in coverage decisions. A wider audience sees them thanks to the influential Consumers Union, which does add price to evaluations done by both the Oregon project and AHRQ to create its free Web-based "Best Buy Drugs" guides.
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Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
Copyright 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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