The Downside of Comparative Effectiveness Research

This is doctor Pauline Chen, writing in the New York Times:

While I now accept the constant presence of an invisible and powerful third party in my interactions with patients, I can still feel my shoulders tighten whenever I hear the word "authorization." But it is not the third party per se that causes the hairs on the back of my neck to rise. It is the sense that some of their decisions are based not on well-researched recommendations but on interests, agreements and circumstances that have little or nothing to do with good care.

Comparative effectiveness is not just a future phenomenon. It's already here. See below.

Comments (6)

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  1. Bret says:

    I think Dr. Chen has it just right. The hairs on the back of her neck should rise.

  2. Stephen C. says:

    Before this is over, it’s going to be worse than the HMO’s in the 1990s.

  3. Linda Gorman says:

    Yes, how NICE.

  4. Larry C. says:

    There is an editorial in the New York Times today by another doctor on this very subject. It’s worth reading.

  5. Vicki says:


    I assume that is a pun. NICE being the British agency that helps ration care by doing comparative effectiveness studies in Britain. Right?

  6. Linda Gorman says:


    Yes. On of my all time favorites was the silly NICE examination of water births. A great example of “The emperor has no clothes” scholarship in all its glory. You can see my write-up at