With a little more than $1 billion of the $787 billion stimulus legislation devoted to comparative effectiveness (CE) research, President Obama has made it clear that he believes government should have a role in aiding patient diagnoses. But what exactly does “aiding” mean? If clinicians are increasingly paid by tax dollars through a government-run plan, will CE lead to rationing and/or mandating certain kinds of treatment?

The American Medical Association (AMA) has gone on record supporting CE research, while also making it clear that results should only lend a helping hand and not lead to government mandates. “The AMA supports comparative effectiveness research as a way to provide physicians with information on which treatment works best,” said Nancy H. Nielsen, MD, PhD, immediate past president of the AMA, in her March 2009 statement to the Institute of Medicine. “CE research should be broadly defined to include a comparison of how to manage a specific health problem, condition, or disease. CE research should guide and support clinical decision-making, not dictate it.”

Recent high-profile stories on NPR and other media outlets report that both Democrats and Republicans are wary of using CE to “limit coverage or reimbursements.” Despite the reassurances, clinicians from across the health care continuum have strong opinions. Some fear government-generated data will inevitably lead to rationed medical care that could restrict options. Still others see a harmless, and ultimately beneficial, contribution to the medical body of knowledge.

When viewed from the “body of knowledge” standpoint, Neal D. Kravitz, DMD, MS, has no problem with a national computerized record system for medical/dental history, medications, digital radiographs, or models. “All these may certainly improve patient care, decrease medical-dental errors, reduce long-term national health costs, provide a database for forensic odontology, and offer limitless possibilities in regards to medical-dental research,” says Kravitz, owner of Kravitz Orthodontics, South Riding, Va, and White Plains, Md. “The political hurdle will be the national budget in a time of recession, and protection of patient privacy.”

Long Island orthodontist Zackary T. Faber, DDS, MS, is far less enamored with the concept, calling it “downright dangerous” and a potential lawsuit in the making. “How far do you have to reach to have a nurse practitioner, or lower (mid-level) provider dispensing diagnoses that the computer ‘thinks’ is best?’ ” asks Faber, co-owner of Faber Orthodontics, Melville, NY. “I can see the obvious cost-cutting, because we have removed the doctor from the equation. This is a major problem … and will result in major complications and/or lawsuits. This program will lead to an increase in insurers making decisions for what will, and what won’t be, paid for. This is crazy, and the malpractice lawyers will keep themselves in business.”