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AMA Speaks Up On Comparative Effectiveness

My, how they've changed.

Not all that long ago, doctors seemed pretty much united by their antipathy toward being told by outsiders how to practice medicine — particularly by the government.

That bond helped fuel the American Medical Association's bitter opposition to several efforts to overhaul the U.S. health care system in the 1930s and 1940s and to the original effort to pass Medicare in the 1960s.

The medical establishment was pretty slow accepting even evidence-based practice guidelines that would standardize a starting place for care of many patients showing the same symptoms.

Fast-forward to 2011. Doctors are facing all sorts of challenges, not the least of which is a Medicare program that could cut payments to doctors by 29 percent starting next January unless Congress acts before the end of the year.

But in a conversation earlier this week with All Things Considered's Robert Siegel, outgoing AMA President Cecil Wilson was almost casual in his support for the idea of letting the government study what works in medicine.

Asked by Siegel about a story that appeared in the New York Times about some hospitals apparently double-scanning patients with CT scanners, Wilson said in a portion of the interview that didn't make air that "there is a variation in care" around the country. "And there are some places where variation in care makes sense, but there are others where it absolutely does not," he added.

All of which, he continued, is why it was "so important" that last year's health law included "funding for what we call comparative effectiveness research; in order to gain information that will help us to clearly define what studies are indicated and when."

Physicians, noted Wilson, "have a lot of evidence for a lot of what we do, but there's a lot of what physicians do which is still the art of medicine for which evidence is not strong."

Of course those evidence-based medicine provisions are the same ones that opponents of the law say will lead to a stifling of innovation and rationing of health care.

The AMA, along with other health care provider groups, remains opposed to comparative effectiveness research and practice guidelines in which the government makes decisions based on cost or dictates what care can be provided. Some skeptics say that will inevitably follow.

Still, the idea that the head of the AMA, which for decades was one of the nation's most conservative medical groups, now doesn't hesitate to speak openly about comparative effectiveness research backed by the government is a change worth noting.

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