Regardless of the final direction health care reform legislation will go, comparative effectiveness research (CER) will be a part of it. While many see CER as a vital piece of the puzzle, some in the health care industry are on the fence about its actual value in improving health care as a whole. A New England Journal of Medicine piece I read recently, by Alvin I. Mushlin, M.D., and Hassan Ghomrawi, Ph.D., M.P.H., “Health Care Reform and the Need for Comparative Effectiveness Research” gave four straightforward reasons for how/why CER is both valuable and necessary in our existing system:

1. Findings from CER will provide a buffer against “blind” cost containment.
2. CER can identify preferred therapies, promoting changes in care and outcomes by identifying and validating such treatments. Such research suggests ways for new financial incentives to be applied both safely and effectively.
3. CER should enable innovation in medicine, by creating ‘disincentives’ for the development of “me too” drugs and devices, and by raising expectations and demands for clear evidence of superiority.
4. CER serves as what the authors call the “first line of defense against blind cost containment,” and can serve as a stimulus for the academic medical and public health communities, thus resulting in greater demand and more opportunities for physicians-scientists to get in on the research.

Let’s wait to see how CER fares in the final health reform bill—and if either side stifles the progress in science and service delivery that CER can bring about and that the health care system as a whole desperately needs.

Brain scan evidence that defense attorneys claimed show a defendant’s brain as psychopathic was allowed into the sentencing portion of a murder trial in Chicago, according to a November 23 report, “Courtroom First: Brain Scan Used in Murder Sentencing” from one of my favorite pubs, Wired Science. Not that it helped the intended cause—the defendant was found guilty and sentenced to death. But, with the accuracy rate of brain scan data ranging from 76% to 90% in identifying deception (according to a 2008 University of Pennsylvania Center for Cognitive Neuroscience publication “Detection of Deception with fMRI: Are we there yet?”) the brain scan has equal or better accuracy than lie detectors. And, discerning judges and juries will likely find brain scans to be more credible than hired-gun forensic psychiatrists and psychologists. Look for more diagnostic metrics in the courtroom.