Can We Afford the Gold Standard?
When I was getting my public health degree, we took numerous modules on statistics and research methods. One of the things we were taught, which I already knew, was that randomized clinical trial (RCT) was the best way to clearly answer a research question. It is the "gold standard." The other things we learned about RCTs were that they are time-consuming, the most expensive form of research, and contain some very ethical issues about who does and doesn't receive treatment.
The CMS has created the Innovation Center, which is looking at different ways to pay for and provide healthcare. What they are doing is a fair number of demonstration projects. What that means is they fund a project, evaluate the results, and apply mathematical models to determine things like efficacy, sustainability, and savings potential. I worked in a program in New York that began that way in 1998 and went on to become the benchmark in care management for the frail elderly as recognized by the Commonwealth Fund. There was no control group, yet the results bore out to be very beneficial.
Today, Gina Kolata of The New York Times (no friend to physical therapists after her article, "Treat Me but No Tricks Please") just came out with an article denouncing the Innovation Center as wasting funds because they're not using RCTs for most of their studies.
The responses are as interesting as her article. She's an MIT researcher by profession, so hardly an unbiased voice when commenting on this topic. It could mean whether or not she gets studies funded and articles to publish in professional journals.
So my question is: In this day and age, with shrinking resources and increasing demand, can we afford for all of our health policies to be based upon RCTs or should we make use of demonstration projects to accomplish more with less time and expense?