Among the many provisions included in Obama / Congress’ "Stimulus Plan" passed in February is $1.1 billion for "comparative effectiveness" research ("CER"), which will finally start putting some money into figuring out if many of the medical treatments routinely prescribed across America at considerable expense are actually worth it. DB at Medical Rants is all in favor, but Kevin MD raises a red flag:

Newsweek’s Sharon Begley comments on how patients can refuse to adhere to the findings of comparative effectiveness research by suing doctors who try to do so. As she points out, "What are [doctors] supposed to do when a patient demands antibiotics for a cold? for a child’s ear infection? when a patient demands an MRI for back pain or knee pain? If they refuse, several doctors told me, they can expect a call from the patient’s lawyer that afternoon."

Yes, physicians are the ones ultimately responsible for ordering unnecessary antibiotics or MRIs. But, the threat of malpractice is indeed a cloud that hangs over every decision a doctor makes. Just because Mr. Cross disagrees with that doesn’t make it any less true, or any less of a factor.

The patient’s lawyer will call that afternoon and… what? Threaten the doctor for complying with a Federally-approved de facto standard of care?

Put simply, CER will cut both ways. A doctor who does not utilize a CER-approved treatment will have a lot of explaining to do down the road if that treatment would have helped. Conversely, a plaintiff alleging a doctor should have used a CER-disapproved treatment will have a hard time convincing a jury that the doctor should have overridden the billion-dollar research.

From a liability / malpractice standpoint, doctors who abide by the standard of care should welcome the CER with open arms, as it will give them a powerful tool to wield when a plaintiff’s lawyer later asks "why didn’t you do _____?" They can quite honestly answer "because the CER says it’s not effective."