Comparative effectiveness research through the looking glass.

The goal of comparative effectiveness research (CER) articulated by the United States government is to provide information on relative strengths and weakness of medical interventions. Such information is intended to help clinicians and patients make better decisions which, in turn, would improve the performance of the health care system. However, it is unclear how information on relative benefits would enable improvement. Making sense of the CER debate requires addressing 2 issues: the ethical framework must be made explicit, and greater critical thinking must be applied for developing goals. Frank discussion about the problems CER will address, viewed through an ethical lens, will lead to operational objectives and desired outcomes. Ultimately, the extent to which a proposed publicly-funded CER institute meets expectations will depend on governance, structures and processes. Without a clear vision, CER as currently construed may touch on many problems plaguing US health care but runs the risk of solving none.