From:
Sukie Crandall
Date: 2011-06-20 14:54:26 UTC
Subject: [ferrethealth] Comparative Effectiveness Research: vet students and vet researchers
To: fhl <ferrethealth@yahoogroups.com>
Comparative Effectiveness Research looks at which approaches appear to work best.
The resources I have found discuss this in relation to human health but it looks like some of the new approaches could be used by veterinary researchers and by vet students who are deciding on a senior year research topic to advance veterinary medical knowledge quite a bit since some of the newer approaches also keep down research costs. A quick Google search also shows that this approach might not be utilized much yet in veterinary medicine, but it seems like it could help all.
At times the better medical approaches are also the less costly ones, and that consideration is sometimes one which can make the difference between receiving care or not receiving care when the family just can not afford expensive care. With our four footed family members we hear of this quite often, especially when people are rather new to ferrets and did not put savings aside, and for shelters it also is a consideration. Obviously, this is not a determination which can be made from how approaches work in just a few households because that simply is not carefully enough sampled data -- a factor that a number of people forget -- but that determination can be made when a very large population is used and the comparison groups are well matched.
What is revolutionizing CER currently in human medicine is the use of electronic medical records in hospitals, clinics, and insurance companies to find individuals in each group who match each other well enough to create fair and very large comparison groups and then look at the results. It takes what would otherwise be studies with tens of thousands to hundreds of thousands of participants costing in the many millions of dollars and can get those studies done for a cost in the tens of thousands. This approach could have very useful implications for veterinary research. While it can not be used for all types of such studies it can be used for a large chunk.
In the U.S., which is currently is below the median (i.e. below the middle) for human lifespan among the Industrial nations but is by far the most expensive industrialized nation for human health care, CER has not been embraced as well as it has been in the other industrial nations. (For comparison, the U.K. which has used it more in the last decade is above the U.S. for lifespan, being right at the median = middle, and other nations have a strong history of using CER for human medicine.) That is part of what an article in the July 2011 issue of "Scientific American" does: it provides those of us in the U. S. with an introduction to CER since there are some very misleading propaganda statements from who do not want such research done and those who earn money from them (such as those who might profit economically from general use of a newer and more expensive medical approach which on careful study might turn out to NOT be better for most patients -- or for their wallets -- who are trying to mislead people into thinking that CER is a form of rationing, their lobbyists, and those to whom those lobbyists give money).
BUT the lack of such data prevents medical personnel -- both veterinarians and human care providers -- from being able to say to clients and patients, "Well, there are large studies with well matched comparison groups showing how well these approaches do. No one approach is right for everyone, but for those who can use either A or B and have the same the same health aspects as Hjalmar (who for this note can be a ferret or a person) here are the survival times for each of these approaches and here is what they cost." Personally, I know a LOT of veterinarians who would like to be able to provide their clients with just such data, and would welcome its eventual existence. Mining information from the computerized data at veterinary clinics, vet schools, animal insurance companies, breeding farms, and even in some cases from those who have already done other animal studies could really help get some very useful chunks of information.
My own experience is that vets do an especially good job of trying to balance costs with care needs, and therefore I think that this approach may be even better embraced by the veterinary community than by the human health one for at least a while in certain locations.
The SciAm article lists the following links:
http://www.effectivehealthcare.ahrq.gov/what-is-comparative-effectiveness-research1/
The beginning of the SciAm article for those who want to see if they may way to buy an issue or not:
http://www.scientificamerican.com/article.cfm?id=the-best-medicine-july-11
The article also lists a link to an article which I did not find applicable enough to be on-topic for the FHL.
There is also a link to a trailer about a film which I think gets far too off-topic for the FHL, BTW.
Sukie (not a vet)
Recommended ferret health links:
http://pets.groups.yahoo.com/group/ferrethealth/
http://ferrethealth.org/archive/
http://www.afip.org/ferrets/index.html
http://www.miamiferret.org/
http://www.ferrethealth.msu.edu/
http://www.ferretcongress.org/
http://www.trifl.org/index.shtml
http://homepage.mac.com/sukie/sukiesferretlinks.html
all ferret topics:
http://listserv.ferretmailinglist.org/archives/ferret-search.html
"All hail the procrastinators for they shall rule the world tomorrow."
(2010, Steve Crandall)
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