Creating Disincentives for "Me Too" Drugs and DevicesIn addition to having direct effects on clinical decisions, the authors write that CER should also improve medicine in other ways. One way is changing the climate so that health care decision makers favor data from CER that will create disincentives for the development of "me too" drugs and devices that offer the same benefits as existing therapies without lowering the cost. And once the medical community begins to expect and demand clear evidence of superiority, pharmaceutical companies and device manufacturers will have to devote more of their resources to the discovery of true advances.

Furthermore, if the emphasis is also on cost reduction, there is an added incentive to do the research and development that will bring to the marketplace not only superior therapeutics, but equivalent interventions that are cheaper than their predecessors and therefore more cost-effective. Such comparative effectiveness and cost-effectiveness requirements have already led to the development and introduction of superior drugs in Britain, Australia and Canada.

Finally, CER will help the academic medical and public health communities to develop a research agenda that will provide health care professionals with information for clinical decision making. At the same time, the push for CER will result in greater demand and thus more opportunities for physician-scientists to do this type of research.

"The medical and public health communities should be enthusiastic about CER and support it. It is physicians' first line of defense against blind cost containment. On the basis of CER, our drug and device industries will be encouraged to produce products that really matter," says Dr. Mushlin. "Important medical decisions should be guided by the scientific community, not the capricious nature of the marketplace."

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