I finally got around to reading Pres. Obama’s speech to the AMA and, as expected, it was carefully tooled to mitigate doctors’ trepidation over a number of the administration’s policy initiatives.  This was especially true in the way he framed his views on comparative-effectiveness research.  In his speech, Obama made the case that the government needs to get more involved in researching what medical treatments are the most effective and creating a way to quickly disseminate this information to doctors across the country.  Many doctors worry that this will lead to the government rationing health care and controlling how they treat patients.  The worry is that the comparative-effectiveness initiative will become something similar to Britain’s controversial National Institute for Clinical Excellence, a government institution that guides what Britain’s National Health Service will and will not cover.  Obama carefully emphasized to the AMA audience that this government research would not be used to dictate clinical decisions and assured them that the research would only be used to provide doctors with better information.

Obama put it this way:

Now, let me be clear -- I just want to clear something up here -- identifying what works is not about dictating what kind of care should be provided.  It's about providing patients and doctors with the information they need to make the best medical decisions. See, I have the assumption that if you have good information about what makes your patients well, that's what you're going to do. I have confidence in that. We're not going to need to force you to do it. We just need to make sure you've got the best information available.

Despite this clarification, doctors should continue to be very worried by Obama’s comparative-effectiveness initiative.  Doctors need to ask themselves whether Obama made this statement out of convenience or conviction.  My guess: Convenience.  In recent weeks, news headlines report that Obama has “pivoted” and “shifted” on other key health care issues, including his opposition to taxing employer-based health benefits and individual mandates.  Why should we expect that he has more conviction when it comes to comparative-effectiveness research?