The Great P Value: We the People

April 2008, Vol 1, No 3 - Editorial
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New clinical, business, and regulatory healthcare systems are offering unprecedented opportunities for providing quality and value. At the heart of the healthcare debate lay evidence, balance, and competing incentives in search of a point of consensus. Data are poorly understood and do not speak for themselves. Cooperation between stakeholder groups is still elusive, with stakeholder polarization strong, de spite the urge to unite forces. The healthcare system is circling around looking for an organizing principle. A recent patient advocacy conference showed promise for breaking the deadlock, suggesting that, as our governmental premise states, people are the proper source of consensus and power. For more about this radical-populist notion, read on.

On March 6-7, 2008, the National Working Group on Evidence-Based Health Care convened in Washington, DC, to discuss the most important of all "p values"—the patient. This patient advocacy summit, titled "Advancing the Evidence of Experience: Practical Issues for Patient/Consumer Inclusion," brought to light the possibilities for involving patients in the determination of quality and value in healthcare delivery. Driving the conference was the search for evidence and a balanced, humane, and effective use of resources, and the right of people—the patients—to know and drive their own medical care.

We will cover this event and the topics it explored in future issues, as these suggest a worthy guiding force for the healthcare debate. The theme of the conference happens to align with topics discussed in this issue of American Health & Drug Benefits. For healthcare innovation is meaningless unless it is accurate, relevant, and practicable. Accuracy entails validating the evidence concerning disease states and the measures invoked to treat them. Relevance requires serving the people's priorities and interests at every step of the healthcare process. Practicability means bringing these interventions into mainstream patient use, which is the process of health and drug benefits. We cover each area of inquiry across several articles.

Dr Nirav Shah looks into an accuracy tool of great interest—meta-analysis—in the first of a series of articles on the evidence pyramid that has been undergoing some radical reconstruction lately. Dr Joseph Antos presents his insights on Medicare policy in regard to biologic products. Dr Alberto Colombi reports on his model for benefit designs at PPG Industries, an innovative approach to healthcare intervention that marries patient wellness with employer productivity. Dr Thomas McCarter's overview of depression provides an action document that summarizes the clinical reality of this disease, the clinical burden, and the tactical steps for its treatment, including a drug utilization chart. Cynthia Pigg explains the defining resource allocation measures that managed care pharmacy experts are using. Dr Gary Owens analyzes generic drugs in terms of evidentiary accuracy, relevance, and practicality. Mark Senak captures the confrontational atmosphere in Washington, DC, as Congress pushes to change the US Food and Drug Administra tion's policy from pro-efficacy to pro-safety, a dynamic that is of vital interest to all stakeholders, given its impact on patient outcomes. The net effect of this editorial lineup is, we hope, a practical guide to evidence as felt by not only the providers, payors, purchasers, and policymakers, but the people as well.

The same search for evidence seen in the patient advocacy summit is also evident in the tag line of this journal—The Peer-Reviewed Forum for Evidence in Benefit Design. Open dialogue and discussion must drive the research that addresses patients' priorities. In this spirit of inclusiveness, we invite you, our readers, to join our editorial process, by joining our reading group or editorial review team, by bringing us your ideas and articles, always keeping in mind the ultimate beneficiary: "we the people." If we grant that the pursuit of happiness involves good health, then the people are as much the basis for all scientific discovery as they are the foundation of all political activity. A free people will not only have access to good evidence, it will be part of the process of defining its intended applications.

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