This post first appeared on the Practice Fusion Blog.

Last week, the venerable Institute of Medicine released a list of 100 research priorities designed to provide a roadmap for the comparative effectiveness agenda mandated by the Big O’s January Hail Mary otherwise known as ARRA.

At the top of the list are treatment strategies for common conditions like obesity and back pain and the prevention of falls in hospitalized patients. The list also includes mechanisms by which  medical research findings are disseminated to the bedside and to the public.

The full list is here.

Congress allocated $1.1 billion of its $787 billion stimulus package to comparative effectiveness research, assuming such research can improve the quality of health care, though such an impact would be years away.

This “is a program about improving decisions for patients,” Harold Sox told the Wall Street Journal. Sox co-chaired the IOM committee that established the list.

Sox’ team distilled the final 100 from more than 2,600 suggestions submitted by professional groups, policy experts and the public.

Although the products of medical device and pharmaceutical companies will be the primary focus of the research, the former contributed only 11 suggestions and the latter managed just 17. “For whatever reason, we didn’t get many suggestions from them,” Sox understated.

“Right now, the winners and losers (among the various drugs and devices in extant) are based on which company has the best marketing department, rather than who has the best product,” said University of Pennsylvania professor Brian Strom.

“If we show that in certain drugs, the more expensive one is better than the cheaper one, the answer is use the expensive one,” added Strom. “The focus of comparative effectiveness research is that it leads to better care, not cheaper care.”

Responding to a flood of stories regarding unseemly relationships between researchers and the private sector, the venerable Institute of Medicine has released a report that declares it’s time for the medical community to clean up its act.

“Such conflicts present the risk of undue influence on professional judgments and may jeopardize the integrity of scientific investigations, the objectivity of medical education, the quality of patient care, and the public’s trust in medicine,” the report said.

The report’s notable recommendations include:

Professional societies, academic medical centers, and medical journals should implement conflict-of-interest policies that require financial disclosures between their staff and Big Industry.

Practice guideline-writing groups should exclude participants that have conflicts of interest.

Insurance companies should avoid promulgating policies based on guidelines that could be perceived as having conflict of interest problems.

Scientists should not undertake human trials if they are tied financially to the outcome of the research.

Teaching hospitals should proscribe staff from engaging in industry-controlled presentations, accepting gifts and claiming they wrote ghost-written manuscripts.

The IOM panel that prepared the report was chaired by Bernard Lo, director of medical ethics at UCSF.

“We do not say that if you disclose, problems will go away,” Lo told MedPageToday. “(But) there are certain types of relationships that are longstanding that doctors should not engage in anymore.”

The Pharmaceutical Research and Manufacturers of America responded that Big Pharma is already “careful to ensure that relationships with healthcare professionals and students are ethical and appropriate.”

And a device maker advocacy group said her groups’ code of ethics already covers the bases.

“We feel that physicians and industry interaction is important,” said Wanda Moebius, VP for policy communications at AdvaMed. “It helps improve communication, drives innovation and improves patient care.”

Last week, the Institute of Medicine presented its 2008 Gustav O. Lienhard Award to John E. Wennberg for his contributions to evidence-based medicine, outcomes research and informed patient choice.

John Wennberg

Dr. Wennberg is the Peggy Y. Thomson Chair for the Evaluative Clinical Sciences and Founder and Director Emeritus of the Dartmouth Institute for Health Policy and Clinical Practice.

Wennberg became a household name in the 1980s when he and colleague Alan Gitlesohn began documenting marked variations in procedure rates from region to region, state to state and even physician to physician in the same locale. Wennberg was able to show that his findings were driven by physician preferences which were in turn based on their own anecdotal experiences rather than evidence from scientific trials. This research helped drive us toward evidence-based medicine and served as an impetus for legislation that created the Agency for Health Care Quality and Research.

Wennberg also founded, along with Al Mulley, the Foundation for Informed Medical Decision Making, a non-profit organization that provides objective scientific information to patients so they can participate more effectively in their own care.

Wennberg is the 23rd recipient of the Lienhard Award, which includes a medal and a $25,000 prize. The Award program is funded by a grant from the Robert Wood Johnson Foundation. Lienhard was chairman of the Foundation’s board for sixteen years beginning in 1971.