Issue 38 | June 2010
www.academyhealth.org
AcademyHealth
Reports
Evidence and Fear: Navigating the Politics
of Evidence-Based Medicine
by Michael K. Gusmano, Ph.D., The Hastings Center; Bradford H. Gray, Ph.D., Urban Institute
[F]or the purposes of this Act, and for the purposes of any other provision of law, the current recommendations of the
United States Preventive Service Task Force regarding breast cancer screening, mammography, and prevention shall
be considered the most current other than those issued in or around November 2009. (Section 2713 of the Patient
Protection and Affordable Care Act)
Features
Section 2713 of the Patient Protection and Affordable
Care Act that President Obama signed into law on
March 23 contains lessons for those who believe in
evidence-based policy and practice. The passage above
tells potential users to ignore a recent evidence-based
practice recommendation. This curious legislative
language was, of course, the outcome of a public
controversy that began with the publication in
November 2009 of the Preventive Service Task Force’s
updated recommendations on the use of screening
mammograms.
1 Evidence and Fear:
Navigating the Politics of
Evidence Based Medicine
For a professional society whose members are engaged
in the enterprise of generating evidence that might
inform policy, it is worth considering why research
can stimulate powerful objections.
Departments
The Mammography Screening
Recommendations
Contents
2 Letter from Leadership
3 The Latest
6 Coalition Corner
7 Members Matter
In November 2009, the U.S. Preventive
Services Task Force (USPSTF) published new
recommendations about routine breast cancer
screening mammography.”1 If followed, the new
recommendations would reduce substantially the use
of the procedure among women ages 40 to 49.2
The 2009 recommendations, which replaced
guidance issued in 2002, were based on a detailed
review and analysis of the relevant research. They
called for the continuation of routine screening
mammography among women age 50 and older, but
not for younger women who had no specific risk
factors. The Task Force explained that “for biennial
screening mammography in women aged 40 to 49
years, there is moderate certainty that the net benefit
is small”3 and that the harms associated with breast
cancer screening outweighed the benefits. These
harms include “psychological harms, unnecessary
imaging tests, biopsies in women without cancer, and
inconvenience due to false-positive screening results.”
They also include “harms associated with treatment of
cancer that would not have become clinically apparent
during a woman’s lifetime (overdiagnosis), as well as
the harms of unnecessary earlier treatment of breast
cancer that would have become clinically apparent but
would not have shortened a woman’s life.”4
The Task Force enjoys a reputation for independence
and quality, and some responses to its mammography
recommendations were positive. Groups such
as Breast Cancer Action, the National Women’s
Health Network, the National Breast Cancer
Coalition, and Our Bodies Ourselves, embraced
the recommendations. The recommendations were
touted by some leading health policy researchers as
“rational”5 and “objective.”6
Yet, the positive evaluations were overwhelmed by
an avalanche of negative reactions from professional
associations, patient advocates, and elected officials
from both political parties.7 Some of the opposition
came from organizations with obvious economic
interests, but strong objections also came from
advocacy organizations like the American Cancer
Continued on page 4 
Advancing Research, Policy and Practice
Letter from
Leadership
As the nation forges ahead
in today’s new era of health
reform, the field of health
services research is well
positioned to support
the implementation and
evaluation of this historic
legislation. As evident in the panels and research
presented at this year’s Annual Research Meeting,
the field possesses the expertise and insight that
will be essential for informed decision-making.
Our challenge is to continue building and
maintaining the infrastructure needed to support
the increasing demand for our work.
Reflecting on my 11-year tenure as president
and chief executive of this organization and
my membership in the Association for Health
Services Research (AHSR) and position as
leader of the Alpha Center, I can say with
certainty that AcademyHealth has never been
better poised to meet the needs of our nation’s
policymakers and practitioners. We have a
highly capable and dedicated staff, a vibrant
and growing membership, a strong financial
position, and a distinguished Board of Directors
that understands the challenges of guiding
a professional society. With these strengths
and capabilities, AcademyHealth has the
commensurate skills and substantive experience
to continue its well-established leadership role in
supporting health and health care improvement.
And, while the field embraces new opportunities,
I am preparing for a new era of my own: my
retirement as your president later this year.
The board and staff are fully prepared for
the transition, guided by a strategic plan and
governance review developed over the last few
years under a transition committee led by Sara
Rosenbaum and John Colmers. With their
2
guidance, the board has begun its search for a
new chief executive with the skills and experience
needed to lead this dynamic organization. Under
a new CEO, AcademyHealth’s staff will continue
their efforts to support the development of
the field, facilitate the use of the best available
research and information, and assist health policy
and practice leaders in addressing major health
challenges. Without a doubt, the new executive will
value as I do the staff’s ability to launch important
new projects, expand our offerings to enhance
your professional development, and improve
membership services and our national conferences.
The new CEO will also benefit from the
leadership provided by the Board of Directors
of the Coalition for Health Services Research in
directing our advocacy for the health services
research field. In recent years, the board has
spearheaded our efforts to secure significant
funding increases to support health services
and comparative effectiveness research, the
national data systems needed by our researchers
and policy analysts, and policies that ensure the
timely publication of research.
Of course, none of this is possible without you,
our members. Engaged members are the lifeblood
of our organization and our field. Working
together with the board and staff, you can achieve
AcademyHealth’s vision of improving health and
health care by generating new knowledge and
moving knowledge into action. I look forward to
joining you on that journey.
Health Care Reform:
Where do we go from here?
AcademyHealth
Reports
Chair
Elizabeth A. McGlynn
Associate Director, RAND Health
Rand Corporation
President and CEO
W. David Helms, Ph.D.
AcademyHealth
Staff
Ayesha Pathak................................................... Senior Associate
Edward Brown.......................................... Art Director/Designer
If you have questions or comments about
AcademyHealth Reports, please e-mail
kristin.rosengren@academyhealth.org.
W. David Helms, Ph.D.
President and CEO
AcademyHealth
AcademyHealth Reports
The Latest
Members to Elect Two New Directors for Board: Same Process, New Timing
This year, AcademyHealth will open voting for the
Board of Directors member election to coincide with
the start of the Annual Research Meeting (ARM).
Online voting will open on June 27 and close at 5
p.m. EDT on July 30. AcademyHealth members will
receive voting instructions by email in advance of the
election, along with information on the candidates.
Members attending the ARM will be encouraged to
vote at available on-site computers.
This is your opportunity to make your voice heard
in selecting AcademyHealth’s leaders. Your vote
does matter. Members active on June 1 may vote
online for two of the following four candidates:
g Romana Hasnain-Wynia, Ph.D., director,
Center for Healthcare Equity, and
associate professor, research organization:
Northwestern University, Feinberg School
of Medicine
g Len M. Nichols, Ph.D., director, Center
for Health Policy Research and Ethics,
George Mason University
g Eduardo J. Sanchez, M.D., M.P.H.,
vice president and chief medical officer,
Blue Cross and Blue Shield of Texas
Earlier this spring, the Board elected three
directors to the 2011 Board. Carmen Hooker
Odom, M.R.P., president, Milbank Memorial Fund,
and Craig V. Thornton, Ph.D., managing director for
health research, Mathematica Policy Research, Inc.
were elected to a first term, and Lisa Rubenstein,
M.D., professor of medicine and public health,
VA Greater Los Angeles and UCLA, will rejoin the
board for a second term.
Questions about the election process may be
directed to Bonnie Austin, director, at 202.292.6756.
g Kevin A. Schulman, M.D., professor of
medicine and business administration,
Duke University
AcademyHealth Prepares to Help States Policymakers Implement Federal Reforms
State Coverage Initiatives (SCI), a national
program of the Robert Wood Johnson
Foundation administered by AcademyHealth,
has had a tremendously busy year. Even before
federal health reform was enacted, SCI was
preparing to support states in the event that
some form of the legislation would pass while
also recognizing that many states were working
on reforms regardless of whether or not federal
reform occurred.
With the knowledge that many states were
contemplating creating or already working
towards implementing exchanges as a way
to improve the individual and small group
markets, SCI partnered with the Massachusetts
Health Insurance Connector Authority to host
a meeting January 21-22, 2010, on health
reform in Massachusetts. This meeting focused
on the organization and implementation of
health insurance exchanges. More than
150 participants representing 41 states and
the District of Columbia were in attendance.
The meeting addressed the benefits and
challenges of implementing an exchange, the
operational aspects of running the subsidized
Commonwealth Care and unsubsidized
Commonwealth Choice programs, the outreach
and educational efforts the Connector Authority
undertook, and other important topics.
As a result of the meeting, SCI produced an
issue brief, “Preparing for Health Reform: The
Role of the Health Insurance Exchange.” This
report provides policymakers with an overview of
the potential role of a health insurance exchange,
what a state should do to prepare for the creation
of an exchange, state-specific issues that should
be considered before establishing an exchange,
and the different ways in which an exchange
might be structured and operated. Bob Carey,
the author of the brief, joined SCI for a webinar to
discuss his findings with state officials.
Another recent report, “Implementing State
Health Reform: Lessons for Policymakers,”
prepared by Navigant Consulting for SCI, draws
on the reform implementation experiences of five
states: Massachusetts, New Mexico, Tennessee,
Vermont, and Wisconsin. The report identifies not
only the key questions that policymakers should
ask when considering various aspects of health
care reform, but also provides a set of related
takeaways, particularly about what must happen
operationally pre- and post-implementation. The
For more information, please visit our website at
Issue 38 | June 2010
questions and takeaways are relevant to both
state and national reform initiatives because
state governments are typically charged with
implementing reforms and state experiences
offer insight into the overall design of reforms.
Understanding these issues is particularly critical
now as the enactment of federal reform has
enormous implementation implications for states.
SCI is currently in the final stages of producing
two additional briefs; one focusing on providing
an overview of all-payer claims databases for
state policymakers and the other looking at
the potential for value-based purchasing and
consumer engagement by state employee health
plan purchasers.
Now that health reform is law, the SCI program
hopes to join state officials on the journey of
operationalizing health reform and recognizing
that a lot of hard work lies ahead for states as
they take a major role in implementing the core
components of the law. One of our major goals
here at SCI is to focus technical assistance on
the implementation of exchanges and other
insurance market reforms as defined in the final
legislation.
www.academyhealth.org.
3
 Evidence and Fear Continued from page 1
Society. Susan G. Komen for the Cure® stated that,
“There is enough uncertainty about the age at which
mammography should begin and the frequency of
screening that we would not want to see a change in
policy for screening mammography at this time.”8
Objections also came from within the medical
profession. Former NIH Director Bernadine Healy,
M.D., said on Fox News, “I’m saying very powerfully
[to] ignore [the recommendations], because
unequivocally ... this will increase the number of
women dying of breast cancer.”
Some political leaders also responded with strong
criticism. Within two weeks of their release,
Secretary Sebelius decried the “confusion and
worry” the recommendations had stimulated and
noted that the Task Force does not “set federal
policy and [doesn’t] determine what services are
covered by the federal government.” She advised
the public, “Keep doing what you have been doing
for years: talk to your doctor about your individual
history, ask questions, and make the decision that is
right for you.”9 Within a month, the Senate agreed
by voice vote to an amendment that effectively
required the federal government to ignore the Task
Force’s recommendations.10 In altered form, but
not changed substance, the amendment found its
way into the health reform legislation.
Lessons from the Mammography
Controversy
It is not unprecedented for new practice guidelines
to generate powerful opposition, as when the very
funding of the Agency for Health Care Policy and
Research was successfully attacked in 1996 in part
because of political objections to practice guidelines
regarding back surgery.11 Similarly, recommendations
from MedPAC, particularly those that call for
payment reductions, are also criticized regularly by
stakeholders.12 Even so, an important point about
such controversies regarding practice guidelines is
they have been unusual. Several hundred new or
revised practice guidelines are added every year to
AHRQ’s National Guideline Clearinghouse which
now catalogues about 2,400 guidelines, few of which
have attracted any public concern.
So, why the controversy in this case? Comparative
effectiveness research (CER) and evidencebased medicine (EBM) seem most likely to face
challenges when findings call for some degree of
“disinvestment”13—reducing use of an established
technology. The mammogram recommendations,
like the back surgery guidelines 15 years earlier,
involved replacing some uses of a technology with a
more conservative approach. Health care providers
4
and the public at large have an appetite for the
new. Calls for doing less can be more difficult to
accept. Even so, recommendations to do less do
not necessarily generate controversy. For example,
there was little public debate in 1996 when the
USPSTF recommended against the use of screening
asymptomatic persons for lung cancer with either
low dose computerized tomography or chest X-ray.
The mammography guidelines had important
economic implications for providers of the service in
question—and indeed, there were some allegations
that this was the primary source of the objections to
the new guidelines14—but several additional factors
were also involved in the mammography case. One is
the special nature of breast cancer, a disease that has
generated a highly active advocacy community, many
of whose members have long promoted screening
mammography among women ages 40 to 49 based
on the presumption that early detection saves lives.
The research community has gone back and forth on
the issue of screening for years,15 but this ambivalence
had not always been reflected in the messages from
the advocacy community. As one commentator
put it, “Breast cancer is viewed as a plague. A ‘war’
on breast cancer is viewed as a crusade. Screening
mammography is Excalibur.”16 The USPSTF
recommendations differed from the long standing
public health message advanced by several prominent
advocacy groups, and they responded accordingly.
The response of the breast cancer community
may also have been affected by the way the
recommendations were developed and released.
The Task Force is a private, non-governmental
entity, and its meetings are not open. The release
of the recommendations took place in a peerreviewed journal that has rules against prior
release of content. There was little awareness that
the Task Force was seriously considering this
particular revision of its breast cancer guidelines.
Had there been, the Task Force might have
received information that would have helped it
to anticipate the shock the recommendations
would produce and it could have worked more in
advance to address possible misinterpretations,
as it in fact did after the controversy blew up. (As
the controversy raged, the Task Force reconsidered
the matter and decided to stick with its
recommendations, but with modified language.)
Another factor was that the Task Force’s
recommendation was based on a particular weighing
of the evidence. That is, it was possible to consider
the evidence that the Task Force cited and come to
a different conclusion. Deciding how much weight
should be given to false positives and to the possibility
that screening might detect some cancers that
would never become life-threatening are matters of
judgment, not fact. The Task Force decided that the
risks of breast cancer screening of women younger
than age 50 who carried no known special risk factors
(e.g., genetic) outweigh the benefits of screening.
Some advocates of screening, reviewing the same
evidence, reached the opposite conclusion. Evidence
that is less subject to conflicting interpretations may
not produce the same defense of the status quo.17 But
judgment about incommensurate factors will often be
needed when evidence is evaluated.
Perhaps most important factor in this particular
instance was the highly charged political
environment into which the Task Force released its
recommendations. Attacking the USPSTF and the
mammography recommendations gave politicians
an attractive way to advocate for women’s health.
The recommendations also became part of
the broader argument about the dangers of
government control of health care. When the
Obama administration had included $1.1 billion
for CER in the stimulus package in early 2009,
opponents warned that such research would be used
by government to ration care and deny life saving
treatments.18 Although USPSTF is independent, the
recommendations by the Task Force are often adopted
by public and private purchasers. In the context of
the health reform debate, the recommendations were
painted as a move toward government rationing of
care and framed as “a glaring example of the dangers
of increasing the federal government’s control of
health care.”19 An online editorial published by The
Wall Street Journal argued that this was an example
of the “political rationing of care” that we can expect
under “ObamaCare.”20
Indeed, both the Senate bill (Patient Protection
and Affordable Care Act - H.R. 3590) and the
final reconciliation act adopted by both houses
of Congress, “require qualified health plans to
provide at a minimum coverage without costsharing for preventive services rated A or B by the
U.S. Preventive Services Task Force.”21 Screening
mammography for women ages 40 to 49 had
received a rating from the USPSTF of “C,” so the
charge that this recommendation could affect
coverage was understandable.22 That helps to
explain why Secretary Sebelius made her statement
about the recommendations and why Congress
included a provision in the health reform bill to
disregard them.
AcademyHealth Reports
Summary and Lessons
Professional and advocacy opposition, along with
financial interests and ideological concerns about
government “rationing,” may create barriers to the
implementation of CER and EBM, particularly when
existing practices are challenged. This seems more
likely when health policy issues are highly salient to
industry, professional, and consumer organizations.
With the adoption of U.S. health care reform
and the future expansion of government-funded
health insurance, health care costs will continue
to be a major concern for policymakers. Both
governmental and private purchasers of care will
continue to have to make decisions about what
services to pay for. Although analysts disagree
about the potential for CER to reduce health care
spending,23 the idea of using evidence to improve
health care policy decisions enjoys support from
a broad range of actors.24 Nevertheless, the strong
negative reaction to the 2009 mammography
recommendations from the USPSTF is a powerful
signal that the implementation of CER and EMB
can encounter great resistance, particularly when
this research suggests that broadly accepted health
care technologies that have been promoted by
the health care community and patient advocates
may not be worth the cost. Although, to date,
controversies regarding practice guidelines have
been unusual, the conditions that produced the
objections in the mammography case could
become more important, and more common, as
the use of CER and EMB are extended.
The USPSTF did not base its mammography
recommendations on possible cost savings,
but proponents of CER and EMB often claim
that this research will reduce spending by
eliminating unnecessary care.25 The reactions to
the mammography recommendations suggest that
the health services research community needs to
understand better what the public believes about
evidence and ways that health care costs might be
constrained. Greater focus on likely public reactions
may encourage the research community and entities
like USPSTF to work with the media, anticipate
possible misinterpretations, and reduce public
anxiety. Leaders at AHRQ and USPSTF appear to
be moving in that direction already by providing
additional opportunities for public comment on
forthcoming recommendations, which will be posted
on http://www.preventiveservices.ahrq.gov. 26
Issue 38 | June 2010
Providing such opportunities for public comment
may help the health services research community
build support for basing policy decisions and
practice guidelines on a strong evidence base and
perhaps increase understanding of and confidence
in the research base for such decisions. The new
health reform legislation calls for establishment of
a Methodology Committee to advise the PatientCentered Outcomes Research Institute, which is
charged with conducting CER. The Methodology
Committee is required to “develop and improve
the science and methods of comparative clinical
effectiveness research.”27 Establishing the credibility
of its methods among a broad array of stakeholders
will not insulate the new Institute, or health services
researchers more generally, from controversy.
Nevertheless, establishing broader support for the
value of health services research, coupled with
sustained efforts to communicate more effectively
with the public, is crucial as the United States
grapples with how best to improve the quality and
efficiency of its health system.
Endnotes
1 U.S. Preventive Services Task Force. 2009. “Screening for breast
cancer: U.S. Preventive Services Task Force recommendation
statement.” Annals of Internal Medicine. 151 (10): 716-726.
2 Annals of Internal Medicine. 2009. “Editorial: Evidence-Based
Breast Cancer Prevention: The Importance of Individual Risk.”
Annals of Internal Medicine. 151(10): 750-752.
3 U.S. Preventive Services Task Force. 2009. “Screening for Breast
Cancer: U.S. Preventive Services Task Force Recommendation
Statement. Annals of Internal Medicine 151(10): 717.
4 U.S. Preventive Services Task Force. 2009: 718.
5 Reinhardt, U.E. 2009. “The Uproar Over Mammography,”
Economix, Explaining the Science of Everyday Life. The New York
Times, November 20.
6 Wilensky, G.R. 2010. “The Mammography Guidelines and
Evidence-Based Medicine,” Health Affairs Blog (http://healthaffairs.
org/blog/author/gail/, accessed on March 22, 2010).
7 The Wall Street Journal. 2009. “Liberals and Mammography:
Rationing? What rationing?” Review and Outlook, The Wall Street
Journal online, November 24 (http://online.wsj.com/article/SB10001
42405274870477970457455232022212599.html, accessed on March
22, 2010).
8 (http://ww5.komen.org/KomenNewsArticle.aspx?id=6442451487,
accessed on March 21, 2010).
9 http://www.upi.com/Top_News/US/2009/11/18/SebeliusMammogram-policies-unchanged/UPI-18271258591793/
10 http://prescriptions.blogs.nytimes.com/2009/12/03/gopamendments-aim-at-new-cancer-guidelines/
11 Gray BH, Gusmano MK, Collins S “AHCPR and the politics of
health services research” Health Affairs June 2003
12 Committee on Ways and Means, Subcommittee on Health,
U.S. House of Representatives. 2003. MEDPAC REPORT ON
MEDICARE PAYMENT POLICIES. Hearing, One Hundred Eighth
Congress, First Session, March 6. Seria. No. 108-14. Washington,
DC: U.S. Government Printing Office.
13 Elshaug, Adam G, Janet E Hiller, Sean R Tunis and John R Moss.
2007. “Challenges in Australian policy processes for disinvestment
from existing, ineffective health care practices,” Australia and New
Zealand Health Policy 4:23; Nuti, Sabina, Milena Vainieria and
Anna Boninia. 2009. “Disinvestment for re-allocation: A process
to identify priorities in healthcare,” Health Policy doi:10.1016/j.
healthpol.2009.11.011; Pearson S, Littlejohns P. 2007. “Reallocating
resources: how should the National Institute for Health and
Clinical Excellence guide disinvestment efforts in the National
Health Service?” Journal of Health Service Research Policy 12: 160–5.
14 Virgina Hopkins wrote: “The controversy is all about those billions
of dollars that won’t be flowing into the mammogram industry—
the manufacturers, the hospitals, the clinics, the radiologists, the
oncologists, the labs doing the biopsies, and so forth. Hopkins,
Virginia. 2009. “Mammogram Controversy—Follow the Money.”
Health Watchers’ News and Views. November 18.
15 Wilensky, G.R. 2010.
16 Hadler, N. 2009. (http://abcnews.go.com/Health/OnCallPlus/
story?id=319641&page=1, accessed on March 20, 2010).
17 For example, after years of hope and hype, the use of high-dose
chemotherapy with bone marrow or stem cell transplantation
for the treatment of advanced and early-stage breast cancer was
stopped once there was sufficient evidence that this approach did
not work (http://www.cancer.gov/cancertopics/high-dose-chemo).
18 During a December 1, 2009 statement on the floor of the U. S.
Senate, Senator Coburn claimed that seniors “are going to die
sooner” as a result of health reform
19 “Majority’s Health Bill Empowers Government Task Force at
Center of Mammogram Controversy.” From Website of Senator
Tom Coburn (R-OK).
20 The Wall Street Journal 2009.
21 Patient Protection and Affordable Care Act (P.L. 111-148) with
amendments included in the Health Care and Education Reconciliation Act of 2010 (H.R. 4872); Patient Protection and Affordable Care Act (H.R. 3590).
22 This provision does not state that recommendations with a grade
below B should not be covered, but that is a reasonable interpretation.
23 Callahan, D. 2009. “Controlling Costs: Do as Business Does,”
Health Care Cost Monitor, January 29; Fisher, Elliott S., Julie P.
Bynum, and Jonathan S. Skinner. 2009. “Slowing the Growth of
Health Care Costs — Lessons from Regional Variation.” NEJM
360 (9):849-852; Marmor, T., J. Oberlander and J. White. 2009.
“The Obama Administrations Options for Health Care Cost
Control: Hope Versus Reality.” Annals of Internal Medicine 150
no. 7 485-489.
24 Cannon, M.F. 2009. A BetterWay to Generate and Use
Comparative-Effectiveness Research. Policy Analysis 632:1-21;
Chassin, M. 1986. “Variations in the Use of Medical and Surgical
Services by the Medicare Population.” NEJM 314(5):285-90;
Fisher, Elliott S., Julie P. Bynum, and Jonathan S. Skinner.
2009. “Slowing the Growth of Health Care Costs — Lessons
from Regional Variation.” NEJM 360 (9):849-852; Iglehart, J.K.
2009. Prioritizing Comparative-Effectiveness Research – IOM
Recommendations. NEJM 361(4):325-28; Wennberg, J.E. 1984.
Dealing with Medical Practice Variations: A Proposal for Action.
Health Affairs 3(2):6-32.
25 Fisher, E.S., J.P. Bynum, and J.S. Skinner. 2009
26 Maloney, S. 2010. “AHRQ Prevention Program - Opportunity for
Public Comment” (updates@subscriptions.ahrq.gov, April 26).
27 P.L. 111-148.
5
Coalition Corner
Advocating for Health Services Research and Data
The Coalition for Health Services Research is the
advocacy arm of AcademyHealth, working to
educate policymakers and federal decision makers
about the value of health services research (HSR)
in transforming health and health care. Supported
by a portion of AcademyHealth members’ dues,
the Coalition advocates for members’ priorities to
strengthen our field such as increasing funding for
investigator initiated research and training grants to
support the development of the next generation of
health services researchers.
What Have You Done for Me Lately?
The Coalition has been busy this past year meeting
with congressional and administration staff,
attending briefings, submitting comments and letters
to Congress and leaders of federal agencies, and
working for the inclusion (or, sometimes, removal)
of language in relevant legislation. Results of the
coalition’s efforts to date include the following:
g Helped secure $1.1 billion in funding for
comparative effectiveness research (CER)
through the American Recovery and
Reinvestment Act (ARRA), of which $8.5 million
has funded AcademyHealth member research;
the $8.5 million represents 4.5 percent of the total
amount of CER ARRA funding awarded thus far.1
g Secured approximately 10 percent funding
increases for the Agency for Healthcare Research
and Quality (AHRQ) and the National Center for
Health Statistics (NCHS) in FY 2010, allowing
both AHRQ and NCHS to preserve and restore
core activities.
g Provided language that was incorporated into
House and Senate appropriations bills that
targeted funding for investigator-initiated
research at AHRQ. Additional language requested
AHRQ to support a more balanced research
portfolio, supporting all aspects of health care
research outlined in its mission.
g Ensured that CER provisions remained in the
Patient Protection and Affordable Care Act,
signed by President Obama in March 2010.
The law provides an unprecedented mandatory
funding stream for CER.
g Modified health reform legislation that would
have inadvertently restricted the publication of
research findings generated under contract with a
new CER entity.
The Coalition also helps AcademyHealth members
by conveying news and information on the federal
agencies that support HSR. For example, the
Coalition recently produced a guide of what the new
health reform legislation means for health services
researchers. The document may be accessed at
www.chsr.org/healthreform.
Is the Coalition Just a Department of
AcademyHealth?
No. The Coalition is a separate organization
distinct from AcademyHealth. The Coalition was
established because AcademyHealth’s principal
funders require advocacy and lobbying activities to
remain separate from AcademyHealth’s educational
and programmatic activities. As such, the Coalition
operates with its own board of directors and bylaws.
Talk the Talk…
The Coalition’s legislative term of the
quarter is, “Deeming Resolution.”
In years where Congress does not agree to a budget resolution
to set overall caps on federal spending, a “deeming resolution”
is adopted to specify the spending levels and allocations to the
Appropriations Committees. Without such a resolution, there
would be no effective cap on total spending that could be
included in the appropriations bills, and the House and Senate
could assume different levels of overall spending. At the time
of this writing, the Senate Budget Committee has passed its
FY 2011 Budget Resolution; it is unclear when the resolution
will come to the floor of the Senate and the House has yet to
act. It is likely that a deeming resolution will be included in the
forthcoming war supplemental so appropriators may begin
work on the FY 2011 spending bills.
Can I Get Involved?
Yes! We rely on AcademyHealth members to help us
advocate for certain issues. For example, last year,
we mobilized members in key states and districts to
advocate for inclusion of CER funding in ARRA. As
the FY 2011 appropriations season begins and the
U.S. Department of Health and Human Services
undertakes the Herculean task of implementing
health reform, please look for emails from us about
ways to get involved. You may also contact the
Coalition at coalition@academyhealth.org.
Advocacy in Action!
The Patient Protection and Affordable Care Act authorizes Public Health Services and Systems Research (Sec. 4301) to optimize public health delivery. The Act also authorizes $500
million in both FY 2010 and FY 2011 to support a Public Health and Prevention Fund (Sec. 4002) to support programs authorized by the Public Health Service Act. The Coalition for
Health Services Research collaborated with other national public health organizations to urge the Secretary of Health and Human Services to provide $50 million of this mandatory
funding to support the newly authorized PHSSR program. A copy of the joint-letter is available at: www.chsr.org/policy.htm
* Source: Analysis of NIH RePORTER data, April 16, 2010.
6
AcademyHealth Reports
Members Matter
AcademyHealth’s Career Center Can Help You
Whether you are looking for a new job or are
preparing to take the next step in your career,
AcademyHealth’s Career Center can help you find
the opportunity that is right for you. Positions
are categorized under the headings of faculty/
university-related, researcher/non-faculty, health
policy, and fellowships. The service is offered free to
AcademyHealth members.
AcademyHealth’s Career Center is an important source
for career advancement in the fields of health services
research and health policy. This comprehensive
and growing online resource offers access to job
opportunities and fellowships, a place to advertise
position openings, a calendar of events publicizing
national health services research related events, and
a list of current funding opportunities. Visit www.
academyhealth.org/training for more information.
As an employer, you can effectively reach your target
audience and recruit the most highly qualified
candidates through AcademyHealth’s Career Center.
Our Career Center brings your professional needs
to the attention of a diverse membership composed
of health services researchers, public policymakers,
business decision makers, policy analysts, economists,
sociologists, political scientists, consultants, clinicians,
and students. Our Career Center is the largest single
resource of position listings for health services
researchers and health policymakers. It is widely
reviewed by the industry’s top candidates.
Employers may submit advertisements online to
begin recruiting from AcademyHealth’s diverse
and talented membership. Employers that are
AcademyHealth organizational affiliate members
can post positions on the Career Center at a
discounted rate.
AcademyHealth’s funding opportunities Web page
has been expanded to provide members with a
more comprehensive resource. You will find a list
of funding opportunities and fellowships offered
by federal government agencies and foundations.
All funding opportunities are ordered by the date
of posting on the Web site, making it easy to locate
new funding opportunities.
Take advantage of AcademyHealth’s Career Center–
find a job or fill a position–quickly and easily. And
learn about a funding opportunity for your next
research project.
News from the Journals
AcademyHealth’s official journals, Health Affairs
and Health Services Research (HSR), provide
updates on recent issues in health services
research and policy. Subscription discounts are
available for members. For more information,
visit www.academyhealth.org/membership.
Health Affairs May Issue Examines
Primary Care
Bold changes are needed in how the
United States delivers and pays for
primary care if the key goals of national
health reform are to be achieved,
according to the May issue of Health
Affairs. This thematic issue of the journal examines
the crisis facing the U.S. primary care system as
well as promising solutions for reinventing primary
care. Building a state-of-the-art primary care
system, the issue concludes, is critical to achieving
Issue 38 | June 2010
better health care, better value for the dollars spent,
and expanded access for the tens of millions of
Americans who will gain insurance coverage over
the next few years.
Featured studies in the May issue include:
g An overview of the current landscape of U.S.
primary care;
g The huge pay gap between primary care physicians
and specialists;
g Analysis of the essential elements of the patientcentered medical home;
g The need to train physicians to be managers; and
g Practice profiles and case studies from around the
country.
To access a full table of contents from this
issue, visit http://www.healthaffairs.org/Media/
May_toc.pdf.
HSR Theme Issue Call for
Papers:
Global Health Systems
Global health—the study of improving
human health and achieving equity in health
worldwide—has attracted the attention of key
stakeholders including policymakers and politicians,
international corporations, and international
nongovernmental agencies. Likewise, research, policies,
and financial resources have been increasingly focused
on global health, most notably over the past decade.
Yet as funding has grown, so has a consensus that we
lack solid evidence about the effectiveness of efforts
supported by such funding, particularly with regard to
improvements in and impacts on health systems.
For this upcoming theme issue, HSR and Yale
University are soliciting studies, evaluations, policy
analyses, and simulations that use rigorous and
scientific research methods to assess the impact of
systems to improve global health, including delivery,
financing, and regulatory systems.
7
AcademyHealth
Reports
Issue 38 | June 2010
Go Behind the Scenes of Health Policymaking in Washington
2010 Health Policy Orientation: October 25–28
The annual Health
Policy Orientation
gives participants
an in-depth
understanding of the
formal and informal
processes shaping the
nation’s health policy agenda. With expert faculty
members, group discussions, hands-on tutorials,
and a congressional site visit, participants master
the fundamentals of policy development and
implementation and experience the Washington
health policy environment with insiders.
The orientation is ideal for health policy fellows and
analysts, public officials, federal or state government
employees, private sector health care employees, and
consultants. Space is limited to 50 participants for a
nearly one-to-one ratio of participants to faculty.
The program reviews the essentials of health
policymaking and provides diverse stakeholder
perspectives on timely issues. Expert faculty members
share their insights from their years of experience in
advising the president, serving as staff to members of
Congress, and administering federal health programs.
The faculty also includes leading researchers, legal
scholars, and public opinion experts.
The 2010 orientation is scheduled for October 25–28
in Washington, D.C. Registration opens July 15.
Visit the orientation website at www.academyhealth.
org/orientation for more information, or call Anna
LaFayette at 202.292.6739.
This program is organized with support from the U.S.
Centers for Disease Control and Prevention’s National
Center for Health Statistics
Dates to Watch
July
15
Registration opens for Health Policy Orientation
30
Deadline to submit nominations of HSR Impact Award
October
25-28 Health Policy Orientation
www.academyhealth.org
1150 17th Street, NW
Suite 600
Washington, DC 20036
202 292 6700 Phone
202 292 6800 Fax
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