It's well known that there's a type of locust that materializes every 17 years (actually, it's a cicada, Magicicada septendecim, but scientific precision has never been one of our strong suits). Less widely appreciated, however, is another organism --Comparatae effectamicus -- that swarms over the public policy landscape on roughly this same 17-year cycle. 
"Comparative effectiveness," as this second organism is sometimes known, has been spotted in the mid-Atlantic region of the United States this past winter and early spring. Innovators everywhere are taking note, and there's some sense that this year's wave could be particularly virulent.
The organism has infested the Senate-passed 2008 budget resolution, where fiscally neutral acreage has been reserved for "a new federal or public-private initiative for comparative effectiveness research" -- said by Senate Budget Committee Chairman Kent Conrad (D-ND), in a floor statement, to be a promising means to "address rising health care costs." Not to be outdone, Senate Finance Committee head Max Baucus (D-MT) has included comparative-effectiveness provisions in his Chairman's Mark on the Part D drug pricing negotiations bill, while health policy expert and former MedPAC chief Gail Wilensky, in a Heath Affairs article, has called for a new agency to carry out comparative-effectiveness reviews. Finally, later today, MedPAC itself fields a panel on comparative effectiveness, one more stop enroute to inclusion of this topic in the Commission's June report to Congress.
What's the strength of this spring's Comparatae effectamicus strain, relative to infestations of years past?
There was a mild outbreak in 2003, when MMA section 1013 established a new program on comparative-effectiveness research at AHRQ. Some scientists believe this 1013 sub-species is not as potent because it's yielded less appropriated funding than the more energetic of the comparative-effectiveness advocates believe necessary.
To put this year's infestation in proper relief, one has to drop back into that murky era before (digitally) recorded time -- back roughly those rhythmic 17 years, when the Omnibus Budget Reconciliation Act of 1989 gave AHRQ's predecessor agency assorted lightening bolts of outcomes-related authority. Indeed, "outcomes" was in those days the organism of interest, but Comparatae effectamicus lurked within it, silently oozing purported statutory authority that CMS to this day cites as justification for such comparison-oriented enterprises as Medicare's Coverage with Evidence Development guidance and clinical trial coverage policy (proposed new version of latter released earlier this week).
The mid-1980s saw the Institute of Medicine try to cobble together a public-private partnership to take on comparative effectiveness (remnants of the effort are still visible). But the most concerted comparative effectiveness effort -- the one that today's calls for an independent agency/initiative most closely resembles -- returns us to the 1970s and the short life of an independently authorized HHS agency, the National Center for Health Care Technology.
"NCHCT," as it was known, hatched from a study by another now-deceased entity, the Congressional Office of Technology Assessment, or OTA, then grew to maturity under legislation sponsored by Representative Henry Waxman (D-CA) and Senator Ted Kennedy (D-MA). Controversial from the start, NCHCT took such steps as compiling an annual "emerging technology list" to help assessors draw a bead on innovations before they got too far along on the diffusion curve. Early in the Reagan Administration, the agency's appropriations were pulled, and, later, NCHCT's authorization was collapsed into that for another Public Health Service entity. After that, NCHCT became just another extinct agency, much to the chagrin and even the outrage of a sizable and vocal cohort of technology assessors worldwide.
For some, then, the current comparative-effectiveness discussion sparks hope for resurrection of technology assessment's Lost Cause -- as represented by the kind of "single organized and adequately funded program or agency" for which OTA pined in 1982. For others, Comparatae effectamicus signals possible return of a type of government policy that they had hoped would long stay dormant.
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