Polarization, the Pandemic, and Public Trust in Health System Actors.

CONTEXT: Public opinion on the performance of health system actors is polarized today, but it remains unclear which actors enjoy the most (least) trust among Democrats and Republicans, whether the Covid-19 pandemic has influenced how people view their own physicians, and whether doctors have retained the ability to influence public beliefs about policy issues. METHODS: We conducted two national surveys in 2022 and 2023 to examine these questions. FINDINGS: Democrats rate the performance of medical research scientists and public health experts during the pandemic more highly than do Republicans and independents. About three in ten Republicans say that the pandemic decreased their trust in their personal doctors. Nonetheless, most Americans report confidence in physicians. We replicate the findings of Gerber et al. (2014) to demonstrate that respondents continue to have more positive views of doctors than other professionals, and that public opinion is responsive to cues from a doctors' group. CONCLUSIONS: What polarizes Democrats and Republicans today is not whether medical scientists and public health experts are competent, but whether the advice offered by these actors is in the public interest and should guide policymakers' decisions. Democrats strongly believe the answer to these questions is yes, while Republicans exhibit skepticism.

Comparatively Ineffective? PCORI and the Uphill Battle to Make Evidence Count in US Medicine.

The Patient-Centered Outcomes Research Institute (PCORI) was established as part of the Affordable Care Act to promote research on the comparative effectiveness of treatment options. Advocates hoped this information would help reduce wasteful spending by identifying low-value treatments, but many conservatives and industry groups feared PCORI would ration care and threaten physicians' autonomy. PCORI faced three challenges during its first decade of operation: overcoming the controversy of its birth and escaping early termination, shaping medical practice, and building a public reputation for relevance. While PCORI has won reauthorization, it has not yet had a major impact on the decisions of clinicians or payers. PCORI's modest footprint reflects not only the challenges of getting a new organization off the ground but also the larger political, financial, and cultural barriers to the uptake of medical evidence in the US health care system. The growing attention among policymakers and researchers to provider prices (rather than utilization) as the driver of health care spending could be helpful to the political prospects of the evidence-based medicine project by making it appear to be less as rationing driven by costs and more as an effort to improve quality and uphold medical professionalism.

Doctor knows best: physician endorsements, public opinion, and the politics of comparative effectiveness research.

The Obama administration has made a major investment in comparative effectiveness research (CER) to learn what treatments work best for which patients. CER has the potential to reduce wasteful medical spending and improve patient outcomes, but the political sustainability of this initiative remains unclear because of concerns that it will threaten the doctor-patient relationship. An unresolved question is whether it is possible to boost public support for the use of CER as a cost-control strategy. We investigate one potential source of public support: Americans' trust in physicians as faithful agents of patient interests. We conducted two national surveys to explore the public's confidence in doctors compared to other groups. We find that doctors are viewed as harder workers, more trustworthy, and more caring than other professionals. Through survey experiments, we demonstrate that the support of doctors' groups for proposals to control costs and use CER have a greater influence on aggregate public opinion than do cues from political actors including congressional Democrats, Republicans, and a bipartisan commission. Our survey results suggest that the medical profession's stance will be an important factor in shaping the political viability of efforts to use CER as a tool for health care cost control.

The public wants information, not board mandates, from comparative effectiveness research.

We conducted two national surveys of public opinion about comparative effectiveness research and the integration of findings from the research into clinical practice. The first survey found broad support for using research results to provide information, but less support for using them to allocate government resources or mandate treatment decisions. In addition, the public is willing to consider the use of financial incentives to encourage patients to choose cheaper treatments, if research demonstrates that they work as well as more expensive ones. The second survey found that support for comparative effectiveness research dropped in response to general debates about its consequences but that arguments against the research could be effectively countered by specific, targeted rebuttals.

A national survey reveals public skepticism about research-based treatment guidelines.

Using research to develop treatment guidelines is one way to lower medical costs and improve care. However, findings from a national survey show that the public is skeptical about this approach. Specifically, the public finds arguments against establishing research-based treatment guidelines more convincing than arguments in favor of it. Our findings suggest that for evidence-based treatment guidelines to win public acceptance, the public needs to be reassured that guidelines would not lead to the limiting of access to beneficial care.