Heterogeneity or Just Plain ol’ Differences?

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The Alliance for Aging Research was pleased to be a co-sponsor of the National Pharmaceutical Council’s Myth of the Average Patient Conference in Washington, D.C. I had the opportunity to attend the event and share my thoughts on why the topic of heterogeneity among patients is important to consider when conducting comparative effectiveness research.

Factors that scientists say play a role in heterogeneity can pretty much be boiled down to plain ’ol differences. You may think this is simplistic but this important observation often gets lost in conversations in Washington about how to approach the study of “subpopulations” in an effort to better understand varying patient responses to a particular treatment or care practice. When speaking about subpopulations, in most cases the reference is to some identifiable fraction of a group of people. While researchers spend time thinking of the best way to package people into a semi-neat category to study, or developing a composite of what the “average” patient looks like, people are busy being different. Some invisible differences can be captured with biomarkers or other tests that can reveal the outcome a particular group of people might have. These tests could guide research and recommend the use of a particular intervention. A patient may present to the doctor with outward physical symptoms that could make a specific treatment choice apparent. However, there are differences, particularly as people grow older, that stem from their site of care, personal values and (too often) complex health status that cannot be overlooked, even though they complicate research.

We have known for decades that older people with multiple chronic conditions account for a vast share of healthcare spending in the U.S. yet we still do not have enough information to guide many of their treatment choices. The Patient Centered Outcome Research Institute (PCORI) is focused on providing information for patients and health care providers to help achieve the outcomes that are important to them. I believe this presents an opportunity for us to work with the scientific community to ensure that some of the messy differences that are at the heart of heterogeneity in an aging population get factored into future comparative effectiveness research studies.

To learn more about the Myth of the Average Patient visit www.npcnow.org.