Kansas Governor Kathleen Sebelius, President Barack Obama’s choice to be Health Secretary, has divided legislators with her views on comparative effectiveness research.

Her appointment as Secretary of Health and Human Services (HHS) has to be approved by the Senate, which the chamber’s powerful Finance Committee moved a step closer this week by supporting her nomination, albeit on a 15-8 vote.

Eight of the panel’s 10 Republicans voted against her, one of the most vocal being Senator Jon Kyl of Arizona, who said he did so because of her response to written questions from him about her views on comparative effectiveness research.

She had told him that “comparative effectiveness is about gathering and sharing information on what's most effective; it has nothing to do with government dictating choices or rationing care."

But, said Sen Kyl, her answers made it clear that the Administration is unwilling to support pro-patient safeguards, without which, he believes “the government can misuse comparative effectiveness research to deny coverage.”

“She left me with no assurance that HHS, federal health care programmes or any new entity - such as the Federal Coordinating Council - will not use comparative effectiveness research as a tool to deny care. And this should be a matter of concern to all of us,” he said. Moreover, he added that Gov Sibelius’ justification of the process “relied on two points which were inaccurate and contradicted one another, raising more doubt than providing assurance.”

The first of these is her comment that “the law prohibits Medicare from using comparative effectiveness research to withhold coverage." Here, says Sen Kyl, she is referencing the 2003 prescription drug bill, “which is considerably insufficient as it only applies to prescription drugs, not all of the other aspects of treatment.”

She also said that: “when authorizing comparative effectiveness research in both the Medicare Modernization Act and the American Recovery and Reinvestment Act, Congress did not impose any limits on it.” This, says Sen Kyl, “is precisely the problem - NIH is already taking the steps necessary to make cost-based research a priority,” and he noted that one recent project description reads “cost effectiveness research will provide accurate and objective information to guide future policies that support the allocation of health resources for the treatment of acute and chronic conditions.” According to Sen Kyl, “allocation of health resources” is “a euphemism for denying care based on cost. Yet, Governor Sebelius did not agree to pull this project,” he says.

Another dissenter was healthcare specialist Senator Charles Grassley, who told Gov Sibelius that “parallels have been repeatedly drawn between” the UK National Institute for Health and Clinical Excellence (NICE) and the development of a US Federal Health Board, and that a recent New York Times article noted that NICE has placed an approximate $22,750 price tag for every six months of quality of life for a patient. He asked her: “do you think it’s appropriate for the United States government be in the business of determining the value of a person‘s life?”

She replied: “We should be in the business of ensuring a health care system that promotes quality of care. As you know, we have a uniquely American health system…The President aims to build on what is best in the system while improving affordable, high-quality choices for all Americans. Obviously, he has not suggested that we adopt the British system. If confirmed, I look forward to working with you on crafting a uniquely American solution to the health system crisis.”