21 May 2006

The unimportance of outcomes in medicine

From Medical Guesswork, by John Carey, 'BusinessWeek', 29 May: the first quotes refer to Dr David Eddy, a heart surgeon turned mathematician and health-care economist:

He began to ask if there was actual evidence to support what doctors were doing [ie cardiac surgery]. The answer he was surprised to hear, was no. Doctors decided wheher or not to put a patient in intensive care or use a combination of drugs based on their best judgement and on rules and traditions handed down over the years, as opposed to real scientific proof.
...Eddy proved again and again that the emperor had no clothes. In one study, he ferreted out decades of research evaluating treatment of high pressure in the eyeball, a condition that can lead to glaucoma and blindness. He found about a dozen studies that looked out outcomes with pressure-lowering medications used on millions of people. The studies actually suggested that the 100-year-old treatment was harmful, causing more cases of blindness not fewer.
Carey rightly sees, in a related article, the importance of incentives:
The way the U.S. health-care system is structured offers doctors, hospitals, and companies enormous financial incentives to provide more and more care. Surgeons will get paid if they do a bypass operation, insert ear tubes in children, or take out a prostate. If they recommend waiting or doing drug therapy instead, there's no payday.

Of course, as the article does make clear, there are plenty of areas of medicine where the benefits have been huge and unarguable. But the message is clear. Medicine in the US has been badly skewed by perverse incentives, and the information asymmetry between health-care providers and consumers.

Speaking not for attribution, the head of health care atone of America's largest corporations puts it more bluntly: "There is a massive amount of spending on things that really don't help patients, and even put them at greater risk. Everyone that's informed on the topic knows it...."

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