A Swift kick

That’s what our ig­no­rant, pan­der­ing politi­cians need

Modern Healthcare - - Opinions Editorials - NEIL MCLAUGH­LIN Man­ag­ing Edi­tor

Notes on the news:

It’s too bad Jonathan Swift isn’t around to wit­ness the an­tics of the U.S. Congress. The au­thor of Gul­liver’s

Trav­els would rec­og­nize the in­creas­ingly boor­ish, ya­hoo be­hav­ior of our lawmakers.

An ex­am­ple oc­curred re­cently when House Ways and Means Com­mit­tee mem­bers tried to tie down CMS chief Dr. Don­ald Ber­wick with threads of hos­til­ity like Lil­liputians. Repub­li­cans have painted Ber­wick, the noted pa­tient-safety and qual­ity ad­vo­cate, as a lover of gov­ern­ment-run health­care and ra­tioning. They de­test the re­form law and any­one con­nected to it or Pres­i­dent Barack Obama. The tense tenor of the hear­ing—the first Ber­wick has un­der­gone since his ap­point­ment—was es­tab­lished early when Chair­man Dave Camp (R-Mich.) asked, re­fer­ring to the U.K’s sys­tem: “Are you still in love with the Na­tional Health Ser­vice?”

Camp was re­fer­ring to Ber­wick’s state­ments about sin­gle­payer health sys­tems and preven­tive medicine. It’s doubt­ful that Camp and col­leagues have a han­dle on health­care in the U.K. Amer­i­can politi­cians’ fuzzy un­der­stand­ing of health­care is ex­ceeded only by their ig­no­rance of other coun­tries. Com­bine the two, and you cre­ate a gi­ant in­tel­lec­tual sink­hole.

For more than two hours, Ber­wick was pelted with ob­jec­tions from rep­re­sen­ta­tives rail­ing against the re­form law and warn­ing that it will con­jure up all man­ner of evil, in­clud­ing the plac­ing of health­care in the hands of de­monic gov­ern­ment of­fi­cials and the demise of cap­i­tal­ism. Through­out this, Ber­wick re­mained calm and de­clined the bait. What­ever Ber­wick’s faults, it is hard to view this Har­vard pe­di­a­tri­cian-turned-qual­ity ad­vo­cate as a mad bu­reau­crat bent on thin­ning the Amer­i­can pop­u­la­tion by de­vour­ing its ba­bies, as Swift satir­i­cally sug­gested about the Ir­ish in A Mod­est Pro­posal. This mag­a­zine has raised

ques­tions about how ef­fec­tive his 100,000 Lives Cam­paign re­ally was, but the fact re­mains that he has tried to save lives. That’s bet­ter than most mem­bers of Congress, whose record likely will be mea­sured not in lives saved but in lives ru­ined.

Af­ter the hear­ing, two de­vel­op­ments showed the im­por­tance of com­par­a­tive ef­fec­tive­ness re­search, a con­cept reg­u­larly de­nounced by un­en­light­ened or cyn­i­cal politi­cians as a gateway to ra­tioning and the demise of our own cit­i­zens. One was a new book by Dart­mouth

re­searchers ti­tled Over­diag­nosed: Mak­ing Peo­ple Sick in the

Pur­suit of Health. It con­tends that medicine’s push for early diagnosis of disease can harm pa­tient health. Au­thors say the tests of­ten lead to un­nec­es­sary and ex­pen­sive treat­ments for ail­ments they may never de­velop, let alone die of. The sec­ond item was a new study in the Jour­nal of the Amer

ican Med­i­cal As­so­ci­a­tion show­ing that many women with early breast cancer do not re­quire painful re­moval of can­cer­ous lymph nodes from the armpit. That’s about 20% of pa­tients in the U.S., or 40,000 women each year. This find­ing runs con­trary to a cen­tury of con­ven­tional wis­dom among Amer­i­can sur­geons, who thought it would pro­long women’s lives by pre­vent­ing the cancer from re­cur­ring and spread­ing. That prac­tice, how­ever, some­times re­sults in in­fec­tion and dis­abling swelling.

The goal of these stud­ies is not to deny care. A key ob­jec­tive is to be com­pas­sion­ate and spare the pa­tient un­nec­es­sary dis­tress. Blast­ing such re­search may be good pol­i­tics, but it is not good for peo­ple.

At a time when Amer­ica’s prob­lems are be­com­ing more com­plex, our po­lit­i­cal lead­ers, par­tic­u­larly in Congress, are ped­dling cliches as so­lu­tions. Health­care pro­fes­sion­als un­happy with ef­forts to mind­lessly slash health pro­grams and re­tard progress have op­tions. One is to vote to dump the cyn­ics and the will­fully ig­no­rant of both par­ties in fa­vor of can­di­dates ded­i­cated to se­ri­ous gov­er­nance.

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