Dubious research promotes high costs while others seek to end waste
Notes on the news: Much of the media last week breathlessly aired reports on a cancer study without noting some important points. The study, in the journal Health Affairs, suggested that higher cancer-care spending in this country is worth the price tag because U.S. patients who were diagnosed from 1983 to 1999 lived longer after the diagnosis than people in 10 European countries. The study estimated the value of those U.S. survival gains at $43 billion annually. This result was surprising because of the overwhelming number of studies concluding that the U.S. spends far more on healthcare than any other nation and gets mediocre results at best. Maybe all that spending was worth the extraordinary cost after all.
Unfortunately, the cancer study is based in large part on misleading mathematics. It relies on survival times versus mortality rates. A tumor diagnosed early may mean that one person survives a certain number of years after diagnosis but dies at the same age as another person whose illness was detected later. The length of life is the same.
“As long as your calculation is based on survival gains, it is fundamentally misleading,” said Dartmouth healthcare researcher Dr. H. Gilbert Welch. He was quoted in a lengthy Reuters news service story examining the study.
Another expert quoted by Reuters was biostatistician Donald Berry of the MD Anderson Cancer Center in Houston. “This study is pure folly,” he said. “It’s completely misguided and it’s dangerous. Not only are the authors’ analyses flawed but their conclusions are also wrong.”
Many stories also failed to note significant information about the study’s pedigree. It was funded in part by Bristol-myers Squibb, a maker of cancer drugs—some of them quite expensive. And it might have been helpful to know that the research was led by University of Chicago health economist Tomas Philipson, who is affiliated with, among other groups, the free-market, corporate-friendly American Enterprise Institute and the Manhattan Institute.
Meanwhile, it’s good to see healthcare professionals embracing reason in trying to contain costs rather than raise them.
The American Board of Internal Medicine Foundation-led Choosing Wisely campaign this month urged physicians to think twice before ordering many diagnostic tests (April 9, p. 8). Nine specialty societies representing about 375,000 physicians each identified five common tests that should be re-evaluated. In a Journal of the American Medical Association article, authors said that if information provided by some tests is unlikely to change treatment, they should be avoided.
The article notes that while some spending doesn’t contribute to the health of individuals or the community, “the polarizing political environment makes it difficult to conduct rational public discussions about this issue.”
It’s long past time that we started having such discussions and rejecting the idea that any attempt to use resources wisely amounts to “rationing.” Many Americans have been conditioned to believe that more testing is better. Until recently, they haven’t been told that tests can lead to adverse health consequences for them and unnecessary spending in what is already the world’s costliest healthcare system.
Dr. Rakesh Patel, a Phoenix-area family physician, reacted by telling Modern Healthcare the Choosing Wisely campaign was “long overdue.” He said that doctors who object to the findings should do more research and realize the changing nature of the medical profession. “These guidelines are based on science,” he said. What the industry—and the country—needs right now is more and better science and research.