Good in­for­ma­tion

Du­bi­ous re­search pro­motes high costs while oth­ers seek to end waste

Modern Healthcare - - OPINIONS EDITORIALS - NEIL MCLAUGH­LIN

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.

Man­ag­ing Ed­i­tor

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