I made a mistake.
I don’t buy the New York Times. I told you why. But, someone snuck one of their recent articles into my email. And, yes, I read it.
The article was written by a person with well-known hostility toward private practice physicians. That’s fine. He was giving his interpretation of a study.
The study appeared almost one year ago in a medical journal published by the American Medical Association (AMA). The AMA is the same society who last month, in response to increasing prescription medication costs, recommended that we ban all television commercials for pharmaceutical drugs.
Whatever your take is on this one, I don’t really care. I just wasn’t certain opening up more advertising slots for beer commercials and Doritos would be the answer. Of note, the AMA failed to mention any need to ban the dollars they receive from pharmaceutical ads appearing in their own magazines. (Perhaps, that will be a post for another day.)
Regardless, the New York Times article was about a study that evaluated outcomes of heart patients admitted to hospitals during two distinct periods of time: (1) during days of the year when a handful of cardiologists are away from work “learning” at national meetings, and (2) during similar days when they are not.
I’m going to tell you the real goal for a clinical trial in medicine these days.
It’s to be landmark.
It’s what the trial sponsors seek and their investigators envy.
Landmark is the ultimate goal.
In fact, trial sponsors will frequently call their own study landmark even before it gets published in a scientific journal. Kind of like getting your Super Bowl ring fitted during the preseason.
One of the more enjoyable writers I follow on social media is Dr. John M.
I’ve never met him personally. We only rarely exchange comments in the online environment. You know, 140 characters or less stuff. I don’t really know him.
I read his articles. Although I currently have no way of knowing this with absolute certainty, he seems to be very sincere. He may have me fooled. But, I don’t think so. He comes across as passionate about medicine, patients, and the physicians who care for them. He believes in doing the right thing.
He is an advocate for something known as RightCare. I’ll get to more about this in a minute.
An independent company, known as ProPublica, made healthcare news this week by releasing the complication rates of nearly 17,000 surgeons nationwide.
ProPublica is another one of these non-profit groups that has been granted charity status by the Internal Revenue Service. Their self-stated mission is investigative journalism in the public interest.
You should know that ProPublica claims to be supportive of the “little guy.” I, too, like underdogs, so I enjoyed reading on their own website about their goal to shine “a light on the exploitation of the weak by the strong… [to expose] the failures of those with power to vindicate the trust placed in them.”
Giddy up, ProPublica.
I also favor transparency in medicine. In fact, I wrote a book, in part, to outline my support for it. But, ultimately, what I care about most is taking back medicine. Returning the practice of it to those things that are really meaningful to patient care. And, in our modern era of excessive third-parties mooching off the healthcare system, my focus has settled in on chiseling away at the less meaningful.
With that in mind, I’ll tell you about the “Surgeon Scorecard” that ProPublica has now made public.
“Deaths from high blood pressure should plummet under Obamacare.“
That’s the title of a recent news story that got my attention.
The article was a press release about a study performed by several non-physician investigators with a background in public health. For those less familiar, public health relates to the science of population medicine, or what’s good for the group is good for the individual. Basically, four non-physician investigators sought to analyze the impact that the Affordable Care Act (ACA), also known as “Obamacare,” will have on deaths in this country due to high blood pressure.
“Deaths should plummet,” says the story.
Essentially every concept has positives and negatives.
No matter how opinionated a player on one side wants to be, there are usually always some benefits to the opposing team’s approach to the game.
In healthcare, whether you think we need a single-payer system, a multi-payer system, or no system at all, I can find you a simulator that will reveal perceived benefits for each of these strategies. The simulator will tell you the negatives, too. And, then, no matter how robust it may be, the simulator will still manage to imperfectly predict real life.
You see, what often makes sense to a simulator becomes bizarely twisted in application. Human beings display surprisingly self-directed and unpredictable behaviors. Uncertainty is a certainty.
Cause and effect are challenging to prove and our own observations even interfere. For example, there was a time when we wrongly associated ice cream consumption with the spread of the Poliovirus, merely because both were more prominent in the summer months. Life is complicated. And, everyone has an angle.
Dr. Atul Gawande is an American surgeon and public health extraordinaire. He is one of the most successful physician authors of this century, and he writes routinely for The New Yorker. His most recent article discussing unnecessary healthcare is, as expected, a good read.
I applaud Dr. Gawande’s passion towards advancing medicine. And, yes, there is universal agreement that we need to be better in America at providing high-quality low-cost healthcare. There just remains disagreement on what our biggest obstacles are, and how they should be overcome.
I agree with Dr. Gawande on some things, but after reading his most recent opinion piece, I must caution you about several medical inaccuracies found within it.
I’m a cardiologist. I’ve written one of the most transparent books about the U.S. healthcare system that you will ever read. Yet, if you believe the news, you will assume my entire medical speciality is shady and full of morally suspect physicians. Let me tell you WHY.
In the last month, two articles surfaced in the lay press, one published by The New York Times and the other by U.S. News & World Report. Like the majority of medical news that I’ve seen originate from these sources over the last few years, the articles provide no meaningful contribution to advancing quality standards in medicine or improving patient care. They are written by medical outsiders and fraught with errors. But, to their defense, the authors have been tasked with the impracticable job of interpreting a data dump of poorly understood numbers released to the general public by the Centers for Medicare and Medicaid Services (CMS).