One of the surest signs that a topic has gone mainstream is its recurring appearance in the newsstand press, both consumer and business press. Kudos to Business Week for its May 29 cover story, “Medical Guesswork: From heart surgery to prostate care, the medical industry knows little about which treatments really work,” by John Carey, and for giving the topic seven insightful pages.
Carey wastes little time getting to the heart of the matter: evidence-based medicine (EBM) and the pervasive lack thereof in modern medical treatment. Part of Carey’s article focuses on Dr. David Eddy, a heart surgeon by trade, a current mathematician and healthcare economist, and a proponent of amassing clinical evidence upon which to base medical treatments. Eddy also is the braintrust behind Archimedes, an elaborate computerized program of simulated clinical trials in which myriad virtual doctors treat myriad virtual patients and the computer analyzes the results.
What’s good about this article? The writing is masterful, the information is eye-opening, and the path to a future of cost-effective medical treatments that work is artfully constructed. But those are the minor goodies.
What works the best in Carey’s treatise is the exposure to the public of a critical issue in healthcare. In many instances, doctors simply don’t know if the treatments they prescribe are the ones most likely to produce the desired results. They don’t know because they don’t have hard evidence; they lack validated clinical reports resulting from years of trials and studies. Adding fuel to the fire, says Carey, is “America’s infatuation with the latest advances. … New radiation machines for cancer or operating rooms for heart surgery are profit centers. … Once a hospital installs a shiny new catheter lab, it has a powerful incentive to refer more patients for the procedure. It’s a classic case of increased supply driving demand. …”
Carey is quick to admit that randomized clinical trials cost millions and take years to conduct, and that even when time and money are available, sometimes advances in medical knowledge render the results not so relevant. As enticing as Archimedes sounds, even Eddy says it is technology in its infancy.
Perhaps Carey and Eddy need a stronger familiarity with the NHIN, nationwide interoperability and the an-EMR-in-every-pot initiative. After all, that endeavor is sweeping the nation and being written about by national press as well as hamlet-based newspapers—as if there were a master plan, a national budget for the master plan or a prototype in existence, and as if anyone had any idea of where the gargantuan amount of necessary funding is going to come from.
When it comes to carts and horses, evidence—from rigorous clinical trials or simulated Archimedes-style trials—is the cart that should precede any variety of horse. With the government teetering on the edge of another unfunded mandate that threatens to extract investment from hospitals, physicians, payers, employers and even patients, maybe evidence is the most deserving candidate for a hearty helping of government investment.
It’s simplistic, of course, to suggest that no entity should be required to invest in information systems, connectivity platforms, hardware or harmonization until such time as doctors know, beyond a doubt, which treatments are most likely to work for which patient populations. Isn’t it?
For now, anyway, I’ll keep my money on Colonel Mustard with a debit card in the U.S Treasury.