About Healthcare
I attended a biotech conference this week and that can be a humbling experience. It places a huge strain on the intellect and especially the memory component. The profession has developed a language of its own which may be necessary for good internal communication, but it leaves outsiders feeling inferior.
Every industry conference makes extensive use of buzzwords and it is interesting to note the changes over time. At an energy conference in April the most frequently heard term was “liquid rich,” because today we have an abundant supply of natural gas but oil is in strong demand. It seems sacrilegious to point out the Gulf of Mexico is liquid rich, because 40, 000 barrels per day from a single well is simply incredible when we consider that a Bakken well (North Dakota) is good if initial production is 1,500 per day (it usually falls off rapidly to about 500 per day). Philip Stephens wrote the other day we are drilling in the Gulf because we are addicted to oil. True, but as Willie Sutton said about banks, you have to go where the oil is.
In biotech the buzz word today is targeted populations. What this refers to is what is called personalized medicine. Every cancer has its own characteristics, depending on the genetic makeup of the patients. Personalized medicine is expensive because it requires the use of many different kinds of bullets. Treatments have to match the characteristics of the patients.
It was also noted that cancer has become a chronic disease because people are now able to live a long time even if the cancer has metastasized. Chronic diseases are expensive to treat.
In America the culture is that when we get sick we expect to be treated. This runs up against the political requirement that we must find ways to reduce costs. One speaker noted the situation is different outside the US, where people tend to look at doctors as authority figures that must be listened to. In America people will read articles about various treatments and have conversations about this with their doctor.
I asked one CEO what would happen to innovation in health care if America suddenly disappeared from the map. He did not quite understand my question because his answer had to do with how research would proceed if studies were not done in the US. The CEO, who is a Canadian, said if a study was done in Canada if would take four years longer because of bureaucratic delays. He also said quality would be affected because the best researchers preferred to work in America, where the best outcome took priority over cost.
It is surprising to me that so little attention has been given to the New York Times article about the shortcomings of the Dartmouth study, because it seems to be “the smoking gun.” It was a study designed to assist the Obama administration in passing health care reform, even though it has serious flaws. In yesterday’s New York Times there is a letter from the two lead researchers which says they have not backed off from their conclusions or overstated their findings. Elliott Fisher and Jonathan Skinner writes:
“There are marked variations in spending observed across hospitals and regions that are largely due to how much time similar patients spend in the hospital, how many specialists they see and how many diagnostic tests they receive. On average, health systems that spend more on these services are less likely to deliver safe and effective care.”
They add that the key point is not how much you spend, it is what you spend it on. The concluding comment is:
“And all thoughtful scholars agree that the United States has tremendous room to improve the quality and costs of care.”
What is strange about this is that when the researchers were interviewed by the Times reporter they said their study was only about cost and not about outcome. They even said they made no effort to adjust for differences in the cost of living from region to region. Still, they insist on saying if a lot of money is spent on a patient it is likely to do more harm than good.
Another letter writer says the Dartmouth researchers “found that surgeons in some towns were far more likely to remove children’s tonsils than surgeons in others, and the difference had little to do with medical need or quality.”
I have no doubt that some doctors are better than others and some hospitals do a better job than others. But the problem with best practice medicine is that it is constantly evolving, and it is also not practical to expect every hospital across the country to be run as efficiently and effectively as the Cleveland Clinic. There are not enough high quality people available for this goal to be achieved.
It is noteworthy that we do not find the same attitude toward spending in the education profession. We do not say the more we spend per student the less the student is likely to learn. Instead we say what is needed is more teachers and smaller classes, even though it is likely the new teachers hired will be of lower quality. We also say the education profession should be left to the professionals, with as little interference from the parents and public as possible. However, in the health care field we cannot trust greedy doctors and hospitals to do what is best for the patients. They need to be managed by bureaucrats in Washington.
One Response to “About Healthcare”
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Interesting read and I certainly sympathize with your worries about personalized medicine and how it fits with the economics of health care. Our little start up (http://www.dynemobiosystems.com) is in the personalized medicine domain. Our feeling is that by helping pharma find the right patients for their drugs we can bring the over all cost on both the development and delivery end down. I see a bright future for personalized medicine. But the current Modus Operandi is not the way forward.