We appear to be entering an era of uncertainty, where once again we realize that the practice of medicine is an art, not a science.
While doctors may carry scientific tomes in their heads and engineering marvels on and around their persons (although surprisingly few computers to date), the clinical practice of medicine is being rediscovered as an art, not a cookbook science. As new studies challenge the existing metrics evaluating risk through a black/ white approach dedicated to lowering intermediate clinical markers (see cholesterol for the otherwise low risk patient, glucose for Type 2 diabetics, BMI for the overweight, quantity of bloodborn “humors” to be released by lancet, etc)
Big lesson: Lower does not mean better
So, as we find out that cookbook medicine may actually be harmful in addition to being expensive, we have the same issue that is currently cracking the mortgage industry: evaluating and managing risk is hard and replacing underwriting with automation and customer service reps leads to problems when real judgment is required.
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There are a lot of numbers and a lot of theories floating around about why the US healthcare system is as screwed up as it is. The fact is that we today spend around $2 trillion dollars on health in the US, and anyone wanting to really do something about it needs a starting point that encompasses where all that money actually goes.
This McKinsey Global Institute report, called “Accounting for the Cost of Healthcare in the US” is a great first step in that direction. (Disclosure: I am an alumni of McKinsey & Co, but was not involved in preparing this report)
They used a robust framework to analyze the drivers of the cost of US healthcare spend:
This report by the McKinsey Global Institute outlines the present distribution of costs in the US system, and highlights where the spend deviates from a metric called ESAW–Estimated Spending According to Wealth, calculated from 13 OECD countries.
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The NYTimes has a new wellness blog, by Tara Parker Pope (of the WSJ). It has an interesting title to the latest article, called “And now, the Exercise-Resistant dieter“.
This is another instance where scientific terms such as “not statistically significant” really throw normal people for a loop (see statistical power)–and create implications that take people away from simple conclusions, in this case, that people prescribed exercise who don’t lose weight often eat more (and balance out the increased exercise with less activity elsewhere in their life).
Its really hard to get statistically significant evidence with a small trial. If you take away the statistical mumbo-jumbo, on average, the people who lost weight (when prescribed a 500 calorie exercise regimen) ate 400 less calories a day than those who didn’t, increased intake of 270 calories for those who gained weight, and decreased intake of 130 in those who lost weight. Given that initially starting an exercise program can cause initial increases in lean weight from energy getting stored in the muscle, this is a pretty easy dietary change which combined with exercise leads to weight loss.
Here’s her take (emphasis mine):
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A recent Wall Street Journal/ Harris poll shows that consumers are supportive of separating employment status from healthcare.
Sixty-nine percent of Democrats and 55% of Republicans believe the U.S. health-care system could be improved by creating an insurance program that isn’t linked to individuals’ employers. Only 6% of those polled disagree strongly with that proposal, while 21% said they aren’t sure.
And this would seem to make sense in an era where changing jobs occurs relatively frequently, and most people are not employed by large organizations and therefore are not certain to find group coverage. As I’ve explored in a previous article, the employers providing health benefits are not doing it because they gain great benefits in optimizing the health of their employees.
However, despite the poll’s headline “Americans want leaders to address coverage for uninsured” the data within the poll shows that Americans do not care strongly about changing the system, which means that little is likely to happen when hard choices need to be made. As marketers will tell you, people who do not feel strongly about an issue are unlikely to actually push for change.
In the data presented below, it is clear that only up to ~1/3 of those responding actually felt strong agreement with any of the statements, and this is in the absence of any hard choices or trade-offs. As we’ve seen with health proposals in the last few decades, the details of those proposals are likely to drain support from different factions as compromises are made.
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