Marya Zilberberg, a physician researcher who specializes in complications stemming from medical care, has written a great article about health care reform. She weaves together several aspects: treatment that results in more harm than good, electronic health records that could allow researchers to better track and understand patient outcomes, and comparative effectiveness research (CER) that will allow us to focus health care delivery on practices that really work. Her questioning of the widespread practice of mammograms starting at age 40 is interesting, and should lead us to ponder the concept of “waste” in healthcare. Are some things that we tend to regard as essential really not that important? Could they perhaps be doing more harm than good?
I found another article that Dr. Zilberberg wrote about the H1N1 epidemic in its early days, and I’m impressed with her point of view. She isn’t swayed by popular wisdom (mammograms are widely considered to be as essential part of preventive health care – in Colorado they are a state mandated benefit on all health insurance policies), nor frightened by scare stories. Her focus is on data and research, and I respect that greatly.
One of the problems facing our health care system is that there are so many people involved who are looking out for their own best interests, rather than what is best for the system as a whole and patients as individuals. The sheer force of the lobbying power that has descended on Washington this summer is evidence of that. My knowledge of the risks and benefits of mammograms is limited at best, but what if transparent CER were to find that mammograms aren’t as beneficial as we think they are? Would that data make its way into mainstream medical practice, or would the device manufacturers and radiologists push to continue with routine mammograms anyway?
Over the course of the summer, as the health care reform debate heated up, the waters got increasingly muddied. It became tough to separate fact from fiction, reality from scare tactic. Hopefully as time goes by and CER becomes more common, we’ll see health care that is influenced primarily by science, data, and patient outcomes, without regard for who may or may not profit from the results of the research.
Dr. Zilberberg’s article was in Grand Rounds this week, hosted at Suture For A Living.