Sunday, April 1, 2012

Medical Experts and the American People

Believe one who has proven it.  Believe an expert.

Virgil (70-19BC), Aeneid

An expert is one who knows less and less about more and more.

Nicholas Butler (1862-1947),  Commencement Address, Columbia University

April 1, 2012 -  Medical experts dominate medicine -  or think they do and should.  
Government experts, mostly situated in Washington and Boston,  tell us evidence from outcome based studies, should serve as a guide as to what tests and procedures to order and to do. 

Health plan experts in giant firms,  such as Aetna, Wellpoint, Cigna, and the United Healthcare, are fond of  deploying data to instruct  doctors and patients as to  what constitutes the “best practices” and what they will or will not pay for.

Presumably,  these experts, relying on vast databases which they have parsed, analyzed, and summarized,  will present us with objective impartial data to direct care to produce the best results.

I say “presumably” because many patients or  doctors do not necessarily buy the experts’ advice or follow instructions. 

The Problem in a Nutshell
Culturally, the United States is a nation whose people believe everybody puts on their pants the same way, one leg at a time.  They instinctively embrace the notion that  there is no single best way to do anything. In the end,  they believe they have a right to choose what to do, based on their particular individual preferences.

This is not just my opinion.   A husband and wife team of doctors from the Harvard Medical School  faculty,  Pamela Hartzband MD  and Jerome Groopman MD,  have picked up on this theme.   On March 31, they wrote a learned article in the Wall Street Journal “The Rise of Medical Expertocracy” on the subject containing these observations.

                                                                                                                                                                                                                                                                                                                                                          “As As the health-care debate heats up again in Washington, both Democrats and Republicans will try to convince us that they have the experts to answer all our health questions.”

“President Barack Obama and the Democrats propose panels of government experts to evaluate treatments and, in the president's words, "Figure out what works and what doesn't."
“Republicans claim that the free market (that is, insurance companies with their own experts) will pay for value and empower consumers. Both sides insist that no one will come between us and our doctors.”

Democrats and Republicans share a fundamental misconception about medical care. Both assume that, as in mathematics, there is a single right answer for every health problem. These "’ practices,’ they believe, can be found by gathering large amounts of data for experts to analyze. The experts will then identify remedies based strictly on science—impartial and objective.”
“For patients and experts alike, there is a subjective core to every medical decision. The truth is that, despite many advances, much of medicine still exists in a gray zone where there is not one right answer. No one can say with certainty who will benefit by taking a certain drug and who will not. Nor can we say with certainty what impact a medical condition will have on someone's life or how they might experience a treatment's side effects. The path to maintaining or regaining health is not the same for everyone; our preferences really do matter.”

 I agree with these observations and conclusions. In the end, there is usually  no single right answer to treating an individual, and patients, in conjunction with their doctors, have the right to choose what to do.

Tweet:  Despite the rise of medical experts, armed with vast accumulations of data,  there still exists no single answer to most medical problems.

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