New York Times Op-Ed piece yesterday by the unusual triumvirate of Bill Beane, Newt Gingrich, and John Kerry analogized the obsessive nature of baseball statistics to where we should head with health care. Baseball has left simple batting and earned run averages for a next generation of statistics including WHIP (walks and hits per innings pitched) and VORP (value over replacement player) and the writers propose medicine take a similar course to elevate its game.
At the heart of what they are trying to get at is called evidence based medicine. Traditionally medical students learned how to practice medicine based on what their mentors learned when they were students. This is what is sometimes referred to as anecdotal medicine. At one time in med school someone quoted to me that less than 50% of physician’s treatments had any data behind them, but don’t ask me to cite my source–this is anecdotal as well. There has been a movement in medicine for over ten years now to go back and actually study these anecdotal treatments and to not implement new ones until the data is there. Overall, the movement is clearly a positive one for patients.
Unfortunately I must disagree to a certain extent with the article’s conclusions. While I have a tremendous amount of respect for Sen. Kerry, perhaps he is still a little disoriented from the Red Sox loss. Contrary to what Beane, Gingrich, and Kerry believe, however, data driven medicine can be a slippery slope in the wrong direction. We have already seen an explosion in pay for performance programs to reimburse physicians based on their stats. Unfortunately the data for these programs themselves is quite poor. For example, a large study published last year in JAMA showed that Medicare’s performance measure program for patients with congestive heart failure, which rewards hospitals based on how well they adhered to a handful of data driven measures of quality, made absolutely no difference in how well patients fared when implemented as part of this program.
The difference between baseball and medicine or airplanes and medicine (another common analogy) is an unpredictable variable called the patient. When flying an aircraft the laws of physics always apply, but when caring for patients the laws of human nature are not always as well grounded. When managing a Major League Baseball game, managers can generally count on that their players are focused on performing well and winning the game. When a doctor takes care of a patient, however, the patient is often more concerned with getting back to work, or their finances, or the pleasure they get from a cigarette, or the comfort they receive from food than with evidence based medicine or their physician’s statistics.
Evidence based medicine is amazing tool, but it is just a tool. We must know when and where to use it appropriately. Insurance companies don’t have a clue how to do this. On my blog, The Country Doc Report, there is a page of general truths, or “The Gospel”, of country doctoring. Amongst them is that, “The art of medicine is the proper application of the science.” Perhaps this is true for baseball as well.