Health care in need of repair
By Mary A. M. Rogers
Sometimes I think that Click and Clack — you know, the Car Talk™ experts — could give us a lesson on repair. They are pretty good at diagnosis; have plenty of experience in knowing how to test things out; are great listeners to the concerns of people who have a problem; and they really know subtyping — the characteristics specific to certain makes and models of different cars.
This is just the sort of expertise that is required for one aspect of the new health care policies which are being implemented across the United States. This particular initiative is called comparative effectiveness research. It is being funded to test things out (head-to-head comparisons), involves listening to concerns that are important to people (patient-centered outcomes), and evaluates which therapies work best in specific types of people (subtyping).
While mechanics and others working in various industries tend to do this as a normal part of everyday business, it is remarkable why we haven’t made a renewed effort to do this better in health care years ago. It only makes sense. Who wouldn’t want to know which treatments work better than others? Who wouldn’t want to know whether specific therapies make it easier (or more difficult) for you to function day-to-day when at work or at home? Who wouldn’t want to know whether a treatment tends to work particularly well in people who are just like me — of similar age, background, and medical history? Certainly, the patients involved and their families would like this information. Such information can provide the basis for better decision making. And, besides, it’s good business practice.
As a medical researcher, I work with others to design studies to test things out, take care to include outcomes important to patients, and am currently making a renewed effort to discover which therapies work better in particular types of patients. From the perspective of a person who is working in the trenches of research, there is too much rancor over the concept of comparative effectiveness research. Perhaps, as usual, there is the concern regarding where the money will be spent. Rigorous debate is to be anticipated whenever money is involved. But the concept — well, who could argue with that?
Here again we can take a lesson from Click and Clack. They do an incredible job in educating the public. Even people without an intrinsic love of the inner workings of a car find helpful tips and direction on how to handle car issues — all interspaced with humor. They deliver information to a wide swath of America so that even people like me — who have no real love of cars per se — learn something and love learning it. If we could only tap that type of energy to help people learn about other choices in their daily lives — those involving their health. There is some good evidence already available in the medical literature that is useful when making health choices. These are published medical studies in which head-to-head comparisons of treatments have been made in a fair, unbiased manner. But the findings from such comparative effectiveness research do not belong on the back shelf. Strong evidence from well-conducted studies deserves up-front attention. Why would you want to waste your money (and time and health) on a treatment that doesn’t work? Certainly we wouldn’t want to spend our hard earned money on paying for unnecessary car repairs when there really isn’t a problem or to purchase costly repairs when a cheaper, more effective fix is available. When the outcome is your health, the stakes are even higher. There may not only be wasted dollars but detrimental impacts on your ability to function every day.
As the squabbling in the United States continues regarding changes in our network of health systems, know that a part of these new policies involves testing to find out what works better. Those of us doing this fieldwork believe that good health can be enhanced through good information. It’s important to know whether I only need a serpentine belt change rather than a whole engine overhaul.
Mary A. M. Rogers, PhD is a Research Associate Professor and Clinical Epidemiologist in the Department of Internal Medicine at the University of Michigan. She is the author of the upcoming Comparative Effectiveness Research.
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