April 11, 2016
Don’t Trust The Conventional Wisdom In Healthcare—Part 1
By Michael D. Shaw
While he may not have been the first to say it, Steven D. Levitt, co-author of Freakonomics: A Rogue Economist Explores the Hidden Side of Everything (2005) is credited with the quotation: “The conventional wisdom is often wrong.” Levitt bundles this concept with a distinction between positive and normative analysis.
In the purest sense, positive economics is objective and fact based, while normative economics is subjective and value based. However, this clear distinction can become muddied. As Investopedia reminds us, “Positive economic statements do not have to be correct, but they must be able to be tested and proved or disproved. Normative economic statements are opinion based, so they cannot be proved or disproved.”
By way of example, the statement, “Government should provide basic healthcare to all citizens” is a normative economic statement. The statement, “Government-provided healthcare increases public expenditures” is a positive economic statement, because it can be proved or disproved by examining healthcare spending data.
Riffing on John Kenneth Galbraith’s The Affluent Society (1958), which devotes an entire chapter to the topic, Levitt asserts that conventional wisdom must be simple, convenient, comfortable, and comforting, though not necessarily true. Moreover, once established and enshrined by the experts and their media co-conspirators—who often cite each other as proof—this “wisdom” can be exceedingly difficult to remove.
Consider tendinitis, or more specifically, lateral epicondylitis aka tennis elbow. Many, if not most sources emphasize stretching the forearm extensors and supinators. However, most sufferers of this condition achieve little relief via stretching. So, what’s wrong with this conventional wisdom? Listen to good guy Jamie Dreyer, the owner of Overhaul Training.
“The reason you’re experiencing tendinitis in your forearm is because the muscles in your forearm are not strong enough to resist the force that’s going through them. The repetitive swinging action exerts a strong pulling motion on those muscles and tendons. They start to get overstretched, they become inflamed and irritated, and there’s your tendinitis. As you can see, the cause of the condition is overstretching, so why would you stretch to heal it? You wouldn’t.”
In keeping with our basic theme, here’s one more quote from Jamie’s website: “Common knowledge is kinda like reality TV, it’s not a great representation of the truth.”
Students of American history are familiar with the conventional medical treatment given to George Washington, which likely hastened his demise. A brutal combination of bloodletting, enemas, and induced vomiting—to “balance his bodily fluids”—as a treatment for what was probably little more than a nasty upper respiratory infection, killed him in the space of two days. For what it’s worth, his wife Martha did not buy into the treatment, but could do little to dissuade her stricken husband. After all, he was George Washington, and he was getting the best of care!
Now for some big picture stuff. Inasmuch as the mission statement of essentially all healthcare institutions is some form of “Putting the patient first,” by definition, that is the conventional wisdom. Check these out…
New York-Presbyterian Hospital: “Patient-centered clinical care”
Cedars-Sinai: “Quality patient care is our priority. Providing excellent clinical and service quality, offering compassionate care, and supporting research and medical education are essential to our mission.”
Johns Hopkins: “Patient- and family-centered care is a key priority”
Mayo Clinic: “The needs of the patient come first.”
Virginia Mason: “Our mission is to improve the health and well-being of the patients we serve – Healing illness is our first priority and is what gives our people the energy for our vision.”
If you delve further into the matter, you will also discover—on hospital websites—odes to transparency, and in some cases reporting of outcomes. So, this is all good, right?
Unfortunately, no. We need only reflect on the scandal of endoscope related infections. Ignore, for the moment, that proper infection control is not exactly rocket science. Heck, compared to the high-tech activities that occur in a hospital every day, it comes off as grammar school playtime. Focus instead on how these outbreaks were handled.
In virtually every case, disclosure of the incidents was made only after information was leaked by an unofficial source, or was revealed during the investigations of Senator Patty Murray. Notably, in the latest case, the name of this hospital has not been disclosed.
More than that, since a goodly number of the procedures in question were either performed with recalled medical devices, or reprocessed (disinfected) with a recalled AER (automated endoscope reprocessor), informed consent would have been required. Yet, in light of the draconian information blackout foolishly imposed by the affected institutions, informed consent was almost surely not obtained.
We are left to conclude that at least in this situation, “patient first” has become “patient last.” And that those cynics who define “patient” as a mechanism to extract revenue from a third party payer may be onto something.