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The Dartmouth Atlas Debate: Careful Consideration Needed

The worst-kept secret in journalism circles recently was that the New York Times was planning an article critical of the Dartmouth Atlas. Among the main points in the article:

• “The mistaken belief that the Dartmouth research proves that cheaper care is better care is widespread.”

• “The atlas’s hospital rankings do not take into account care that prolongs or improves lives.”

• “Even Dartmouth’s claims about which hospitals and regions are cheapest may be suspect.”

• “Failing to make basic data adjustments undermines the geographic variations the atlas purports to show.”

The Times has also published the correspondence it had with the Dartmouth team about methodology questions.

The Dartmouth team challenges each of these criticisms. The team says the Times made at least five factual errors and several misrepresentations. They write:

“What is truly unfortunate is that the Times missed an opportunity to help educate the American public about what our research actually shows — or about the breadth of agreement about what our findings mean for health care reform.” Read more »

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

Regional Variations in Total Knee Replacement Surgery

It has been proven than there is tremendous variation in the practice of medicine across the United States. The Dartmouth data (Wennberg et al) has documented the differences in how medical resources are used and how different physicians practice medicine, depending upon where they live. The Dartmouth studies are mainly focused on cost and outcomes and make the case that improved quality is often inversely related to the cost of care. More (expensive) care is not necessarily better care.

Now that I am recovering from a total joint replacement, I am amazed to see the differences in how physicians, doing the same surgery, treat the patient. Total knee replacement (TKA) is one of the most common orthopedic procedures done today. Despite this, the patient cannot expect the same post op care. Read more »

*This blog post was originally published at EverythingHealth*

Does Poverty Help To Explain Medical Practice Variation?

MilwaukeeIs poverty the major factor underlying geographic variation in health care? It assuredly is. There is abundant evidence that poverty is strongly associated with poor health status, greater per capita health care spending, more hospital readmissions and poorer outcomes. It is the single strongest factor in variation in health care and the single greatest contributor to “excess” health care spending. It should be the focus of health care reform but, sadly, many provisions in the current bills will worsen the problem.

Much of this is discussed elsewhere on this blog and in our recent “Report to The President and The Congress.” In this posting, I would simply like to tap into your common sense. We all know that poverty is geographic. There are wealthy neighborhoods and impoverished ones, rich states and poor ones, developed countries and developing ones.  Sometimes poverty is regional, as in Mississippi, but sometimes it’s confined to “poverty ghettos,”  as in the South Bronx. Read more »

*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*

Latest Interviews

The Surprising Economic Burden Of ADHD (Attention-Deficit Hyperactivity Disorder)

If you can read this you need to download a more recent browser It is estimated that as many as million U.S. adults have ADHD Attention-Deficit Hyperactivity Disorder A recent research study publication-pending suggests that the economic burden of ADHD on America could be as high as billion annually. I…

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Is The Adderall Shortage A Harbinger Of Future Drug Supply Problems?

If you can read this you need to download a more recent browser Today most- if not all- Doctor’s offices are strained by the shortage of some prescription medication or vaccine. A month ago President Obama signed his executive order directing the FDA to take steps to reduce drug shortages…

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Latest Book Reviews

Book Review: The First Step To Improve Health Care Is A Close Examination Of How It’s Delivered

My friend and former Chair of the CFAH Board of Trustees Doug Kamerow has written a book that I think you will like. Besides being a mensch and witty as heck Doug is a family doctor and a preventive medicine specialist. In his new book Dissecting American Health Care Commentaries…

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“Your Medical Mind” Explores Factors That Influence A Patient’s Medical Decisions

Recently I had a conversation with Shannon Brownlee the widely respected science journalist and acting director of the Health Policy Program at the New America Foundation about whether men should continue to have access to the PSA test for prostate cancer screening despite the overwhelming evidence that it extends few…

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Book Review: Food Truths, Food Lies

Food Truths Food Lies written by family physician Eric Marcotte M.D. may be the most refreshingly evidence-based diet book of the decade. You will not find a single mention of super-foods magical berries or supplement must-haves in the entire book. What you will find is the cold hard truth about…

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