Two elderly women were comparing notes about the food they had while vacationing in the Catskills. The first was heard to remark, “The food, it tastes like poison,” and the second replied, “Yes, and such small portions.” That very old joke comes to mind in looking at the Pew Research Center’s report on science and medicine. There seems to be an even split between those who believe that medical treatments are “worth the costs,” and those who feel those same treatments “create as many problems as they solve.” Can we use this snapshot of opinion to paint a broader picture? That of course, depends on how you connect the dots of data.
Consider this apparent contradiction; 60% felt that side effects create as many problems as they solve, 44% felt that new treatments were released before we fully understood their consequences; yet 50% of respondents felt the process to evaluate safety and efficacy was too slow. The most comfortable narrative is that these people "just don’t get it,” they have no real understanding or appreciation of how treatments move from the lab to the office, I suppose in the same way some of us have difficulty appreciating food’s farm to table path. So that is a problem of better educating the populace. But what if those three thoughts are not contradictory and that our regulatory system may be broken in two ways, too slow and not focused on what matters, do they work and is there harm? Here’s an opportunity for policy wonks, both patient-centered and Big Pharma, to use the same data to advocate for their “fix” the problem.
46% of those surveyed said that physicians are too quick to order tests and procedures that may be unnecessary. Is this the factoid that starts the article on the continuing erosion in trust of physicians and other experts? Could the same finding represent physician’s navigating and choosing among the same treatments that respondents thought caused too many untoward side effects and unknown consequences, with the threat of malpractice litigation and “an abundance of caution” in their minds? Or perhaps physicians are meeting “quality indicators” mandated by government or the latest best-practice guidelines.
70% feel that people rely too much on prescription medicines that may be unnecessary. There can only be one drug in that category, opioids. Does this represent the reality that we see daily in the news feeds, social media, and that excellent lagging indicator [1], Congressional hearings? Or are we indeed over medicating and medicalizing? So many stories can make use of the same data dot.
Finally, 83% of respondents felt that the cost of treatments makes quality medical care unaffordable. This dot fits so many narratives, price transparency, the disparity of care by income, the failures or success of the political beliefs of your choice. It can be used by every advocacy group to blame their target de jour, doctors, insurance companies, administrators, regulators.
Data Dots
Quantification, sums and aggregates numbers, act as data dots, but we are wrong in believing they shed absolute light on a problem or concern. They are used to tell a story and can be refashioned to show a different tale. We all have points of view, and we use those skills every time we tell a story, be it to entertain or inform.
I chose to connect the dots to discuss connecting the dots.
[1] A lagging indicator is a sign that occurs after an event whereas a leading indicator appears before an event. Our Congress chooses to “lead from behind.”
Chuck Dinerstein, MD, MBA
Director of Medicine
Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.
