June 9th, 2009 by drval in Health Policy, Humor
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I’ve been attending a series of health policy conferences recently - and twittering them live. I’ve heard a lot of smart ideas and a lot of not-so-smart ideas. For your consideration, I offer you my best and worst recent health policy quotes:
The best quotes:
1. Evan Falchuk, Best Doctors: “Since the leading cause of misdiagnosis is a failure of synthesis - a failure by the doctor to put together available information in a way that leads them to the right conclusion - our system ought to be built around helping make sure this happens each and every time.”
2. Aneesh Chopra, Federal CTO: “HIT should not be in a box unto itself - put in a corner, making a capital-sucking sound.”
3. Clay Shirky, New Media Guru: “The problem is that, since we all die eventually, everyone will be unhappy with their healthcare at some point. This creates a social dilemma that’s neither transitory nor small. First, there will always be snake oil salesmen peddling ‘eternal life,’ and second, there will always be an unhappy faction who rail against the medical establishment.”
4. Joshua Ofman, Amgen, on comparative clinical effectiveness research: “We don’t want 2 different evidence standards. One to gain market access and a second to lose market access… There is a role for observational data to gain insights. There is a great allure of large, readily accessible databases that are fast - but the power and speed cannot overcome bias and confounding. ”
5. Vivek Kundra, Federal CIO: “We need to bake security into the architecture that we purchase from the private sector. The sprinkler system is part of any house you purchase - you don’t have to add it later.”
The Worst Quotes:
1. Senator Tom Harkin: “The NCCAM has failed to do their job of validating complementary and alternative medicine therapies.”
2. Senator Max Baucus: “Going to the doctor is like buying a car, except buying a car is a lot more fun.” Bonus quote: “If men liked shopping, they’d call it research.” [???]
3. Theresa Cullen, CIO, Indian Health Service : “At some point we’ll have to tell providers ‘you have to use EHR, we’ve drawn a line. If you don’t use it you’ll have to leave.’”
4. Sean Tunis, Center for Medical Technology Policy: “Randomized Clinical Trials can be designed with generous inclusion and exclusion criteria. Their limited inclusion criteria are not a permanent defect… We can’t wait 5 years for RCTs to be done. We have to find new methods that we can use (a “silver level of evidence” rather than the RCT “gold level”) to help inform our care decisions.”
5. Congressman Pete Stark: “I’m sick of rich doctors driving up in their Porsches saying ‘I’m pulling out of Medicare.’”
June 2nd, 2009 by drval in Celebrity Interviews
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New Media guru Clay Shirky was the keynote speaker at the Management of Change conference in Norfolk, Virginia. His recent book, Here Comes Everybody, is considered a must-read by most web 2.0 enthusiasts. Clay and I escaped the conference for a tête-á-tête at a local Starbucks where we wrestled with the thorny issues of healthcare and crowd sourcing.
Dr. Val: I’ve noticed that there is a difference between being right and being influential. Doctors are having a hard time adjusting their tone to be more compelling in a social media culture. What do you think physicians can do to be more influential online?
Shirky: The problem is that, since we all die eventually, everyone will be unhappy with their healthcare at some point. This creates a social dilemma that’s neither transitory nor small. First, there will always be snake oil salesmen peddling “eternal life,” and second, there will always be an unhappy faction who rail against the medical establishment. You should not try to stamp out that faction, but referee it. Federalist Papers No. 10 states that faction is the normal case of government - the trick is not to allow factions to gain disproportionate power. Physicians need to realize that patients have different priorities than they do, and speak to those as much as possible.
Dr. Val: What do you mean that we have different priorities?
Shirky: Take Medpedia for example - physicians are eager to write about rare types of liver cancer, but they don’t want to write about the basics of biopsy technique. For the physician, it’s perfectly obvious what a liver biopsy entails, so he/she doesn’t think to write about it. But the patient is probably more interested in learning about biopsy procedure than the scientific details of a rare liver cancer. The entries in Medpedia strongly reflect physician interests and priorities, though the resource is ultimately supposed to serve the educational needs of patients.
Dr. Val: What’s the best way to close that gap in priorities?
Shirky: We need to fuse the conversation between physicians and patients. The more they work together, the more valuable the content will be.
Dr. Val: What do you think about the trend towards “user-generated healthcare?”
Shirky: It’s important to have checks and balances. When lay people discuss medicine, their unguided conversation can degenerate into vitamin hucksterism. I think that whole movement was initiated when the FDA decided not to regulate the supplement industry - people have been used to getting input from others who aren’t scientifically qualified. Now everyone gives medical advice, and people listen.
Social media is a very new phenomenon. We have not figured out how to apply good checks and balances yet - amateurs’ opinions and voices can drown out the experts. We want to believe that everyone’s opinion is equally valid - but that’s just not the case. In the end, quality and clarity of messaging is a source of power.
