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Small Data

September 11, 2013

The debate about quality health care when it comes to technology vs prevention has two camps: those who think Big Data and High Tech are the way to go, and those who think more human interactions are the key.  Sometimes we have data.  Sometimes we don’t.  Three articles in the media in the last week can serve to illustrate this dichotomy.  There is more evidence that robotic surgery is not all the company that makes it would have us think.  Getting an angioplasty faster does not decrease your risk of dying.  And house calls are on the rise.  Here they are:

 

http://well.blogs.nytimes.com/2013/09/09/new-concerns-on-robotic-surgeries/?ref=health&_r=0

http://www.latimes.com/search/dispatcher.front?Query=angioplasty&target=adv_all

http://opinionator.blogs.nytimes.com/2013/09/05/hi-its-your-doctor/?hp&_r=0

 

The article about robotic surgery surprises no one who works with the device.  The significant thing to me about Ms Rabin’s article is that it starts with an anecdote, a common journalistic technique, and most of the evidence against robotic surgery is indeed anecdotal.  The only way to find out if something is safe and effective is to have data points that are meaningful.  We in the medical profession MUST hold ourselves accountable for reporting bad things that happen.  Litigation will inevitably result.  That’s the world we doctors live in.

The angioplasty study brings up a different point: just because something makes intuitive sense doesn’t mean it works.  Everybody was so sure that earlier intervention would improve mortality in people having acute heart attacks that there was a nation-wide push for “door to catheter” time, before we had any data.  Now we do.  It appears that we might have reached the limit on what this particular technology can do.

Anyone who reads my blog knows my bias is going to be towards Dr. Emmanuel’s comments on house calls.  Unlike in the angioplasty study, there is no large-scale data on the health and economic benefits of more house calls.  Intuitively it makes sense that going to someone’s house to treat them should be more effective and cheaper than putting everyone in the ER.  We could be wrong.

In a purely economic sense, angioplasty and robotic surgery “cost” more, in the sense that they are re-imbursed at a much higher rate than a house call is. From a time perspective, house calls are much more costly.  From a purely quality of care perspective the robot is arguably poor quality, angioplasty is arguably high quality but limited, and a house call is arguably great quality.  The cost-benefit ratio appears to be an inverse one.  Not what we were going for.

 

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