WHAT ABOUT THE HEALTH CARE OF THE OAKLAND ATHLETICS??

OK— got that off my chest. Interesting piece for many reasons. The philosophy makes sense. Wonder if Gingrich was the spur for this— and how exactly he enlisted Kerry. But mostly I wonder what this tells us about the future of one William Lamar Beane— if he’s sticking his toes in as big a pond as our health care system, I would think his days as a GM of a baseball team are numbered— Moneyball or no Moneyball.

The VA system already has practices similar to those described in the article in place. I worked for the VA for a while. It has it’s problems, but it is the best health care system in this country. It costs less, gets better outcomes, and is more likely to use evidence based approaches to care than private doctors.The big problem is that patients don’t want to follow evidence based practice. People really want the new wonder drug, or this drug their private doctor is really enthusiastic about weather or not there is evidence of efficacy. To use a baseball analogy, there are a lot of people who are in the bottom of the 9th of a tie game with one out and really want to bunt the runner to second. It doesn’t matter to them that there is good evidence that they are decreasing their chances or scoring. Following evidence based practice frequently means a patient doesn’t get their way, and that’s a hard thing to sell to people. I recommend The Best Care Anywhere or this article.

I’ll also point out that there are a few problems with Beane’s NYT article. The authors seem to be really fond of the Cochrane Review. It’s a fine resource, but meta analysis has many of its own pitfalls. They essentially attempt to statistically combine many studies into one data base and reanalyze results based on larger samples. The problem is that, unlike baseball where everyone is playing by the same rules, studies are done significantly differently. They use different populations, different exclusion criteria, different protocols, etc. Conclusions based on meta-analyses have historically been later proven false at alarmingly high rates (I’ve seen error rates up to 33%).

They also miss the boat in their call for standardized guidelines. These likewise already exist. If you are diagnosed with any reasonably common medical condition, you will probably find treatment guidelines at either www.guidelines.gov or the web site of the relevant major professional organization (American Diabetes Association for diabetes, for example).

One of the things I find most frustrating in the ongoing health care debate is the continual problem of smart people completely misunderstanding the state of health care in this country. It’s not that we don’t know what the common problems in patient care are, it’s just that there really is no system at all. Consider this: when you go into a hospital, the doctors have no way of knowing what conditions you’re being treated for or what medications you’re taking. When you pick up a prescription, your pharmacist has no clue what conditions you have or what your being treated for. How is a professional supposed to make good, evidence based decisions in a system when we are given no information on the patients we’re treating? How can you expect patients to get the best possible care when the entire reason d’etre of the system is to make a profit by giving as little care as possible? As with baseball, the results we get are a product of the process we have in place. Europe gets better health care outcomes at a lower cost because their entire approach to healthcare is different. If we want better results, we need a fundamental change in our process.