Super Crunching and Medical Care

Evidence Based Medicine is a simple concept: using evidence and data (on top of intuition) to help inform physicians regarding diagnostics and treatment. Why would any physician object to this practice? It’s not like the data will be taking over their minds, or forcing them to make decisions. Medical data will do what data always does: present facts (sometimes unintuitive, but facts nonetheless) to aid in decision-making.

Consider this example from history: in the early 1840s, a doctor in Vienna by the name of Ignaz Semmelweis noticed that pregnant women examined by doctors who had not washed their hands had very high death rates. He collected data and found that mortality rates dropped from 12 to 2 percent when physicians washed their hands. He published his results and advocated hand washing for all physicians (his work laid the foundation for the germ theory of disease). His physician colleagues did not react to the data the way he expected them to. He had hoped to save the lives of mothers across the world. Instead, he was ridiculed, rejected, and fired. Apparently, one argument was that hand washing took too much of their valuable time.

Doctors today know the importance of cleanliness. But why didn’t they listen and change immediately?

Currently, the evidence based medicine argument is moving toward diagnostics. The New England Journal of Medicine reported an instance of “Google diagnostics.” That is, a patient’s symptoms did not lead medical experts to determine a cause, but when a fellow plugged those symptoms into Google, the syndrome popped right up. A leading engine for evidenced based diagnostics is a search engine entitled Isabel. Isabel is essentially a medical version of Google (one wonders when (not if) Google itself will enter the evidenced based medicine market). It takes less than a minute to enter symptoms and receive a list of common syndromes from Isabel, complete with a question to the physician: “have you considered…” This method prevents misdiagnosis from “premature closure,” a common cause of misdiagnosis.

Surprisingly, evidenced based medicine is not wildly popular among politicians. Why not? Why not invest money in evidenced based medicine? Policy makers should announce a tax subsidy or tax reduction for evidence based medicine data firms or for physician offices that utilize evidence based medicine or technologies such as Isabel.  Obamacare created a Patient-Centered Outcomes Research Institute to further comparative effectiveness research, and while the effectiveness of the Institute is unclear, it may be overkill. An entire government agency may be more cumbersome and intrusive than individual subsidies and tax breaks.

Regardless of policy specifics, policy should be made to incentivize evidenced based medicine. Data and statistics are tools that enhance the effectiveness of most fields, and they have the potential to save lives and improve the quality of care, with very few risks.