They Atlas research data shows that there are numerous specialists, tests, hospital days, etc, etc, in those last two years. But, if just one preventable complication happens to an otherwise healthy Medicare patient after surgery….that can lead to months of hospitalization and ‘over-use’. The problem is that the overuse could have been prevented by better quality/preventing the complication that led to the over-use.

I asked Eliot Fisher if they do tease out this data to see how much of an impact poor quality/preventable errors or complications have on over-use and he said they don’t look at that.

This has significant implications. The devil is in the details here. I’m sure my mother’s case happens a lot; what was supposed to be a 5 day stay recovering from surgery—-turned into 8 months of severe “over-use” (sepsis from MRSA, a bedsore, at least 2o more infections, 2 broken ribs, etc.) and over 1 million dollars in costs. If they are not digging into these details, and instead making a global statement that it’s technology-driven overuse instead of preventable complications that lead to the overuse in many cases, then this will lead us to incomplete solutions.

Healthgrades data shows that sepsis, failure to rescue and respiratory failure are the leading patient safety incidents causing death to Medicare patients. This is exactly what happened in my mother’s case.

So why aren’t the Dartmouth Atlas Researchers looking at this data to expose the issue of how poor quality drives up the costs and over-utilization in the last 2 years of life.

And probably the most important revelation to this is that it wouldn’t have been the last 2 years of her life if that initial post-operative infection hadn’t happened.
She’d still be alive today.

CDC has not implied anywhere that they expect people to “lose a lot of weight and keep it off.” If anything, CDC has an pretty good idea of how effective their program will be. They had enough evidence to publish and show everyone their program but comments like this shut the site down. The truth is, the public always wants one side or the other and little details will completely stop initiatives like this. CDC doesn’t have the get the right the first time every time, they should be allowed to make mistakes and fix them as long as they adhere to the main goal. Perhaps we should all have a little more faith and a little less criticism in what the government does for all of us.

Doctors are trained to render opinions based on the evidence available, through careful reading of journal articles and relative literature, including assessment of the statistics, methods and other details of the studies. They don’t, usually, ask other experts “what do you think about this or that?” A good doctor makes it her business to keep up with the literature and to practice medicine according to what she reads in current medical publications.

Journalists often are trained, by contrast, to collect data by asking around - the more sources the better. The convention is to provide at least one voice for each “side” of a story, rather than providing an “answer.” As a result, there’s relatively more emphasis on what the experts say than on the technical findings of a new study or report.

I find this approach – of asking experts - irrelevant to most good science journalism, where the facts should be clear or not, and unhelpful in most medical reporting. That’s because an expert’s insight, represented in a pulled quote, doesn’t necessarily advance the public’s knowledge of the facts, whatever those are.

Rather, the use of quotes, whether they’re from Dr. Val or Harold Varmus, can distract the reader from the real news, i.e. the scientific discovery or report in itself. Experts are of course biased, that’s why we (journalists) call on them. Quite often it seems the quotes are agenda-driven rather than illuminating. Besides, in representing and ordering experts’ views, we and our editors necessarily introduce our perspective into the story, whether we acknowledge it or otherwise.

So here’s an unconventional view of science and medical journalism: I think that the best, or at least the most objective, journalists (assuming objectivity is possible) would carefully review new findings and report on those directly, without reliance on interviews or other commentary.