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A simple solution to the healthcare crisis
- 1. A simple and overlooked solution to the healthcare crisis Marya Zilberberg, MD, MPH Ignite Boston March 29, 2012 @murzee
- 2. 2,600,000,000,000 $2.6 trillion @murzee
- 3. @murzee
- 4. Overtreatment Between $158 and $226 billion per year Berwick, D. M. et al. JAMA doi:10.1001/jama.2012.362 @murzee
- 5. Avoidable deaths 50,000-100,0001 225,0002 >400,000 2 1Institute of Medicine, 1999 2Starfield B, JAMA 2000 @murzee
- 6. Healthcare is… 3rd leading cause of death in the US 1,000 lives per day 45 lives per hour @murzee
- 7. A radical idea Avoid DEATHS & OVERSPENDING by avoiding OVERDIAGNOSIS OVERTREATMENT @murzee
- 8. Why? Because we are blinding ourselves to the only certain property of medicine UNCERTAINTY @murzee
- 9. How? Open our eyes to uncertainty in medicine Learn to manage that uncertainty Dump “Anything is possible” @murzee
- 10. What if the solution were… Cheap Easy Available Allow me to introduce you to uncertainty’s sensible twin sister… @murzee
- 11. A study • 1,000 people are tested – 900 lawyers – 100 engineers • Jack is chosen at random – Single, 36 years old, introverted – Hobbies: reads science fiction and writes computer programs Adapted from DeNays&Glumicic, 2008 @murzee
- 12. What is more likely? A. Jack is a lawyer B. Jack is an engineer @murzee
- 13. Answer Engineer Lawyer Odds 9:1 in favor of LAWYER @murzee
- 14. When anything is possible, nothing is probable @murzee
- 15. But doctors are much smarter than an average person, right? Surely they don’t fall into these traps. @murzee
- 16. Problem • A disease occurs in 1 out of 1,000 people • A test to detect this disease gives a false positive result in 5% of the people tested Casscells W et al. N Engl J Med. 1978;299:999-1001 @murzee
- 17. Question What is the chance that a person found to have a positive result actually has the disease? 2%33%66%95% Casscells W et al. N Engl J Med. 1978;299:999-1001 @murzee
- 18. Answer • A. 2% AKA PPV (positive predictive value) • B. 33% • C. 66% • D. 95% Casscells W et al. N Engl J Med. 1978;299:999-1001 @murzee
- 19. Answer • A. 2% AKA PPV (positive predictive value) • B. 33% • C. 66% • D. 95% 27 of 60 respondents chose D Casscells W et al. N Engl J Med. 1978;299:999-1001 @murzee
- 20. Premature death causes 10% “Public Health”: •Behavior Medical •Socio-economic 30% Genetic •Environment 60% "Public Health" National Healhtcare Expenditures 3% Medical Public Health 97% @murzee
- 21. The Solution Uncertainty’s sensible twin sister: PROBABILITY We must teach it early and often @murzee
- 22. “I think that a failure of statistical thinking is the major intellectual shortcoming of our universities, journalism and intellectual culture.” @murzee --Steven Pinker