What a myth is not

More commentary on recent news and a round-up of recent posts is forthcoming, but in the meantime, Elizabeth McGlynn, associate director at RAND Health, responds to an op-ed about health reform that appeared in the Wall Street Journal on August 31.   

As a researcher, it is my practice to bring the relevant facts to any policy discussion.  My work is specifically designed to provide evidence that can inform policy decisions. One highlight of my career was leading a team of researchers in a set of RAND Corporation studies where we examined the quality of care that Americans receive, concluding that American adults receive 55 percent of recommended medical care. 

Our research results -- especially that 55 percent finding -- have been quoted extensively by leaders and experts who are seeking to improve the way the nation pays for and delivers health care. What we found in this series of studies points to one of the things we need to change about American health care: we need to do a better job making sure people get the care they need. 

In a recent op-ed published in the Wall Street Journal, Jerome Groopman and Pamela Hartzband characterized the 55 percent finding as one “myth” in the current health reform debate. Their comment suggests our finding was something conjured up from someone’s imagination.  Far from it! The study was conducted at one of the nation’s leading research organizations, supported by the well-regarded Robert Wood Johnson Foundation, and vetted through the peer and editorial review process at the New England Journal of Medicine. Hardly the process used to manufacture myths.
 
Groopman and Hartzband dismiss the finding as a myth because of certain “flaws” in the study. I would be the first to admit that, as with any study, ours was not perfect. But our study was a significant undertaking that used the best and most-extensive methods ever assembled to examine the quality of medical care delivered in the United States. We addressed all of the issues they raise about potential shortcomings when we first published the results of the study in 2003. For example, Groopman and Hartzband criticize the study because we didn’t get medical records from everyone and in some cases we didn’t get records from all of the doctors who saw some of our study participants.  However, they chose to ignore the careful testing we did to see whether fixing either of these limitations would have changed our findings significantly. We found that the results would have been the same. They point out that while the medical records in our study showed patients received flu shots just 15 percent of the time, patients in our study reported they got flu shots 85 percent of the time. However, they failed to acknowledge that we used the 85 percent number when arriving at our overall results.  And again, our conclusions and findings were subjected to the tests of our peers and others who ultimately agreed that our methods were sound. 

It appears that the main point of the op-ed is to argue that any health reform legislation will necessarily prevent doctors and patients from talking about who should get what health services.  It seems to me that most people hope that we can find a way to improve the care Americans receive, eliminate unnecessary or wasteful care, and at the same time, do a better job of delivering the care that Americans really need. With that in mind, I find it all the more frustrating that the Groopman and Hartzband opinion piece uses misinformation and misinterpretation to confuse the debate about health reform. This is exactly what the doctor should not order.