Cheap, Fast, Good: Pick Two

(Rick Egan | The Salt Lake Tribune) John Hayes, left, with Thomas Rockwell Mackie inside the TomoTherapy machine Mackie invented during an open house at St. Mark's Hospital to showcase new image-guided radiation therapy technology.

Paul Levy, the former CEO of Beth Israel-Deaconess Hospital, writes a fantastic blog.  His posts are a window into the workings of the upper echelon of Boston’s hospital community, a talented, aggressive, and historically secretive bunch.  What’s more amazing is that he started this blog when he was the CEO.  He used the blog as a bully pulpit of sorts to push aggressively for transparency in hospital quality results, for fair pricing, and for honest media reporting.

His most recent post is an example of both Paul’s eye for quality reporting and one thoroughly misunderstood fact of medicine. The piece in question is by Kristen Stewart of the Salt Lake Tribune, which comments on a local hospital’s recent addition to the medical arms race:

The rise of high-tech medicine has coincided with a decrease in death rates from cancer. But scientists differ on whether it’s directly responsible for prolonging lives.

[A]bout 80 percent of our increase in longevity is tied to our socioeconomic status — “something about the way we live together, whether that’s job security or education levels,” Hadler said.

Right.  With the billions going to advanced medical technologies every year — which is not always a bad thing — we forget that the main reason we’re living longer, happier, and more productive lives is because the average standard of living and lifestyle is improving.

The average standard of living.  One of the reasons we know that socioeconomic status has such a profound effect on longevity is because we can watch health outcomes change as we become an increasingly stratified society.  The average may be increasing because better-off people can increasingly afford peaceful neighborhoods, healthy foods, exercise that’s actually fun, and general stability.  But that’s not true for the least-well-off groups whose lack of stability and lifetime of powerlessness contribute to declining health outcomes.

Powerlessness, in particular, plays a crucial and well-documented role in deteriorating health.  The Whitehall Studies, which were two ten-year studies on the rigid hierarchy of the British Civil Service, showed that, controlling for most everything else, those that had the least control over their daily activities had the shortest lifespan and poorest health.

The key is that the adversity of poverty alone doesn’t explain why poorer people are unhelathier than their wealthier counterparts.  Latinos, for instance, have some of the highest rates of poverty, work is some of the least powerful jobs, and yet have better outcomes than most because of strong social networks.

Hospitals often pat themselves on the back for acquiring the latest, football-field sized medical technology.  Patients take comfort in the fact that they’ve chosen a hospital with such an aggressive commitment to delivering the most advanced care.  But it’s clear that, even if these things cost a fraction of what they do, it doesn’t really matter that much.  What matters are strong relationships, income stability, meaningful education, clean air, low-stress living, access to regular medical care and nutritious foods, etc.  

Cheaper, more effective — but far harder.

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