There is a great blog post today at Five-Thirty-Eight about mammography. In the post, they discuss the pros and cons of mammography, and I think it provides a fair and thoughtful balance.
There is one quote in the post I want to discuss:"One of the central assumptions of economics is that more information cannot generate worse decisions. Mammography clearly provides more information. The problem is that contrary to our typical economic assumptions, it seems hard for doctors and patients to ignore this information. Once a tumor is detected, we want to treat it."
I think this a great point the authors make - we should not assume that more data necessarily generates better decisions. In particular, they are saying that sometimes both patients and physicians need to be protected from themselves, because they make poor decisions because they have too much data.
Simplifying it further- more data can lead to bad decisions, especially when people act on it inappropriately.
This then leads to the fundamental hypocrisy of the Affordable Care Act (the ACA, or Obamacare) and CMS (the Centers for Medicare and Medicaid Services). They are very expensively creating a major shift in health care to create bigger and bigger data sets, with the idea that this "Big Data" will lead to better decisions.
As a patient, this should feel condescending and infuriating. Basically, the politicians and the administrators behind the ACA and CMS are saying that patients and physicians do not have the discipline or wisdom to use data appropriately, but they do. They are willing to dramatically but how much money they are willing to spend on things like MRIs and mammograms, and shift that money toward making people collect data on behalf of CMS and the ACA.
So, how do you want your taxpayer money spent? Would you rather your doctor and you come to a mutual discussion of whether you need a mammogram, or do you want that decision taken away from you, and have money spent forcing doctors to push buttons to collect data for use by the ACA and CMS.
As an example of how ludicrous this use of Big Data is seen by the shift to ICD-10. ICD stands for the "International Classification of Disease", which is a list of diagnoses. Every time we see a patient, doctors need to assign a diagnosis according to ICD. The current version of ICD is called ICD-9, and the government has forced a very expensive shift to a newer, much larger system called ICD-10, that has a much longer list of diagnoses.
ICD-10 is ridiculous- it's overly complex and creates far more noise than signal. This link gives a list of several of the stupider codes. My favorite is that there are 3 different codes for health effects of walking into a lamp-post- whether it's the first time you walked into the lampost, a repeat encounter, or a secondary complication of walking into a lamp-post.
What the advocates of Big Data are proposing is that patients and physicians working together are not wise enough to use the data from mammography appropriately, but adminstrators and politicians will be able to make brilliant insights because they know which sub-type of injury you have from walking into a lamp-post. Does that make any sense to you?
There is another word for this hypocrisy- arrogance. There have NOT been any studies that have shown this shift to big data will help, and it's very expensive. And it explains why doctors are increasingly literally pushing buttons instead of talking to their patients.
Patients- there is an alternative. Think about who within the health care systems is most aligned with your interests. Is it the politicians, the administrators, the insurers, or your physician? We physicians do not like what is happening, but unfortunately we have not been successful lobbying to protect the interests of patients. Patients need to speak up and protect those who are trying to protect you.
Help physicians help you. Speak up.
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