Wednesday, March 5, 2008

Enough of Open Source already. What really convinces in disease management are anecdotes!

After re-reading prior entries on the topic, the Disease Management Care Blog has no doubts about the non-likelihood that any entity in the business of population-based health care will ever adopt Open Source. So, it's time to blow tanks and surface by ceasing further commentary on the topic (both for the readers’ sake as well as mine)….after one last important point.

The very erudite Thomas Wilson, PhD reminded me once that a key difference in the health care trade versus other types of business is that the former is based on the Hippocratic principle of 'Primum non nocere' (first, do no harm), while the latter, at least in its classic form, is founded upon the philosophy of 'caveat emptor' (buyer beware).

For me, that gets to the heart of the issue. While this is an admittedly overbroad distinction, the fact is that no health care intervention is truly risk free (including the possibility of wasting time and money). The medical community has always had a stake in explicitly measuring the value of its goods and services. In contrast, other sectors of business often leave it up to the customer to assess value. This distinction can be muddied by somewhat by common and contract law as well as other dimensions of business ethics, but I think you’ll agree that there is something to this point.

Add this fundamental Primun non nocere principle to the widely prevalent culture of social mission “research,” in medicine and it becomes clearer why the high standard “prove this works” evidence-based medicine ethos has butted heads with style of many commercial disease management programs. While there is plenty of guilt to go around in the various medical device manufacturers, hospital business lines, pharma, integrated delivery systems and medical schools, that doesn’t absolve the disease management community of also having a responsibility to thoroughly and transparently assess the good, the bad and the ugly of its otherwise proprietary processes and putative outcomes.

There must be ways to move to Open Source that relies on third parties with a viable business model that protects the interests of all involved. It’s happening in genomic medicine, should happen in pharma and is applicable to the science of epidemiology. It could have also provided some additional protection to the hapless hip protector researcher Dr. Kiel as well as the unlucky COX II New England Journal of Medicine reviewers who have apparently been subjected to a subpoena.

Feel free to post your thoughts (if posting works... I'm trying to fix this) or let me know what you think.

As for me, time to move onto a related but different topic:

It’s not research findings that win hearts and minds in the market, but anecdotes! Heart wrenching and tailored to support a pre-ordained conclusion, the DMCB thinks it was raised to an art form during the Reagan Presidency when he stacked the rhetorical decks during the State of the Union Addresses by recognizing examples of the righteousness of his cause in the Visitors’ Gallery.

And it’s spread to healthcare. Rather than debate policy based on just the facts, fans of Massachusetts’s style insurance, the Medical Home (see page 12) and Personal Health Records are buttressing their points of view with convincing anecdotes.

So, the DMCB took a quick walk-about of many of the disease management company web sites and is distressed to report there is a dearth of anecdotes supporting their notions of remote telephonic population based health care. Egads!

As a service to the industry, I’ve hastily created a turnkey, menu driven ‘population based care anecdote template’ below. If you are from a DM company and anecdotes are not liberally sprinkled in your web site and other marketing materials, I suggest you download this, edit freely, plug in the appropriate text and implement it ASAP.

[Name] was [surprised/flummoxed/ready to take a nap] when it was discovered that [he/she/they] had [diabetes/asthma/chronic heart failure/lumbago/other]. [Name]’s condition was [out of control/turning weird colors/becoming radioactive] until there was a life-transforming phone call from the [name of disease management company]’s [coach/sherpa/barista] named [Mary/Hulk Hogan/The Green Lantern]. After being [empowered/spammed/browbeat], [Name]’s [condition] got [better/was posted on YouTube/was found to be a misdiagnosis]! The co-morbidities [- use more than one - gout/writer’s cramp/halitosis/tinea unguum/oculomicturalgia/Pott’s Disease/sausage digits/conkus of the bonkus] was also [improved/cut out/triggered a county wide quarantine] by the [name of company]’s state of the art consumer engagement and activation. ‘If it weren’t for my [name of disease management company]’s [nurse, radiology technician/fruit vendor],’ said [Name], 'I would have never gotten [through this/such a nice tan/my car started]. Thank you [name of disease management company] and all your investors,' [he/she/they] added, 'and please don't let them cancel Medicare Health Support.'

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