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A simple and overlooked solution to the healthcare crisis Marya Zilberberg, MD, MPH Ignite Boston March 29, 2012 @murzee

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2,600,000,000,000 $2.6 trillion @murzee

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@murzee

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Overtreatment Between $158 and $226 billion per yearBerwick, D. M. et al. JAMA doi:10.1001/jama.2012.362 @murzee

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Avoidable deaths 50,000-100,0001 225,0002 >400,000 21Institute of Medicine, 19992Starfield B, JAMA 2000 @murzee

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Healthcare is… 3rd leading cause of death in the US1,000 lives per day 45 lives per hour @murzee

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A radical idea Avoid DEATHS &OVERSPENDING by avoidingOVERDIAGNOSISOVERTREATMENT @murzee

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Why?Because we are blinding ourselves to the only certain property of medicine UNCERTAINTY @murzee

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How?Open our eyes to uncertainty in medicine Learn to manage that uncertainty Dump “Anything is possible” @murzee

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What if the solution were… Cheap Easy AvailableAllow me to introduce you to uncertainty’s sensible twin sister… @murzee

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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

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What is more likely? A. Jack is a lawyerB. Jack is an engineer @murzee

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Answer Engineer LawyerOdds 9:1 in favor of LAWYER @murzee

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When anything is possible, nothing is probable @murzee

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But doctors are much smarterthan an average person, right? Surely they don’t fall into these traps. @murzee

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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

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QuestionWhat 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

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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

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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

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Premature death causes 10% “Public Health”: •Behavior Medical •Socio-economic 30% Genetic •Environment60% "Public Health" National Healhtcare Expenditures 3% Medical Public Health 97% @murzee

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The SolutionUncertainty’s sensible twin sister: PROBABILITYWe must teach it early and often @murzee

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“I think that a failure of statistical thinking is the major intellectual shortcoming of ouruniversities, journalism and intellectual culture.” @murzee --Steven Pinker