20100114 calvin brown 18
Dr. Calvin Brown - 


Kai Ryssdal: There is talk this afternoon of a deal on health care. Not on the whole thing, mind you, but rather agreement between the White House, Congress, and labor unions over those Cadillac health plans and how much they ought to be taxed. Details still forthcoming, I should tell you.

Largely lost in the health care debate, though, is the idea of controlling costs in the way medicine is practiced. There is a school of thought that says what you ought to do is take the results of medical studies and run a statistical analysis to figure out what works best for the largest number of people. That is called evidence-based medicine.

Commentator and physician Calvin Brown says it only goes so far.

CALVIN BROWN: It almost sounds easy: Build a health care system around medical practices that are shown most effective for most people. Take arthritis for example. One pill, let's call it the red pill, has been found to alleviate pain for the vast majority of sufferers. Enough said. Next patient. But wait. For the minority, and let's put you in that category, the red pill has little to no effect. For you, the blue pill shows better results. But it costs twice as much. Should you have to take the cheaper pill even though it doesn't work as well for you?

It's tempting to frame the health care debate in black and white: Do we choose a system that makes us healthier as a whole and saves us money, but may not give each of us the best individual results? Or do we protect the freedom of choice that's given us the most comprehensive, but also the most expensive, health care system in the world.

Why not try a mix of both? We could start by giving everyone the low-cost red pill. When some people get no relief, we switch them over to the blue pill. We could use some of the savings from having most people take the red one.

But this approach does have limits. It may not apply so easily to disease screenings as it does to treatments. Take breast cancer. If we adopt recommendations that women under 50 avoid this screening, we'll save millions of dollars. But some people -- one thousandth of one percent -- will go undiagnosed and die. Is that fair? I don't think so.

Any woman who wants a screening should have it. Health care doesn't have to be an either/or proposition. We can have cost-effective care that is personalized and high-quality. We just need to be smart about how to apply it.

RYSSDAL: Dr. Calvin Brown teaches rheumatology at Northwestern University's Feinberg School of Medicine.