The Poison Review

Last week we noted Atul Gawande’s essay “Testing, Testing”  in The New Yorker and called it essential reading. In that piece, Gawande argues that just as — in the early twentieth century — the Agricultural Extension service reformed farming in the United States through the provision of research, technical advice, and well-designed pilot programs, the Senate healthcare bill’s support of similar pilots could transform American medicine.  Gawande’s argument was hopeful and inspiring.

Unfortunately, a detailed critique of the piece by economist Alain Enthoven is even more convincing.  Enthoven cites several flaws in Gawande’s analysis.  To start with, the farmers and the Agricultural Extension Service in the early 1900s started on the same page — both wanted to improve efficiency, productivity and profits.  Enthoven argues that today medical institutions and providers often resist improvements in efficiency and quality, since such changes can actually reduce pofits. Secondly, Enthoven claims, history shows that when pilot programs are initiated or prove successful, the medical-industrial complex moves heaven and earth to nip them in the bud.  Finally, reformation of American agriculture took decades.  Enthoven points out that we now do not have so much time to turn medicine around before the cost of health care bankrupts the nation.

Depressing reading.  But essential just the same.

Thanks to the blog Number Needed to Treat for linking to Enthoven’s analysis.