Coss Effective

The banking and finance industries were among the first to make extensive investments in information technology.  Perhaps no other industry has done more with detailed information technology. You can see that in your own experience of ATM’s and now web access to your accounts.  Checks clear in a matter of hours and personal credit cards are accepted virtually everywhere in the world.  If you were to think of industries in which there is an abundance of information from which sound decisions can be made, the finance industry would likely rank among the top, yet after all the detailed information across decades, the finance industry did not forsee the problems in which we now find ourself.

In the book the Black Swan, Nassim Taleb points to many failures of financial decisionmakers in their paying attention to details, in particular their propensity to depend upon exotic financial equations in providing them guidance in their decissions.  The challenge we have in Dr. Taleb’s book, is that it was first published 2 years ago and described with great clarity what we are experiencing today.  So what are we to make of this?  What does the lessons of the current financial crisis have for those seeking similar metrics for the future of healthcare, namely Comparative Effectiveness measurements.

First, this is not to suggest that we shouldn’t look into the effectiveness of new products and procedures, but it is a warning to those that place such great hope that such analysis will save money.  It may, but it very well may not.  Truth be known, medicine isn’t much better than the financial industry at predicting the future, and we don’t have nearly the data that the financial industry has.  Healthcare is arguably 20 to 30 years behind the banking and finance industry in regard to their information systems and the information they produce.  Imagine the leap of faith required to think that medicine can do better than the financial industry with less experience, less information and an eminently more complex biologic processes.  Just how are we to believe that?

Medicine profits heavily from surprise and we benefit by capitalizing on the unexpected.  I think of small and powerful things like Folic Acid during pregnancy that lowers the incidents of neuro tube defects.  Or a failed antihypertensive drug that later became Viagra and is now used with great success in the treatment of patients with pulmonary hypertension.  In what possible way could these beneifits be discovered ex ante?  In the end, it is the hight of hubrice to begin to think that we have all the data we require along with the ability to analize it, and in so doing apply Comparative Effectiveness metrics to lower costs while improving outcomes.  This, ladys and gentlemen, is what they call in Basketball a “head fake”.