Comparative Effectiveness Research, Gender and Emotion

A key cost bending feature of PPACA (Obamacare) is comparative effectiveness research (see http://www.hhs.gov/recovery/programs/cer/index.html).

This research is designed to apply statistical, economic and clinical analysis to care and treatment to encourage effective care and block ineffective treatments.

It is highly likely, based on current research, the statisticians will recommend less screening and much less treatment for prostate cancer. As my doc says, "almost all old men die with prostate cancer, almost none of them die from prostate cancer." Screening should likely be focused on younger men and more aggressive forms of the cancer.

With men being somewhat nonchalant about such matters, and prostate cancer being something less than a celebrity telethon issue, it is unlikely there will much of a fuss. Money can be saved and the resulting increased mortality will be slight.

At the same time, current recommendations about breast cancer are suggesting a lot less mammography, and there is an uproar.

Breast cancer hits many women, hits many younger women, and the results are horrifying. The blowback from advocacy groups has been and will be fierce.

So can we get past gender and emotion to become more efficient and effective? Whatever sounds good in the abstract, many of us will go with emotion.

Obesity and the Medical Office

Obesity, and especially morbid obesity (1), is a growing problem for the medical office.

Even offices equipped for general practice patients, and largely in compliance with the Americans with Disability Act (ADA), may not be able to cope with patients in excess of 300 pounds.

Waiting room chairs and exam tables may not be comfortable or safe, and scales may max out well below the weight of the patients. Lifting and positioning patients can create major challenges. Imaging units may have special technical and positioning problems.

Also, this is becoming a country of power scooters, and many offices are not really designed to be friendly or accessible to these scooters.

Many morbidly obese have problems with ambulation, and many will have orthopedic issues affecting mobility.

And then there is staff, training should be designed to deal with everything from lifting and positioning patients to sensitivity in verbal interactions.

This is a challenge for medical practice administrators and staff.


(1) usually defined as Body Mass Index of greater than 40, or weight 100% above the ideal, or weight 100 pounds about the ideal.