Feb 18, 2009

How Would You Advise President Obama?

The American Recovery and Reinvestment Act of 2009 was signed by President Obama yesterday. The $787 billion economic stimulus package's health care provisions have demonstrated that health care reform is still on the table. The package includes funding for comparative effectiveness research, health insurance coverage for unemployed workers, health information technology, Medicare, Medicaid, and the NIH. The many concerns that have been expressed in the past few years in regards to health care have not fallen on deaf ears. Now that you have President Obama's attention, what would you advise him to do?

KaiserEDU.org is now accepting entries for its Annual Essay Contest, giving undergraduate and graduate students a chance to win a prize of $1,000 by writing an essay addressing the elements of health reform that President Obama's team should focus on in 2009.

Essay Topic: President Obama has stated that reforming the health care system is one of his top priorities, and there is broad interest from policymakers and the public in making a change. During the campaign, he outlined a framework for reforming health care. The essay should cover: what elements of his plan should be prioritized given the current economic crisis, what elements are most likely to garner support and which ones will be most challenging and why?

Click here to find out more information about the contest!

Check out an article titled, "The Lessons of Success--Revisiting the Medicare Story," by David Blumenthal, M.D., M.P.P., and James Morone, Ph.D. in The New England Journal of Medicine to start thinking about Presidents and health care reform.

Don't feel like writing an essay? Post a comment and share your thoughts!

Feb 16, 2009

How Many Ways Are There to Bake Bread?

If there was a contest out there that measured the degree to which an individual enjoyed food, my family would take the cake! My relatives in China are notoriously known as the overweight ones. My great uncle in Taiwan insists on trying a little bit of everything and can never eat the same cuisine two days in a row. It's really no surprise that a good percentage of my family decided to live in Houston, one of America's fattest cities. To make matters worse, my family's love for food extends beyond our consumption behaviors. I come from a long line of great cooks! Unfortunately, this has created a very serious problem.

I have been spoiled AND I don't really know how to cook. Living on my own this year and having to prepare every meal by myself has been tough. Someone who doesn't love food so much would be okay with eating ramen everyday. Someone with an unlimited amount of money would be okay with going out to eat everyday. Someone who has never tasted my mom's Russian influenced tomato beef stew would be okay with eating it only once or twice a year. I am not that person. So, in order to satisfy my love for food, I must cook.

Thankfully, I don't have to start from scratch. My parents, Epicurious.com, and the millions of cookbooks out there are my resources for best cooking practices. Years of cooking have taught my mom how to dice and slice meats and vegetables to extract the best flavors and cook without making a huge mess. She's done the experimenting for me. My dad is our in-house bread baking expert. If I wanted to bake a loaf of extra fluffy bread, he'd know exactly how to do it.

While I was home for the holidays, my parents asked me to cook dinner to test my few months of cooking experience. I decided to make a sausage broccoli pasta that was very well received at a pot luck. After about an hour of cooking, my mom walked into the kitchen with a crinkled nose of disgust. My sister didn't even want to touch the food and decided that leftovers would taste better. My dad ate less than usual and had an encouraging smile plastered on his face. Only my dog, May, seemed to enjoy dinner. I'll admit it tasted... different. How did this happen?

    Mistake 1: I left my recipe in Boston
    Mistake 2: I was too lazy to buy all of the correct ingredients so I improvised

This goes without saying, but I essentially made something entirely different. It was untested and it tasted bad. As I poured the pasta into Tupperware reserved for food that only May would eat, my dad asked me a very enlightening question: "Why didn't you use a recipe?"

Why didn't I use a recipe? I didn't have a good answer. My dad told me that even after many years of making bread, he still uses a recipe. He told me that you can make a few adjustments here and there. Add some raisins and cinnamon for raisin bread. Add an egg to make it more moist and rich. Substitute milk for water. But, there really is just one way to make bread. You will always need the basic ingredients and add them in in the same way. Each loaf will be different, but if you are making bread, your end product should look and taste like bread.

Here in the office today, we are celebrating the provisions in the stimulus bill to compare the effectiveness of different treatments for the same illness. Yet, many others see this as a recipe for health care disaster: cook book medicine is what they are calling it. Every patient is different they say. Doctors aren't robots. And what about the value of a doctor's intuition? Isn't that what makes great providers?

But, what would you say to this statistic: Clinical studies conducted by California’s RAND Corporation and other research centers consistently show that, for many medical conditions with well-defined criteria for the best treatment, only about 50 percent of the recommended care is ever delivered (1). That would be the same track record I have with my sausage broccoli pasta and that's clearly unsatisfactory. Thankfully, my pasta was not deadly. But lives are at stake in health care!

Medicine will always have a margin of variability since every patient is different and doctors are human too. But, if it is known that a patient has X disease, as a future doctor, I'd want to give that patient the most effective treatment known to treat that disease. And as a patient, I'd want to know that I'm receiving the most effective treatment available. Standardization is a scary word in the health care debate, but if you have a recipe for success, shouldn't that be shared and used widely?

I think my cooking is getting better. I will admit that I do call my parents to run through all of the necessary ingredients and any sophisticated cooking techniques at least once a week. I have also created a binder for standard dishes (so my parents don't get annoyed by my calls). Each dish has a list of ingredients, possible substitutes, important steps to remember, and plenty of room for edits. It's my binder of best practices and guidelines to ensure a happy stomach.

Comparative effectiveness research in health care can create that binder for medicine and help us prevent things from going wrong. Can you really think of a good answer to the question, "why didn't you use the best practice?"

I can't.
The New York Times on Comparative Effectiveness Research