Thursday, February 19, 2009

Data, use and misuse - Use and Misuse of Medical Data

In God we trust, all others bring data.

W. Edwards Deming, Quality Improvement Pioneer

The false statistics trap can be quite damaging to the quest for knowledge. For example, in medical science, correcting a falsehood may take decades and cost lives.

Misuse of Statistics, Wikipedia

Malcolm Gladwell, staff writer for New Yorker, has written three best selling nonfiction best sellers - Tipping Point, Blink, and Outliers. These three books, in one way or another, are about data.

• In Tipping Point, Gladwell likens massive social change, like the sudden drop in crime in New York City, to social epidemics. Social epidemics are often triggered by small and seemingly insignificant events that reach a critical point that are counterintuitive and unpredictable by data alone.

Blink is about rapid cognition, thinking that occurs in the blink of an eye, in which the mind reaches rapid conclusions based on gut feelings based on intuition and accumulated experience rather than on numerical data.

Outliers suggests extraordinary success and accomplishment in individuals is a product of luck meeting opportunity and inbred qualities of some people to grasp their chance quickly and rise to the peak of society in a way that are outside of the realm of normal human experience that data could not have been predicted.

Two events of yesterday brought Gladwell to mind.

• First was an email from a Chicago software entrepreneur who asked if I had done any recent thinking about “data mining,” a field in which experts mine data to predict how doctors have or will perform or be influenced in a given state of circumstances. In the case of the Chicago entrepreneur he was “aggregating data” for an IPA so that IPA might gather more bonuses by complying with Pay-for-Performance criteria.

• Second was the arrival of the February 19 issue of the New England Journal of Medicine. From the cover, I could immediately tell, with a blink of the eye if you will. i.e., from a glance at the table of contents that this issue was about use and misuse of data.

The first article,” Prescribing Records and the First Amendment – New Hampshire’s Data Mining Statute” – was about a court opinion on sales reps misusing prescription data to influence how doctors prescribe.

A second article, "Commercial vs. Social Goals of Tracking What Doctors Do,“ “urges physicians and policymakers to better define the benefits to society of various uses of health information going forward.”

A third and four article, “CABG vs. Stenting : Clinical Implications of the SYNTAX Trial,“and “Quality of Life after Late Invasive Therapy of Occluded Arteries,” debates what data showing conservative medical therapy vs. more aggressive stent or bypass surgery means for physicians.

What this is all about, in my mind, is the merits of the use and misuse of individual clinical judgments versus aggregated data. Such arguments will form the basis for a proposed Comparative Research Outcome Institute, administired by a Federal Health Board. This Board and Institute are essential parts if a $1.1 billion reform initiative proposed by Congress as part of the stimulus package.

I respect data, but I believe in inspecting principles and motives governing data gathering and applications, their use and misuse, before reaching conclusions. Data is not impersonal. Data has human dimensions and reflects clinical decision-making in individual circumstances at the point of care, sometimes in urgent life-saving situations, Data, no matter how purposefully "aggregated," should not miss theis point. Data is a complement, not a substitute, for human judgment.


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