I’m off to sub-Saharan Africa tomorrow to practice medicine in a way they’d never let me do here in the states (uh, until next month). I may try to write something about it here and there, but there are probably better blogs out there for that kind of stuff already. Tamara Todd’s blog, for example, is interesting to me for the meta-narrative.
Addendum: Some pre-trip reading on the nature of medical imperialism.
There’s uproar amongst opponents of single payer health care over a recent survey published in the Annals of Internal Medicine (letters section, thus avoiding peer review) suggesting that a majority of doctors (59%) support “universal health care.” Critics point out, rightly, that the survey (which consisted of two relatively straightforward questions and unknown accompanying material) was sent to members of the AMA, which is pro-universal health care but not pro-single payer and perhaps not a representative sample of physicians across the board, and that just over half of the surveys sent out were returned, which opens the door for serious selection / response bias. And certainly, the media coverage seems a bit much.
The authors address some of the methodological concerns in a similar study conducted five years ago (opens in pdf format), to which this survey is intended as a follow-up. There’s no mention in the current one of whether the trend towards more support is significant or even amenable to statistical analysis, but the clear implication of publication is that it is meaningful.
More interesting to me than the merits of the survey itself (my opinion is that it’s relatively worthless) are some of the comments by critics that the data is untrustworthy simply because its author, Aaron Carroll, is a member of Physicians for a National Health Program. As best I can tell, Catron goes so far as to lie about Carroll’s credentials.
The lead author of this “survey” is Aaron E. Carroll, a single-payer zealot on the Board of the activist group “Physicians for a National Health Program.” This guy routinely produces “studies” and “surveys” that somehow always show that Americans in general and the medical community in particular want government-run health care.
I will note that a pubmed search for “carroll ae” turned up only the two surveys already mentioned, and Catron only links to a pro-single payer op-ed written for an Indiana newspaper.
Greg Scandlen, who appears to be much more reasonable, still manages to startle.
The letter was written by Aaron Carroll, MD and Ronald Ackerman, MD, both of the Indiana University School of Medicine. I don’t know about Dr. Ackerman, but Dr. Carroll is a member of the board of directors of Physicians for a National Health Program (PNHP), so is hardly an unbiased researcher. Interestingly, the Annals requires the disclosure of financial conflicts of interest, but not political conflicts or biases.
As a fan of overcoming bias of all types, I wholeheartedly support the idea that scientists should try to perform research which disproves their own hypotheses, and I think the restriction of conflict of interest disclosure to direct financial matters absurd (”Dr. Blue discloses that his sense of self worth depends on the positive results presented in this study”) . I doubt that we could trust many papers if all potential conflicts were disqualifying — how many papers in support of HSAs are written by people who don’t support HSAs? Pragmatically, it’s hard enough to get people to disclose their financial conflicts, and it seems that disclosure of political conflicts or personal biases is a nebulous concept that would be impossible to enforce. What biases are relevant? (”Ok, well he’s not really for PNHP, but he did vote for Clinton in the democratic primary”). Interestingly, in papers I could find on pubmed, Scandlen is listed as affiliated with “Consumers for Health Care Choices,” but no disclosure of his own personal biases or political views are made explicit.
Update: Don McCanne of the PNHP comments on Healthcare BS to say that (1) the article was peer reviewed (don’t know the Annals letter policy), and (2) that the doctors surveyed were selected from AMA masterfile, not member file.
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