The U.S. medical system is like a New England toll road: It's designed to extract tolls from patients all along their health-care journeys, with a callous disregard for whether or not these travelers arrive at their desired destination, a place of better health.
Dr. Bach is a physician, an epidemiologist, a researcher and a respected health-care policy expert whose work focuses on the cost and value of anti-cancer drugs. He was also a caregiver who has traveled down the patient side of the system as his wife died of cancer.
In his talk, Bach discussed three of the major toll takers in the system — pharmaceutical companies, hospitals and researchers — and how the public’s wielding of a growing body of health-care data could be used to reign in a process that is driven more by profit than health outcomes.
This week no discussion on escalating health-care costs could pass without mentioning Martin Shkreli, the 32-year-old hedge fund manager whose drug company raised the price of a decades-old anti-parasite drug by more than 5,400 percent. “He made it clear that the system is so broken even a child could manipulate it,” said Bach.
But Bach went on to show some promising quality improvement projects that are helping to bring accountability into the health-care system.
There is ProPublica’s Surgeon Scorecard, which enables consumers to shop for the best surgeons performing one of eight elective procedures. It's based on Medicare death and complication rates, carefully adjusted for differences in patient health, age and hospital quality.
He also demonstrated DrugAbacus.org, an interactive cancer drug pricing tool that he helped to develop. It enables the public to assess whether the price of a cancer drug is aligned with its health benefits, with slider bars that adjust variables such as such as efficacy, tolerability, novelty, cost of development, rarity, and population burden.
And finally, he gave a shout-out to the Yale University Open Data Access Project, called YODA, which advocates for more sharing of clinical research data, so that society can benefit from the data gathered from all clinical trials, both published and unpublished. (Johnson & Johnson is the first company to participate in this program.)
The title of Bach's talk, “Through data darkly: Can healthcare survive its own reflection?” asked a question with an answer that seemed obvious to most of the people in the lecture hall — no, not unless we start paying the toll takers based on health outcomes.
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