POLICY: Canadian Giver By Eric Novack

With well over 25,000 visitors per month to THCB, undoubtedly many are not well grounded in critically looking at published research studies. This, of course, also is true in the media at large.  With the recent publication in the American Journal of Public Health of a study touting the relative greatness of the Canadian healthcare system over that in the United States, I thought it would be valuable to share an appropriate way to begin to look at published studies.

As an aside, remember to distinguish scientific studies from opinion pieces (like those found on THCB).  In opinion pieces, the writer is, of course, expressing an opinion, though the opinions can certainly be based upon facts.

Ok. The first thing you do when looking at a study is: read the title.  This is generally what will (or, more likely, will not) get you reading further.

What next?  Find out who wrote the study.  Biases of researchers are very hard to overcome.  Many researchers have devoted their professional (and activist, in many cases) lives to promulgating certain points of view.  Sometimes these views are heretical, and the researcher finds himself (or herself) at odds with nearly everyone else in the field.

Now that does not mean the researcher is wrong.  Case in point is Dr. Stanley Prusiner’s discovery of prions—better known as the agent responsible for Mad Cow disease.  Dr. Prusiner suffered the withering criticism of nearly everyone for years until it looked like he was right.  Now he is the proud owner of a Nobel Prize.

But I digress.

In the aforementioned article, who are the authors?  Dr. David Himmelstein, Dr. Steffie Woolhandler and Dr. Karen Lasser, all of Harvard.

I had the pleasure of interviewing Dr. Woolhandler on my program.  She is very well spoken and articulates her views very well.  But she (and Dr. Himmelstein) is one of the founders of Physicians for a National Health Program.  For nearly two decades, she has devoted much time and energy to pushing the concept of a national healthcare system in the US (Canada-like).

Do you think that this bias might creep into the study design?  Would you be suspicious of a drug study that was funded entirely by the manufacturer of the drug?

After you get the names of the authors, you must find out if they have any potential conflicts of interest.  This will generally be found at the end of the article, where a single-line biography of study authors are found.  The much-maligned-here-at-THCB American Medical Association has been a big proponent of financial conflict-of-interest disclosures in publications.  And financial disclosures have become the standard in most scientific (or nearly scientific) journals.

But what do we find at the end of the AJPH article we are discussing?  Nothing implying the depth of ideological fervor of the authors.  Not even a mention of the association of the authors with PNHP.

And this is wrong- because it implies that the authors of the study do not have a potential stake in the study’s outcome.  It is no different than a drug or implants study funded by the manufacturer.  It does not make the conclusions necessarily invalid, but it sure does bring them into question and worth corroborating independently before they become headline news.

In this, the internet age, when you hear about a study in the mainstream news—use your considerable internet acumen to do some brief checking up—find the study, find the authors and find out if there could be a major conflict of interest.  Then check out the ‘rest of the story’.

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6 replies »

  1. Peter, remember Karl Marx? He had nothing to gain from his ideas, he just was convinced that he was right. Adn he died before he could witness the disaster and suffering his very appealling and even seductive ideas have brought to millions. Woolhandler and Himmelstein are enthusiastic promoters (maybe fanatics would be a more fiting description) and I hope we will not have to watch our health care system decay into mediocrity because of socialisation. Socialized systems do not work, it is as simple as that. They never have. Neither will the extreme monopoly version of health care that Woolhandler and Himmelstein propose for the US. It sounds oh so nice and seductive, everything will just fall in place, everything will be so incredibly simple, everybody will get everything they need and maybe even everything they want and everybody will be content. ANd nobody will have to pay anything and money will just appear out of nowhere to pay for all of this.
    This truly pleasant phantasy forgets the one thing that has tripped every socialistic system in history so far. Once you disconnect what a person does and what he or she receives in return, the door opens for abuse and unregulated overconsumption. It sic alled “the tragedy of the commons”, but Woolhandler and Himmelstein will vehemntly deny the existence of this principle, as they deny the importance of the “moral hazard”.
    that is one of the most important causes of increasing health care costs and it will not stop after socializing the system. These two also conveniently overlook that all their favorite health care systems have the same increase of health care costs over time. And that is the main issue we have to look at.

  2. > Sarcasm if you can’t detect it.
    Yes, sarcasm detected, thanx.
    Author Eric Novack’s point is valid, notwithstanding.

  3. “For nearly two decades, she has devoted much time and energy to pushing the concept of a national healthcare system in the US (Canada-like).”
    “Do you think that this bias might creep into the study design? Would you be suspicious of a drug study that was funded entirely by the manufacturer of the drug?”
    That’s right Eric, she stands to make millions when we all go to a Canada-like system. Money has to be driving her opinion instead of analysis of the information. Sarcasm if you can’t detect it.

  4. I read all studies touting a national health system with a jaundiced eye especially when they come from librule bastions like Ha’vaad, et al. Too bad the media is playing into their hands and giving them a free pass, but wouldn’t expect anything different. The media, democratic party, and the pointy headed institutions of “higher learning” all have one agenda.

  5. Today’s WSJ has a critique of this study entitled “Where Would You Rather Be Sick?” by David Gratzer.
    This op-ed quotes Dr. Steffie Woolhandler as saying, “Our study . . . is a terrible indictment of the U.S. health-care system. Universal coverage under a national health insurance system is key to improving health.”
    This “indictment” by Dr. Woolhander highlights the disturbing absence of a conflict of interest statement accompanying the AJPH study.
    Dr. Gratzner’s op-ed also points out several other fallacies of the study, such as confusing “problems in public health with flaws in health-care systems,” e.g. health problems related to obesity–more often a fault of life-style choices, genetics, etc. rather than health care access or affordablity.