nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Monday, June 28, 2010

Health Care Quality: How Experts Analyze It V. How Patients Experience It

[I'm back from my daughter's wedding, and back in the saddle.  A great celebration, and exhausting.  Sorry for the minimal output yesterday]

More expensive placebo's work better than less expensive ones.

...Says a study in the Journal of the AMA (March 5, 2008), resurrected at The Healthcare Economist blog.

This is the difference between what objective quality measures tell us about health care and how patients experience health care.

The Dartmouth Atlas controversy is a case in point.  For those who aren't academics, the so-called Atlas is a large scale effort that attempts to relate cost to health care outcomes.  The White House used the Dartmouth work in its assumptions about what type of health care reform to pursue.

In this JAMA study, 82 paid volunteers were enrolled to evaluate whether the cost of a placebo pain-killer drug had an impact on "how well" the subject's pain was controlled.  One group of subjects were told the pill costs $2.50 per pill, the other $0.10 per pill.  The subjects were given electric shocks, asked to estimate the pain level, then took their pill and after a suitable period the shocks and estimates were repeated.

Results:  Better pain reduction from the "higher-cost" placebo.

For Onion Peelers,
In the higher price group, 85.4% (95% confidence interval [CI], 74.6%-96.2%) of the participants experienced a mean pain reduction after taking the pill, vs 61.0% (95% CI, 46.1%-75.9%) in the low-price (discounted) group (P = .02).

The research literature is filled with examples of how patients (and doctors and nurses) "perceive" the outcome of care in ways that are at odds with the actual outcome.

This should be a caution to researchers who design studies based on their own assessment of what's the best result.

Doc D

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