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Death Is More Cost-Effective
David Leonhardt writes in The New York Times that doctors have little incentive to go that extra mile and come up with the correct diagnosis. In one case, after blood tests, doctors diagnosed leukemia in a little boy, and started him on a strong course of chemo:

What the doctors didn't know was that the boy had a rare form of the disease that chemotherapy does not cure. It makes the symptoms go away for a month or so, but then they return. Worst of all, each round of chemotherapy would bring a serious risk of death, since he was already so weak.

With all the tools available to modern medicine — the blood tests and M.R.I.'s and endoscopes — you might think that misdiagnosis has become a rare thing. But you would be wrong. Studies of autopsies have shown that doctors seriously misdiagnose fatal illnesses about 20 percent of the time. So millions of patients are being treated for the wrong disease.

... Joseph Britto, a former intensive-care doctor, likes to compare medicine's attitude toward mistakes with the airline industry's. At the insistence of pilots, who have the ultimate incentive not to mess up, airlines have studied their errors and nearly eliminated crashes.

"Unlike pilots," Dr. Britto said, "doctors don't go down with their planes."

Dr. Britto was working at a London hospital in 1999 when doctors diagnosed chicken pox in a little girl named Isabel Maude. Only when her organs began shutting down did her doctors realize that she had a potentially fatal flesh-eating infection. Isabel's father, Jason, was so shaken by the experience that he quit his finance job and founded a company — named after his daughter, who is a healthy 10-year-old today — to fight misdiagnosis.

The company sells software that allows doctors to type in a patient's symptoms and, in response, spits out a list of possible causes. It does not replace doctors, but makes sure they can consider some unobvious possibilities that they may not have seen since medical school. Dr. Britto is a top executive.

Not long after the founding of Isabel Healthcare, Dr. Bergsagel in Atlanta stumbled across an article about it and asked to be one of the beta testers. So on that Monday morning, when he couldn't get the inconsistencies in the boy's case out of his mind, he sat down at a computer in a little white room, behind a nurse's station, and entered the symptoms.

Near the top of Isabel's list was a rare form of leukemia that Dr. Bergsagel had never seen before — and that often causes brown skin spots. "It was very much a Eureka moment," he said.

There is no happy ending to the story, because this leukemia has much longer odds than more common kinds. But the boy was spared the misery of pointless chemotherapy and was instead given the only chance he had, a bone marrow transplant. He lived another year and a half.

Today, Dr. Bergsagel uses Isabel a few times a month. The company continues to give him free access. But his colleagues at Children's Healthcare of Atlanta can't use it. The hospital has not bought the service, which costs $80,000 a year for a typical hospital (and $750 for an individual doctor).

Clearly, misdiagnosis costs far more than that. But in the current health care system, hospitals have no way to recoup money they spend on programs like Isabel.

We patients, on the other hand, foot the bill for all those wasted procedures and pointless drugs. So we keep getting them. Does that make any sense?

Posted by aalkon at February 26, 2006 8:12 AM

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Comments

This story sort of illustrates how the market is simultaneously a blessing and a curse in the allocation of public goods. An entrepreneurial fellow identifies an opportunity and develops a product that is so useful it can demand a high price. (And the profit will probably spur his company to develop other useful products.) Unfortunately, the price seems prohibitively high for many hospitals, particularly the publicly owned hospitals (which serve communities that also happen to have a lot of lousy schools, neglected rental housing, etc.)

Posted by: Lena at February 26, 2006 8:58 AM

Can it be so far away that Google can do this?

Posted by: Radwaste at February 26, 2006 11:57 AM

I have no idea what kinds of programming work goes into these computer-based decision support tools.

Posted by: Lena at February 26, 2006 1:51 PM

> you might think that misdiagnosis
> has become a rare thing.

Or you might fucking deal. "Caveat emptor" does not translate as "I can sue your sorry ass later!"

Listen, good people read this blog, and I hate to talk out of school, but...

..Life is dark.

Posted by: Crid at February 26, 2006 6:12 PM

Life is way dark, babe.

Posted by: Lena at February 26, 2006 7:03 PM

My wife and I recently spent thousands of dollars, in addition to worrying for two months, because of a misinterpreted result of a thyroid cancer test: we were led to believe that my wife's cancer had recurred because none of the Mount Sinai Medical Center physicians involved were willing or able to admit that there was a possibility of a "false positive" from a 2 millicurie radioactive iodine scan. It was only after we went to see a top specialist at the M.D. Anderson cancer hospital in Houston that the initial diagnosis was refuted and we learned that other cells besides thyroid cells are able to absorb iodine (such as the thymus gland).

Posted by: Odysseus at March 3, 2006 9:13 AM

Sue the fuckers, Odysseus.

Posted by: Lena at March 4, 2006 10:51 PM

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