Surely the Numbers Never Lie, Except When They Do?

This morning’s WSJ ‘Letters to the Editor’ used this heading for several letters submitted regarding the January 14th op-ed by Michael Boskin, “Don’t Like the Numbers? Change ‘Em.” Art Davis of Richmond wrote, “Resolving inequities through a redistribution of income was, and is, the centerpiece of the Obama administration’s agenda. A magnanimous mission of fairness explains why the Obama team is willing to play fast and loose with numbers….”

It certainly does seem impossible anymore to trust data. When the collecting and reporting is in the hands of those likely to gain from the results, most of us are suspect. Like when a pharmacy company sponsors research on its own drug and compares against placebo rather than a competitors product that might be much less expensive. But even some of the long-standing research foundations without a clearly known conflict of interest have known biases. And some of us know there is a history of large media blitzes for some results while either not funding or allowing other funded works to slip quietly into oblivion when in conflict with their underlying mission. We’re spending more time and energy today than ever before collecting and reporting information, often under the mandate of expensive regulatory requirements. And the data often reflects complex research methodologies very difficult to explain but easily used to mislead the end user. Our elected officials and the private sector alike are guilty. The numbers lie because the people behind the numbers lie.

Health Care is in love with “Best Practices”. The concept is that doing the right thing at the right time in the right way will improve quality and lower cost. In a recent interview with a well trained new employee of one of our local delivery systems, I asked if his employer exemplified “Best Practices”. He looked, smiled, and said, “I’ve learned to always just say ‘yes’.” “I say ‘yes’ to any request of a referring physician. I say ‘yes’ to anyone asking for consultation. I say ‘yes’ to anyone asking me to admit a patient. Our system has so many people collecting data and defining policy for what is ‘best’, I would create misery for myself, certainly lower my income, and possibly loose my job if I dared to say ‘no’.” He went on with his elaboration and we both concluded that the concept of ‘best practice’ is easy but the creation of best practices is fraught with all human shortcomings, not the least of which is organizational self interest. And yes, the people behind the numbers lie and forget their primary purpose of providing patient-centered value.

Before our society became so enamored with being smart, before we moved into the ‘age of a knowledge-based economy’, common-sense was the rule of the day. Common-sense was the mode of assessment, the framework of analysis. Formal knowledge was scarce. We explored the world using all our senses, and we made decisions accordingly and either suffered or enjoyed the consequences. The few professionally trained folks in our community were widely accepted but were expected to be there for us, during the good times and bad, fighting for our best interests. We didn’t have the same systems of quality control in place as today, but each and every person had their sense of quality and communicated throughout the community the good and bad. People lied then to but we didn’t debate numbers, we debated one another. Common-sense prevailed.

Sometimes it takes a paradoxical event like Mr. Brown’s victory in Massachusetts to bring us all back to our senses. The electorate finally saw the lies behind the numbers. The people said ‘no’ with a clear sense of conviction as to what was wrong in Washington. Hopefully this was the beginning of a major shift back to the center and recognition the common sense of the people is far more discerning than the lies behind numbers could ever fool. Maybe we’re seeing a new day for the anti-Federalists with recognition domestic policy should be decentralized to best align with the interests of our Citizens and to keep each other more accountable. A healthy society questions, examines, and uses all of its senses to judge. A healthy society recognizes knowledge is just a tool to sharpen the senses. A healthy society knows ‘Best Practices’ must always be ‘in the moment’ in order to be ‘best’, the numbers come later. And a healthy society knows that doctors who just say ‘yes’ are not the caregivers we need nor the systems of care that will bring the highest levels of patient value. Our common sense, collective or individual, must always stand in the front of every potential solution or we can always bet the numbers will lie.