Why oh why can't we have a better press corps?
Harris and Abelson quoted three people who they said were critical of the Dartmouth Group--David Cutler, Harlan Krumholz, and Cedars-Sinai Chief Medical Officer Michael Langberg. Of the three, the first two say that Harris and Abelson took them out of context and that the quotes do not reflect their views.
UPDATE: Harlan Krumholz emails:
Here is what I sent to the [New York] Times:
Although correctly quoted in the article by Harris and Abelson, I am concerned that the context might leave the wrong impression. Debate about methods and data interpretation should not lead readers to question whether our health care system has marked regional variation in spending and quality of care – and that raising the performance of the lagging regions to that of the leading regions could substantially reduce costs without diminishing the care to patients. More care should not be assumed to be better care even though there are many areas in medicine where spending does provide a good return on investment. Our challenge is to encourage spending where there is value to patients and to reduce spending where we have no evidence of benefit. The Dartmouth group should be commended for advancing our understanding of health care practices and furthering the national focus on improving the effectiveness and efficiency of health care delivery.
Maggie Mahar has the story:
Health Beat: The New York Times Attacks the Dartmouth Research Part 1: Today, the New York Times published a piece about the Dartmouth research that is raising eyebrows-- in part because there are so many factual mistakes in the story, in part because the tone is so personal. “It sounds as if it were written by someone’s ex-spouse,” a source who is very familiar with Dartmouth’s work told me in a phone conversation earlier today. “Harris and Abelson were determined to write a story that would ‘take down Dartmouth,’” confides a second source in Washington who spoke with the Times reporters. This is the second critical piece that Times’ reporter Gardiner Harris has written about Dartmouth’s highly-respected work in just four months. I wrote about the first story here noting that the article “garbled the facts” about the research, and quoted Dr. Elliott Fisher, the senior researcher, out of context.
Others quoted in today’s story indicate that the Times’ piece distorted what they said: “Every word is clearly accurate, but the implication is wrong,” says David Cutler, a Harvard economist health care policy expert who has advised President Obama on healthcare. Dr. Harlan M. Krumholz, a professor of medicine and health policy expert at Yale also was quoted.... Today, Krumholz explained:
What I spent most of the interview trying to convey is that a lot of the back and forth [about bits and pieces of Dartmouth’s data ] is inside baseball stuff – and we are all working hard to figure out how to gauge costs and value better. But Dartmouth’s work on variation is pivotal to moving us forward – and we all agree that there is lots of waste and it is unevenly distributed across the country.
After reading the Times' piece, Mother Jones’ Kevin Drum was baffled:
Bottom line: all the "data adjustments" the Times reporters talk about have, in fact, been done. Researchers at Dartmouth and elsewhere have controlled for price levels, for demographics, and for differing rates of sickness, and their results largely hold up.... In the end, then, the authors of the Times piece end up with almost nothing. By the time their piece is done, they've basically only got two things left. First, the Dartmouth researchers admit that, on occasion, they might discuss their findings more broadly than they should when they're talking to a lay audience. Second, there are individual bits and pieces of their dataset that other researchers have disputed. Just as there are with any large, complex dataset. In other words, there's no there there. The Dartmouth research is not the be-all-end-all of healthcare research, but its basic conclusions are extremely robust and have been confirmed over and over. Why the Times chose to pretend otherwise is a mystery...