Are Reed Abelson and Gardiner Harris as Big Tools as Their Attempted Trashing of Dartmouth Suggests? Yes. Time to Shut the New York Times for Good
The only reason to have a New York Times is if it exercises quality control over those it prints in its pages.
And it doesn't. Judy Miller ethics rule.
The big lie from Abelson and Harris comes in paragraph 6:
(1) In selling the health care overhaul to Congress, the Obama administration cited a once obscure research group at Dartmouth College to claim that it could not only cut billions in wasteful health care spending but make people healthier by doing so.
(2) Wasteful spending — perhaps $700 billion a year — “does nothing to improve patient health but subjects you and me to tests and procedures that aren’t necessary and are potentially harmful,” the president’s budget director, Peter Orszag, wrote in a blog post characteristic of the administration’s argument.
(3) Mr. Orszag even displayed maps produced by Dartmouth researchers that appeared to show where the waste in the system could be found. Beige meant hospitals and regions that offered good, efficient care; chocolate meant bad and inefficient.
(4) The maps made reform seem relatively easy to many in Congress, some of whom demanded the administration simply trim the money Medicare pays to hospitals and doctors in the brown zones. The administration promised to seriously consider doing just that.
(5) But while the research compiled in the Dartmouth Atlas of Health Care has been widely interpreted as showing the country’s best and worst care, the Dartmouth researchers themselves acknowledged in interviews that in fact it mainly shows the varying costs of care in the government’s Medicare program. Measures of the quality of care are not part of the formula.
(6) For all anyone knows, patients could be dying in far greater numbers in hospitals in the beige regions than hospitals in the brown ones, and Dartmouth’s maps would not pick up that difference...
That's a lie: patients are not dying in far greater numbers in hospitals in the beige regions than in hospitals in the brown ones.
Why oh why can't we have a better press corps?
First out of the gate in pointing out Abelson and Harris's unprofessionalism is Andrew Gelman of Columbia University:
How can news reporters avoid making mistakes when reporting on technical issues? Or, Data used to justify "Data Used to Justify Health Savings Can Be Shaky" can be shaky: Reed Abelson and Gardiner Harris report in the New York Times that some serious statistical questions have been raised about the Dartmouth Atlas of Health Care.... Abelson and Harris apply a shotgun approach, shooting all sorts of criticisms at the study without a sense of what makes sense and what doesn't. For example, they write....
For all anyone knows, patients could be dying in far greater numbers in hospitals in the beige [low-spending] regions than hospitals in the brown [high-spending] ones, and Dartmouth's maps would not pick up that difference. As any shopper knows, cheaper does not always mean better.
Setting the maps aside, could it really be true that "patients could be dying in far greater numbers in hospitals in the beige regions than hospitals in the brown ones"?? I really doubt that, and I'm pretty sure that this has been checked. I mean, that's an obvious thing to look at. And, in fact, later on in the news article, the authors write that:
a 2003 study found that patients who lived in places most expensive for the Medicare program received no better care than those who lived in cheaper areas.
So what's the deal with "For all anyone knows, patients could be dying in far greater numbers in hospitals in the beige regions than hospitals in the brown ones"?... Abelson and Harris then write:
Even Dartmouth's claims about which hospitals and regions are cheapest may be suspect... [N]urses in Houston tend to be paid more than those in North Dakota because the cost of living is higher in Houston.
Huh? One of the striking things about the cost-of-care map is how little it corresponds with cost of living. The high-cost regions include most of Texas, just about all of Louisiana, Mississippi, Arkansas, Oklahoma, and Tennessee (as well as some more expensive places such as the Bosnywash area and much of California.) There may be a lot of problems with this study, but I can't imagine that one of these problems is a lack of accounting for the (relatively) high cost of living in Houston.
How can this sort of energetic reporting be improved?... Their fundamental difficulty, I think, is the challenge of writing about a technical topic (in this case, statistics) without the relevant technical experience.... What should they (and other similarly-situated reporters) do next time? To start with, I'd recommend getting more input from qualified outsiders. Abelson and Harris do this a bit, with a quote from health economist David Cutler--but they only give Cutler one offhand sentence. I'd be curious to hear what Cutler would say about the claim that "for all anyone knows, patients could be dying in far greater numbers in hospitals in the beige regions than hospitals in the brown ones."...
P.P.S. Jonathan Skinner, a coauthor of the Dartmouth atlas, responds in detail on the New York Times website. The most impressive thing about this response is that Skinner published it on June 13, 2009--nearly a year before the Abelson and Harris article appeared. Now that's what I call rapid response!
UPDATE 1: In my inbox this morning. I will try to check this out:
...Gardiner Harris was appearing in DC offices 3 months ago announcing that he was going to take down the Dartmouth work...
UPDATE 2: From Dartmouth, responses. A year ago:
Jonathan Skinner: http://economix.blogs.nytimes.com/2009/06/13/is-more-care-better-care/
Today: "at least five factual errors and several misrepresentations":
Elliott Fisher and Jonathan Skinner: Skinner_Response.pdf
Today: 24 pages on geographic variations in U.S. health care spending:
Elliott Fisher and Jonathan Skinner: Skinner Fisher DA 05_12_10.pdf