Dr Otis Webb Brawley, Chief Medical Officer of the American Cancer Society, has written a new book called "How We Do Harm:A Doctor Breaks Rank About Being Sick in America."
A CNN article about the book has recounted the story of a woman, Helen, who was diagnosed with early stage breast cancer. As was fairly common in the early 1990′s – surgery was followed by high doses of chemotherapy – and a bone marrow transplant. Quoting Dr. Brawley:
“The therapy Helen received was expensive and commonly given to women with breast cancer in the early 1990s. During this time, numerous women sued insurance companies who did not want to pay for the therapy and nearly a dozen states passed laws saying insurance companies had to pay for it.”
“There was one really good reason why the health insurers did not want to pay for high dose chemotherapy and bone marrow transplant for breast cancer: No study had ever been done to prove it beneficial.“
“Even without evidence, some patients and their doctors had faith that it worked. The procedure was common because some doctors taught that the transplant was beneficial to patients. Truth be told, it was very beneficial to the doctors and hospitals offering it.”
I have not read the book but have read a number of excerpts. We all know that increases in the cost of medical care are not sustainable. We all know that with third party payers, people will seek medical care, and the medical profession will provide it. While much medical care that is sought is unnecessary no one can fault a doctor for doing whatever examination and testing is needed. Therein lies the problem. Dr. Brawley says it best:”The cold hard reality is America does not need to reform health care,we need to transform health care.”
I have seen the same problem with safety of all kinds. There are plenty of studies showing safety problems but few reliable studies showing that the suggested remedies are the solution. Often there are ridiculous claims. One recent news article quote claimed that a certain teen driving program given over a period of years to a few hundred teen drivers in one county was the cause of a reduction in teen fatalities over the same period in this multi-million population state. A basic fallacy of the safety industry is that correlation equals causation.
For many years CPR was taught as a combination of reduce breaths and chest compression. Studies of results showed a low survival rate and the trade varied dramatically from city to city. One city with a low survival rate sends out EMT's in a fire truck with every emergency call. Other studies showed that doctors did CPR poorly. The current protocol is no rescue breaths except for drowning and drug overdose. Chest compressions are all that is done.
Reread the quotes about breast cancer treatment. With no evidence patients and doctors believed that a certain treatment was beneficial. In safety we see this all the time. Often OSHA requires certain measures and of course that becomes the only valid reason to do something.
A safety officer at one company asked me if one AED would be enough at his company. For any effect an AED must be used within four minutes of someone going down. This man's company has two three-story buildings. To answer his question requires knowing how long it would take to get an AED to the site. They might need three in each building, one on each floor. When AEDs are mandated by law who knows how many might be required.
The problem with safety is that many solutions are marketed and sold that will not provide any reduction of risk. The ads generally run "The National Safety Council says that there are X number of injuries every year from Y. The ad jumps to the conclusion. "Therefore buy our product."
Today I saw a simple safety statement in an interview. It was a definition of cowboy safety. I liked it because cowboy safety is not a product brand. Cowboy safety is a process. "My job is to protect bull riders from bulls" was the answer.
The success of "My job is to protect bull riders from bulls" is measured by how many bull riders are hurt or killed. There are stats in all of safety but an OSHA inspection is going to measure a whole lot of other things that may or may not have an impact. Every OSHA recommendation always seems to recommend more training.
What we need in safety is a transformation. We need to understand that there achievement of safety goals is not strictly material in nature. The creative process is viewed as mental and spiritual. Safety is the same.
David Sneed
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