A recurring theme on this blog is my contention that medical care in this country (and probably a large part of the first world) is a joke. As I argued here, Doctors are incentivized to offer or order care that may not be actually needed.

Recently I stumbled across an op-ed piece (written by a Dartmoth professor who has a book out entitled “Overdiagnosed.”) It adds some interesting information to this whole debate. In describing the analysis of one doctor who examined how medical care is dispensed, the article states…

Jack went on to document similarly wildly variable medical practices in the other New England states. But it wasn’t until he compared two of the nation’s most prominent medical communities — Boston and New Haven, Conn. — that the major medical journals took notice. In the late 1980s, both the Lancet and the New England Journal of Medicine published the findings that Boston residents were hospitalized 60% more often than their counterparts in New Haven. Oh, by the way, the rate of death — and the age of death — in the two cities were the same.

So, two populations were getting quite disparate amounts of medical care but were in the same state of health. Observations such as this led the development of medical care epidemiology, the science of studying the effects of medicine.

Medical care epidemiology examines the effect of exposure to medical care: how differential exposure across time and place relates to population health outcomes. It acknowledges that medical care can produce both benefits and harms, and that conventional concerns about underservice should be balanced by concerns about overdiagnosis and overtreatment. Think of it as surveillance for a different type of outbreak: outbreaks of diagnosis and treatment.