Consumer Reports on Health: Worse Than Average

Posted on | June 5, 2008 | Comments Off on Consumer Reports on Health: Worse Than Average

Good intentions do not good tools make, even if you’re Consumers Union

Maybe no one at Consumer Reports has a mother. The first rule of effective consumer information is “tell it to Mom;” that is, explain why something is important in the kind of language you would use if speaking to your mother. Unfortunately, the folks at Consumers Union have now, for the second time, put out purportedly pro-consumer health care information that no one’s mother could love. Their latest offering is at best mildly helpful and at worst seriously misleading. The only explanation I can think of is that the CU folks believe so firmly in their own good intentions that they ignore the impact of what they are actually doing.

And as long as we’re awarding demerits to the self-delusional in the Liberal Do-Gooder category (Conservative Market-Worshippers richly deserving a category of their own), save a sigh of exasperation for the creators of something called the Healthcare Equality Index.

A quick disclosure: I am a subscriber to Consumer Reports online, have known some individuals there for years and did some brief consulting to them some years back. Therefore, let me be clear that my criticisms are based exclusively on public information.

CU’s latest offering is a link to the Dartmouth Atlas of Health Care and its analysis of hospital practice variation. The CU imprimatur suggests this is Major League quality information. The truth is closer to the story of the baseball manager who blurted out about one of his players, “While he can’t hit, neither can he throw.” In that same vein, while the Dartmouth information is not easy to use, neither is it easy to understand.

The Dartmouth Atlas is a health services research tour de force. It takes an incontrovertible outcome (death from a serious chronic illness) and then applies a complex algorithm to account for all medical resources used during the two years before that outcome. The result is more evidence of practice variation and that “more” care isn’t always “better.” However, expecting this insight alone to prove useful to someone making a decision about their own or a family member’s medical treatment means you’ve spent way too much time in an ivory tower.

How should a CU subscriber interpret the fact that one hospital is “aggressive” and another “conservative” in its resource use? In trying to reassure us that we can choose “conservative” and less costly treatment, CU explains that “aggressive care does not necessarily improve patient outcomes and can sometimes shorten life. But wait: doesn’t that mean aggressive care sometimes does improve patient outcomes and lengthen life? If I listen to CU, there’s no doubt I’ll save money for the federal government (the Atlas uses Medicare data), but if I don’t, I may save my life.

Maybe the folks at CU do have mothers: they just don’t like them very much.

“We’re not at a point yet where we can say which hospitals are bad or good," Dr. John Santa, director of Consumer Reports’ new Health Ratings Center, acknowledged to Chicago Tribune reporter/health blogger Judy Graham.

Whatever happened to, “First, do no harm?”

By the way, the Chicago hospital most aggressive in its use of resources before the patient died was a Catholic one, and the hospital with the lowest score was the public hospital. However, the Dartmouth Atlas makes no allowances for the impact of religious beliefs in regard to life extension or the impact of patient socio-economic status (or hospital financial status) on intensivity of treatment.

This is the second time CU has been unable to distinguish between information that sets the blood of researchers racing and information real people might reasonably rely upon. Its ConsumerReportsHealth site debuted with “Best Treatments” from the Cochrane Collaboration evidence-based medicine reviews. This carefully constructed tool from the folks at Oxford University gives us epistemological categories such as “treatments that work but whose harms may outweigh benefits.”

Come to think of it, that’s a logical precursor to the Dartmouth University rankings of hospitals where the harms (an adverse event that kills you) may also outweigh the benefits. Unless, of course, they don’t.

The good news is that CU plans to put out genuine cost and quality information on hospitals by the end of 2009. I hope no one tells them that some of those evil for-profit have been doing this since the late 20th century.

Now on to the Healthcare Equality Index. You might assume this is a clever way to call attention to the disparities in care that we know cause serious harm to African-Americans, Hispanics and other minorities. It is not. Instead, it constitutes the responses to a survey designed to measure “how equitably hospitals in the United States treat their gay, lesbian, bisexual and transgender patients and employees.”

The survey was designed by the Human Rights Campaign Foundation Family Project and the Gay and Lesbian Medical Association. A whopping 88 out of roughly 5,000 U.S. hospitals voluntarily responded and agreed to make their names public. Perhaps some folks have had too little exposure to the ivory tower and the idea of “statistical validity.”

Yes, discrimination against GBLT patients and employees can be a problem, and GBLT individuals’ special health care needs certainly can get short-shrifted by uncomfortable straights. But if you want to talk seriously about health care equality, then get serious. The well-educated, well-insured, solidly upper-middle-class white gay couple is far more likely to get the health care they need than the working-class, dark-skinned, Spanish-speaking couple with no health insurance at all.

Even if they have a subscription to Consumer Reports.