How Do We Move Beyond Regression to the Mean?: Improving Health and Health Care

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In Medicine as in life, we often attribute improvements in well-being to a specific event, treatment, procedure, or drug. We suggest any given treatment effect is the result of our medical decision making, informed by one's diagnostic acumen. In many cases, it is appropriate to take some credit for the effectiveness of a given treatment. However, in nearly all cases, we recognize as scientist and students of statistical methods, there are reasons “why” a specific treatment yields a given result. There are always confounders, factors we often adjust for in measuring outcomes: age, sex, race, education level, and or income. For these known variables we can statistically adjust, allowing for comparisons of one treatment versus another. Similarly, we can’t ignore the potential, “placebo effect,” and regression to the mean, in one's overall interpretation. We are aware of the many human biological processes associated with “watchful waiting,” the natural history of any ailment, and independent of treatment. In many clinical trials we compare treatment A, some intervention to, treatment B, watchful waiting. In the watchful waiting group, heal-thy-self, the natural history of healing for a given malady, has a measureable outcome or effect. Not all maladies require intervention, many require supportive therapy as our normal biological, injury and repair processes, do their job. Think of a simple cut or bruise, watchful waiting, often wins the day.
So given we agree there is a normal distribution for a given treatment and there are often many confounders for which we must adjust, how might we think about moving that normal bell-shaped curve, to the right, wherein society as a whole improves its health and health care? There are likely many ways to achieve such an audacious goal. All require, a structure and governance, a focused strategy, tactics and resources, financial and non-financial, to make the necessary changes needed. The ultimate success requires dedicated leadership, with a clear vision, the courage to lead towards a better place for all and patience, as it will take time, a variable we cannot always control for, decades in this case, to achieve.
This goes way beyond payment and insurance reform. Just as some believe, lowering the “corporate tax rate” will improve the lives of many, corporations investing in new jobs and innovative solutions for the future, I believe, addressing the “social determinants of health,” will narrow the coefficient of variation and inequities. By so doing we will have moved the mean of the whole country to the right. This, in and of itself is not enough but will provide a much needed win and impetus to do more. Tax reform is likely part of the solution. Regressive taxes often impact those who can least afford them, this too must be addressed.
As a nation, we continuously struggle to make meaningful change necessary to create a more sustainable health system. The federal deficit in the United States is approaching $20 trillion, much of which is related to our health care cost of nearly $4 trillion. Notice, I did not say Health Care system. There are no real mysteries here. As a society we have not adequately addressed many of the variables needed to actually move the curve to the right, to alter our current regression to the mean.
At this time in our history, let's not lay fault or blame, let us, together move the ball down the field moving the normal distribution to the right. Each of us has to do our part and we all need to take some responsibility. After all health care cannot and will not improve many of the problems responsible for our nations’ health.

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