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HEALTH POLICY Summers Urges Analytic Approach to Advancing Care As the keynote speaker at the fourth annual Marshall J. Seidman Lecture in Health Policy, Harvard president Lawrence Summers urged people in the health care industry to make greater use of the analytic techniques found in social science for developing better tools to care for patients. "Everything we know about human judgments is that they are highly fallible," he said. Summers highlighted five areas, in particular, where more established quantitative parameters would aid in decision-making: diagnosis, treatment, and prescription; health care reimbursement; compliance; allocation of research funds; and formulation of a national health care system. At the fourth annual Seidman Lecture, Harvard president Lawrence Summers challenged his audience to become more vocal about health care reform and related issues. (Photo by Liza Green, HMS Media Services) "Let me say something slightly outrageous," Summers began, taking the five areas one by one. "Whenever it is proudly asserted by practitioners of an activity that that activity is an art rather than a science, they are describing an activity that is still in relatively primitive form and where great progress will follow the application of more scientific techniques." He argued that too little evidence and data are brought to bear on the arts of diagnosis, treatment, and prescription and that these areas are poised for progress when evidence-based systems become part of the standard workflow. Improvements in care might be achieved through reimbursement policies, as well, Summers explained, the obvious solution being to pay doctors for keeping people healthy. But this fix breaks down because outcomes not only depend on care, but on the original health of the patient. The ultimate answer, according to Summers, is that successful reimbursement depends on measuring initial risks. "This is an area that is exactly right for precisely the kinds of statistical analyses that I've been talking about," he said. An "urgent social problem" that Summers addressed is getting people to do what they should, like taking their medications as directed and avoiding addictions. "I can't help but think that the degree of intellectual talent that has been applied in our society to getting people to do what they should ... has not been one percent of the talent that has been applied to any of 20 aspects of cell biology," he said. Summers also lamented the lack of rational planning that goes into allocating research funds, suggesting that the social payoff would be greater if research outcomes could be measured and the data used as a basis for future funding. On his last point, formulation of national health care, Summers prodded the audience, saying, "I am struck as I look on, very much as an outsider, by the absence of an animating idea around the domestic health care reform debate." He suggested that Harvard is the kind of university where issues like this and the other four can be valuably addressed. Among the attendees of the April 27 program, sponsored by the HMS Department of Health Care Policy, was Marshall Seidman, who established the lectureship in 2000 in addition to the Marshall J. Seidman Program for Medical Economics in the Department of Health Care Policy. --Robert Neal