By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    stress management for healthcare workers
    3 Tips For Healthcare Professionals: How To Stay Beautiful, Healthy, and Happy
    November 2, 2021
    importance of relaxing on the weekend for your health
    Importance of Relaxing During the Weekend for Optimal Health
    March 25, 2022
    LASIK Eye Surgery
    What Is LASIK Eye Surgery?
    May 16, 2022
    Latest News
    3 Ways To Deal With Health Issues In Cities With High Pollution
    March 22, 2023
    What Tools Should Your Caregiver Have?
    March 22, 2023
    How to Combat Home Sickness After Moving Abroad
    March 19, 2023
    4 Ways to Recover from a Broken Hip
    March 14, 2023
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Path Dependency in Health Reform: The Case of Medicare
    June 17, 2011
    Will Washington Prevent a Cure for Cancer?
    July 22, 2011
    Bracing for More Medicare Cuts
    October 20, 2011
    Latest News
    What Are Bioidentical Hormones Made With?
    March 23, 2023
    Cover Medical Costs of Child Dog Bites with Legal Specialists
    March 23, 2023
    3 Ways to Improve the U.S. Healthcare System By 2030
    March 14, 2023
    6 Steps To Ensure Speed And Efficiency Of Clinical Studies
    March 14, 2023
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Myth Busters #3: Hysterectomies in Lewiston, Maine
Share
Sign In
Notification Show More
Latest News
The Best Natural Sleep Remedies & Aids
The Best Natural Sleep Remedies & Aids
Wellness
Bioidentical Hormones
What Are Bioidentical Hormones Made With?
Medical Education
chemical peels for skin disorders
Chemical Peels Can Do Wonders for Treating Skin Disorders
Skin
health benefits of lip enhancements
Cleveland Clinic Cites Health Benefits of Lip Enhancements
lifestyle
child dog bite lawyer
Cover Medical Costs of Child Dog Bites with Legal Specialists
News
Aa
Health Works CollectiveHealth Works Collective
Aa
Search
Have an existing account? Sign In
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Policy & Law > Myth Busters #3: Hysterectomies in Lewiston, Maine
Policy & Law

Myth Busters #3: Hysterectomies in Lewiston, Maine

JohnCGoodman
Last updated: 2011/07/26 at 1:19 PM
JohnCGoodman
Share
9 Min Read
SHARE

One of the consequences of Roemer’s Law has been the idea of “provider induced demand,” and the general notion that everything that happens in health care is because some greedy doctor has deemed it. This means that patients don’t count. What patients may want is irrelevant.

Nowhere is this better illustrated than in Jack Wennberg’s early work on “small area variation” in medical practice.

One of the consequences of Roemer’s Law has been the idea of “provider induced demand,” and the general notion that everything that happens in health care is because some greedy doctor has deemed it. This means that patients don’t count. What patients may want is irrelevant.

Nowhere is this better illustrated than in Jack Wennberg’s early work on “small area variation” in medical practice.

More Read

everest healthcare

The Everest Foundation’s Mission to Support Inclusive Healthcare

Colleges Prove the Huge Benefits of AI in Healthcare Education
Using EHR systems in healthcare for Cost-Effective Services
Benefits of Emerging Technology in Healthcare in 2023
Why Is a Referenced Based Pricing Tool Necessary?

I was working in the research department at Blue Cross Blue Shield of Maine from 1979 to 1984 and we offered the use of our claims files for his research. He had already done some work in Vermont looking at variations in the rate of tonsillectomies in various towns. He found that in some places physicians surgically remove tonsils at a much greater rate than they do in other places. He concluded that this was an example of Roemer’s Law in effect — scalpel-happy physicians were too quick to order up surgery in some places, but not in others.

 

The most startling variation he found in Maine — and the one that put him on the map — was the difference between the rate of hysterectomies in Lewiston and Wiscasset, just 35 miles away. The chance of a woman getting a hysterectomy in Lewiston by the time she was 70-years old was 70%. In Wiscasset it was a fraction of that.

Wennberg, in keeping with the narrative he developed in Vermont, decided that this was because physicians in Lewiston were eager to cut while their fellows in Wiscasset were not. Curious. Why should that be? He didn’t know but speculated that maybe they were trained at different medical schools, or somehow the profession in one town had grown to be more aggressive than those 35 miles away.

Hmm, is Maine so very isolated that doctors in Lewiston never talk to their colleagues just 35 miles away? That was certainly not my experience. In fact, Maine is not exactly crawling with physicians, so opportunities for professional bonding would necessarily include physicians from many different towns. In fact, in a recent search of a physician directory compiled by the Maine Medical Center, I could find only 45 Obstetricians/Gynecologists in the entire state. Is it really credible that those only 35 miles apart would not be talking with each other?

Completely missed in Wennberg’s analysis was the possibility that maybe it wasn’t the physicians who dictated what happened, but the patients. There are stark differences in the populations of the two towns. Wiscasset was an old fishing village with a largely Yankee (Protestant) population. Lewiston was an industrial mill town with a predominantly French-Canadian (Roman Catholic) population. It is far more likely that women in Lewiston were using hysterectomies as a form of birth control that was acceptable to the Church, especially in the early 1970s before birth control pills were widely available. Many of us who lived in Maine at the time, thought this was pretty obvious, and were surprised and amused at the attention Wennberg’s study got.

Even more surprising is that Wennberg’s study is still getting attention thirty years later. In 2009, National Public Radio (NPR) published a major article, “The Telltale Wombs of Lewiston, Maine.” The piece by Alix Spiegel is gushing about Wennberg, calling him, “a certified guru — a man whose insights underlie many of the arguments you currently hear about health reform….” It adds, “Over the past 40 years, he has completely transformed our understanding of what’s going on in the U.S. health care system.”

The article goes on to say there were two possible explanations for differences in medical practice — “The first explanation was that doctor behavior was somehow to blame. The second explanation was that it was the patients; that people in some areas were just much sicker than people in other areas, or maybe just wanted more services for some reason.” The article says Wennberg looked at the possibility of differences in patient demographics and level of sickness and dismissed it.

This is unconvincing because it doesn’t say whether he gave any weight to issues like religious differences rather than just differences in disease severity. It is a profound weakness in research that treats patients like statistics rather than fully developed human beings. Statistics fail to capture the most important aspects of human beings, such as personal values or emotional condition. This is precisely why medicine has always (until now) been centered on a personal relationship between a doctor and a patient.

Wennberg insisted that, “it was doctors, not patients, who drove medical consumption, and all kinds of things influenced the decisions a doctor makes when a patient enters his office.”

Actually, this reveals a bias among the educated elite that “common” working people are not bright enough or involved enough to have much effect on the world around them. An academic like Jack Wennberg assumes that all decisions must be coming from people like himself — other educated elitists. “The people” are just the raw material the elite uses in their machinations. So, to the extent “the people” have opinions, preferences, fears, hopes, values, or expectations, these are just characteristics that have to be managed by the people who know best.

After much discussion, the NPR article finally gets to the heart of the matter — money.  It says, “the truth is the decisions made by your physician when you enter his office are profoundly influenced by the way that doctors get paid in this country.” It quotes Gordon Smith, the non-physician head of the Maine Medical Association, as saying, “If you pay people more, the more things they do, they’re going to do more things.”

That is the conventional thinking among academics these days, and it goes back, once again, to Roemer’s Law (“a built bed is a filled bed”) and the idea of “provider induced demand.” Once again, that notion is driving most of the thinking in health policy today.

But Wennberg’s research, if anything, contradicts that very idea. It does not support it. Physicians in Wiscasset and Lewiston were all under the same payment system. They were all subject to the same incentives. If it were the payment system that drove their decision-making, they would all be practicing in the same way. The fact that they practice differently strongly suggests it is not the payment system that drives behavior.

But once again public policy is driven by an idea that could fit on a bumper sticker — “Greedy Doctors rip out wombs for fun and profit” — even though the doctors in two towns 35 miles apart behaved very differently.

Still, Wennberg went on to create the Dartmouth Health Atlas, which lives on and continues to distort data and influence public policy, all based on this original idea that the payment system incentivizes greedy doctors to over treat hapless patients — but only in some towns.

TAGGED: healthcare policy, Roemer's Law

Sign Up For Daily Newsletter

Be keep up! Get the latest breaking news delivered straight to your inbox.
By signing up, you agree to our Terms of Use and acknowledge the data practices in our Privacy Policy. You may unsubscribe at any time.
JohnCGoodman July 26, 2011
Share this Article
Facebook Twitter Copy Link Print
Share
Previous Article Fusion Still Holds Strong in Spine Surgery
Next Article Bio-Rad receives pre-market approval for HIV test from FDA

Stay Connected

1.5k Followers Like
4.5k Followers Follow
2.8k Followers Pin
136k Subscribers Subscribe

Latest News

The Best Natural Sleep Remedies & Aids
The Best Natural Sleep Remedies & Aids
Wellness March 23, 2023
Bioidentical Hormones
What Are Bioidentical Hormones Made With?
Medical Education March 23, 2023
chemical peels for skin disorders
Chemical Peels Can Do Wonders for Treating Skin Disorders
Skin March 23, 2023
health benefits of lip enhancements
Cleveland Clinic Cites Health Benefits of Lip Enhancements
lifestyle March 23, 2023

You Might also Like

Bioidentical Hormones
Medical Education

What Are Bioidentical Hormones Made With?

March 23, 2023
child dog bite lawyer
News

Cover Medical Costs of Child Dog Bites with Legal Specialists

March 23, 2023
US healthcare system
Global Healthcare

3 Ways to Improve the U.S. Healthcare System By 2030

March 14, 2023
Clinical Studies
Global Healthcare

6 Steps To Ensure Speed And Efficiency Of Clinical Studies

March 14, 2023
//

We influence million of users and is the most authentic source of information on healthcare business and technology news.

Quick Links

  • About
  • Contact
  • Privacy
Subscribe

Subscribe to our newsletter to get our newest articles instantly!

Follow US

© 2008-2023 HealthWorks Collective. All Rights Reserved.

Removed from reading list

Undo
Welcome Back!

Sign in to your account

Lost your password?