An Unbalanced and Harmful Approach to Quality Measurement: Is Life Expectancy Enough?

Jaan Sidorov

Posted 10/12/11 on Disease Management Care Blog

Sei Lee and Louise Walter, in this Commentary published in the Oct 5 issue of JAMA, argue that the current  approach to measuring health care quality often leads to unintended harm for many older adults.  That’s because the guidelines-driven and evidence-based measures are “unbalanced.”

The Disease Management Care Blog agrees that the state-of-the-art is unbalanced, but it’s even worse than Drs. Lee and Walter describe.

First, the Commentary…..

Right now, standard methods for assessing the degree of blood pressure control (typically defined as being less than 140/90) doesn’t account for some elders being prone to getting low blood pressure and dizzy when they’re upright. Blood sugar control is a good idea among most persons with diabetes, but for many reasons, older persons are more prone to having dangerously low dips in their glucose levels.  Last but not least, there’s also the questionable wisdom of screening for cancer when the likelihood of death from other causes is far greater.
Continue reading “An Unbalanced and Harmful Approach to Quality Measurement: Is Life Expectancy Enough?”

Not Everything in Health & Wellness Can Be Reduced to a Single Number

Kent Bottles

First posted 6/26/11 on Kent Bottles’ Private Views

“To measure is to know.” Lord Kelvin

“If you can not measure it, you can not improve it.” Lord Kelvin


“Asking science to explain life and vital matters is equivalent to asking a grammarian to explain poetry.” Nassim Nicholas Taleb

“Technology is at its best when it is invisible.” Nassim Nicholas Taleb

How can technology help us live healthier lives? Why did Google Health fail? Why are Klout and Twitter Grader publicly issuing a number to me by name about how influential I am? What do Lord Kelvin and Nassim Nicholas Taleb have to teach us?

I was taught in medical school and pathology residency that health was defined as absence of disease; this definition pleased me because not much important could happen to the patient until I peered into my microscope and rendered a diagnosis. I looked up to Virchow and Rokitansky who were the most important and influential physicians in the most advanced medical centers in the 19th century.

In the mid-20th century the World Health Organization (WHO) famously stated: “Health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or injury.”

“The dialogue between Asclepios, the god of medicine, and Hygieia, the goddess of health – the external intervention and the well-lived life – goes back to the beginning. Only in the twentieth century did the triumph of ‘scientific’ modes of inquiry in medicine (as in most walks of life) result in the eclipse of Hygieia. Knowledge has increasingly become defined in terms of that (and only that) which emerges from the application of reductionist methods of investigation.”

Continue reading “Not Everything in Health & Wellness Can Be Reduced to a Single Number”