Welcome to the February issue of HOC. In it, we outline why outcomes researchers and health economists might profitably develop a healthy scepticism about research published even in the ‘best’ science journals; we talk about making sense of health economics... and Robert Hand writes about the training programmes that produce future health economists. If you’re about to participate in or lead a panel discussion, Mary Gabb has some useful tips for you. Finally, our HOC People subject this issue is the appropriately named Patti Peeples, a leading light in the field of health economics.
David Woods
"It is easy for persons to sit in armchairs and weave hypotheses; many imagined America before Columbus; but an ocean had to be traversed between the dream and reality. Theorists who do not trouble to verify their own speculations deserve little credit.”
Sir Ronald Ross (1857–1932), Scottish physician and Nobel Prize winner.
Develop a healthy scepticism about research even in the ‘best’ scientific journals
By David Woods (david.woods@rxcomms.com)
The Wall Street Journal published an editorial last month titled “The Lancet’s Political Hit.” It described how that venerable medical journal had published a study exaggerating the number of casualties (by an estimated tenfold) in the Iraq war. It turned out that the study was funded by billionaire George Soros, a famous critic of that war. Moreover, Lancet editor Dr. Richard Horton, according to the WSJ, had said, before rushing the study into print in time for the 2006 US elections, that “this axis of Anglo-American imperialism extends its influence through war and conflict, gathering power and wealth as it goes.”
When even the ‘best’ scientific journals conflate science with politics they not only do themselves an injustice and harm their own credibility; they also do a disservice to readers and researchers who trust them. This ‘fudging’ of science with political partisanship was also the case when in 1999 the Journal of the American Medical Association fired its editor Dr. George Lundberg for injecting JAMA into a major political debate. The AMA accused Lundberg of having “threatened the historic tradition and integrity of JAMA by inappropriately and inexcusably injecting the journal into a major political debate (President Clinton’s impeachment trial that had nothing to do with science or medicine).” This was the case, as well, when the Canadian Medical Association journal ousted its editor Dr. John Hoey for a partisan swipe against a newly-installed Canadian health minister, Tony Clement, suggesting that he would favour privatising Canada’s cherished government-run healthcare system.
In his book “The Trouble with Medical Journals” Dr Richard Smith, former editor of the British Medical Journal, notes that “the two main pressures on medical editors come from politics and from business” – the latter having to do with not offending advertisers. Part of the problem, Smith wrote, “is that the selection of medical journal editors is more opaque than the selection of a pope.” Most editors of the world’s 10,000 or so medical journals have no training in editorship. But editing, he says, is becoming ever more complex and the journals are the main route to the research that underpins medicine; if the process is poor, he says, “there’s something rotten at the root.” Smith argues that it might be preferable to hire professional journalistic editors than academic physicians, some of whom, it seems, see their scientific journals as vehicles for promoting their political views.
But there are other reasons for scepticism about research articles. Dr John Ioannidis, an epidemiologist and researcher at Tufts University, believes that many studies may be flawed by sloppy analysis, which stems, he says, from poor study design or self-serving data analysis. It can be difficult to distinguish error from fraud, sloppiness from deception, eagerness from greed, or, increasingly, scientific conviction from partisan passion. The hotter the field of research the more likely its published findings should be viewed sceptically, he says.
As physician and humorist Michael O’Donnell puts it in “A Sceptic’s Medical Dictionary”: “Scientific Paper – Piece of prose that serves many purposes save that for which it claims to exist – the passing on of information... [and which] often serves the needs of its authors above the needs of its readers.”
So don’t let your sceptic’s guard down when trawling the biomedical literature. After all, scepticism is, as the American philosopher John Dewey put it, the mark of the educated mind.
HOC people: Patti Peeples Gustafson, PhD
By David Woods (david.woods@rxcomms.com)
Dr. Patti Peeples: what a perfect name for the subject of HOC people! She tells me that the origin of the name is from Peebles, in Scotland.
Patti founded a website, www.healtheconomics.com, 16 years ago; and that made her one of the early adopters of the Internet. Today, she says, it’s the number one website for health economists globally... with some 10,000 visitors a month.
The website is an umbrella for her consulting services. She calls it a mega website for health outcomes and health economics resources, and works with several companies in the pharmaceutical industry, including Pfizer, Genentech, J& J and GSK, as well as with related consulting companies. The site also provides employment information.
Patti came to her present position following a stint as director of medical affairs and outcomes research for Alza, now a J&J company, where she ran the Phase IV clinical trials. Before earning a PhD in pharmacy administration with an emphasis on health economics at the University of the Sciences in Philadelphia she was a product manager at Sandoz (now Novartis) with particular responsibilities for that company’s heart, kidney, and liver transplant immunisation drug, Sandimmune.
Today, she says that this particular combination of experience and skills places her ideally to bridge the gap between clinical trials and marketing. Health economics affects so many different stakeholders, she believes, so the market has to tailor itself to each of them... recipients may be looking for different information and benefits depending on whether they are managed care organisations, hospitals, employers, or clinicians.
Of HOC, she says:”I like its conciseness, its breadth of issues and its targeted focus.”
And when she’s not running her health economics website and consultancy, Patti plays the guitar, and tries to cure what she calls ‘nature deficit disorder’ by providing children, including her twin eight-year-old boys, with a solid grounding in nature and environmental issues. In fact, she and her husband Steve Gustafson recently took an RV trip across the United States for 2 1/2 months. Part of the training she offers has to do with survival skills – surely an excellent capability for those in today’s healthcare jungle. As she puts it: “My dream is to be stranded on an island for a year, with only a pen-knife.”
Training programmes: Where do future health economists come from?
by Robert Hand (robert.hand@rxcomms.com)
For those interested in entering or advancing in the field of health economics and outcomes research, and for those looking for newly-minted researchers to employ, it would help to know where training for the field is available. An online search, by no means exhaustive, turned up quite a variety of schools, universities, and organisations offering educational opportunities.
The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) provides a list of university degree programmes, by country, with contact information and web links (www.ispor.org/education/degreedirectory.asp). The list shows 38 universities in the United States, 8 in the United Kingdom, 5 in France, 3 in Canada, 2 each in Germany and the Netherlands, and 1 each in Hong Kong, Italy, Spain, and Thailand. Most of the programmes are at the master’s-degree level. ISPOR also has a network of Student Chapters at many of these universities.
Health Economics education (http://healtheconomicsnetwork.pbwiki.com) presents an online list of universities in the United Kingdom and elsewhere that offer elective health economics modules in undergraduate and MSc programmes. It also lists medical schools that offer health economics in the medical curriculum. This site is under development, so it promises to grow in utility.
The International Health Economics Association (www.healtheconomics.org/education) presents fairly detailed information on current educational programmes. Categories of information include distance learning, master’s, PhD, postgraduate/non-degree, seminars, short courses, and undergraduate education.
The website www.healtheconomics.com also offers information and links to a variety of resources for health economics education. In addition to degree programmes, it includes books, audio programmes, databases, journals, libraries, government agencies, seminars and workshops, and pharma/biotech companies. The founder and president of healtheconomics.com is Patti Peeples, RPh, PhD, the focus of this month’s “HOC people”.
The sources cited are good places to start for anyone wishing to learn more about health economics education. They provide current information and appear to be growing with the field.
How to make sense of health economics
While economics is the main ingredient in most healthcare decisions today, health economics still has many pharmacologists, clinicians, physicians and marketing personnel left confused and appalled that quality of life is equated with money. This is primarily because the audience is fearful of the sheer science behind health economics. And so the need to understand health economics is essential for healthcare professionals.
Economic evaluation in healthcare is rapidly evolving and, as a consequence, so is the associated literature and terminology. The problem that health economists face is that communicating the economics of healthcare is often lost in science and the message is obscured. Ironically, the end result of health economics research is often not intended for the health economist but for payers, drug representatives and healthcare providers.
The onus is on health economists to communicate their messages well. But equally important as the message is the way the messages should be communicated to their specific audience because audiences respond differently to different channels and methods.
Whether it’s reimbursement submissions, value dossiers or internal papers and presentations, communicating health economics needs to be effective, concise and in a form that the audience can understand and digest. That doesn’t mean to say it shouldn’t be attractive, interactive and user-friendly.
How to participate in or lead a panel discussion
by Mary Gabb (mary.gabb@rxcomms.com)
As health economics plays a more prominent role in medical research and public policy, participation in panel discussions – either in front of a live audience or behind closed doors – is becoming part of the job description.
Done well, panel discussions can provide important insights into a topic and can allow the audience to interact with experts with whom they might not otherwise have the opportunity to meet. Done poorly, panel discussions can either devolve into chaotic ponderings or become yet another exercise in didactic drudgery. Here are a few tips on how panel discussions should be held.
If you are a member of a panel:
- Determine the purpose of the panel. Is the purpose to make experts available to audience members (so questions should come primarily from the audience)? To stimulate discussion with provocative ideas? To serve as a point-counterpoint discussion? To arrive at a consensus on a topic?
- Know what is expected of you. Too often, panellists arrive with a full slide set, ready to give their standard presentation. Will you be expected to show slides? If so, how many? Are you expected to make opening remarks?
- Know your fellow panel members. Find out who else will be on the panel, and what expertise they bring, to avoid any surprises.
If you are leading a panel:
- Choose panel members who can effectively think and speak off the cuff. Even though it is not a formal format, good presentation skills are still necessary.
- Prepare your team. Ensure every panellist understands the format – the number of slides to bring (if any), questions they might need to prepare, key discussion points to cover.
- Prepare yourself. Bring your own questions, in case the audience is reticent.
- Guide the audience. Introduce each panellist (more on introductions below) and describe the discussion format. Repeat each audience question and call upon a specific panel member to answer it.
- Stay on message. If taking questions from the audience, discern between appropriate and inappropriate/unrelated questions.
A good panel discussion depends as much if not more on the panel leader than the panel members. The key is to find a panel leader who is willing and able to exert control.
Finally, public speaking is not only about you as a presenter. If you are asked to introduce a speaker:
- Do your homework. Try to obtain from the speaker directly what he or she would like to have said about them. Not all of the information on a person’s CV is relevant.
- Personalise it. Chances are you’ve been asked to introduce the speaker for a specific reason. Try to share with the audience your relationship to the speaker, perhaps sharing a personal story.
- Stay at the podium. Too often we see the host desert the podium before the speaker arrives. It is your responsibility to greet the speaker at the podium, especially as the speaker is there at your invitation. Once the speaker arrives at the podium, shake the speaker’s hand and then step away.
Abstract submission deadlines
Please note that dates were correct at time of sending this email; HOC cannot be responsible for any amendments.
Submit |
Meeting |
Abbrev. |
Therapeutic |
Meeting date |
|---|---|---|---|---|
| 14 Feb 08 | Thomas L. Petty Aspen Lung Conference Aspen, CO, USA www.uchsc.edu/pulmonary/aspen/ |
ASPEN | Respiratory | 4–7 Jun 08 |
| 14 Feb 08 | European Society of Cardiology Munich , Germany www.escardio.org |
ESC | Cardiovascular system |
30 Aug– 3 Sep 08 |
| 15 Feb 08 | International Congress for Infectious Disease Kuala Lumpur , Malaysia www.isid.org |
ICID | Anti- infectives |
19–22 Jun 08 |
| 15 Feb 08 | International Conference on Pharmacoepidemiology Copenhagen , Denmark www.pharmacoepi.org |
ISPE | Health economics | 17–20 Aug 08 |
| 15 Feb 08 | International Epidemiological Association Porto Alegre , Brazil www.epi2008.com/ |
IEA (World) | Health economics | 20–24 Sep 08 |
| 15 Feb 08 | International Symposium on Supportive Care in Cancer Houston, TX, USA www.mascc.org |
MASCC/ ISOO | Oncology | 26–28 Jun 08 |
| 19 Feb 08 | International AIDS Society Conference Mexico City, Mexico www.aids2008.org/ |
IAS | Anti-infectives | 3–8 Aug 08 |
| 21 Feb 08 | Annual Congress of the European Respiratory Society Berlin, Germany http://dev.ersnet.org/412-welcome-address.htm |
ERS | Respiratory | 4–8 Oct 08 |
| 1 Mar 08 | European Haematology Association Copenhagen, Denmark www.ehaweb.org/ |
EHA | Cardiovascular system |
12–15 Jun 08 |
| 3 Mar 08 | Annual Meeting of the European Federation of Neurological Societies,Madrid, Spain www.kenes.com/efns2008/ |
EFNS | Central nervous system |
23–26 Aug 08 |
| 7 Mar 08 | International Congress of Parkinson's Disease and Movement Disorders, Chicago, IL, USA www.movementdisorders.org |
MDS | Central nervous system |
22–26 Jun 08 |
| 10 Mar 08 | European Association for Cancer Research Lyon, France www.eacr.org |
EACR | Oncology | 5–8 Jul 08 |
Introduction to Health Economics Concepts
Or perhaps as a health economist, you need to communicate health economics concepts to your department, company or colleagues? Then let Rx Communications do it for you. Our new range of health economics booklets are designed to communicate the core principles in a digestible language. The booklets can be purchased via our website in a generic format; in addition, the booklets are totally customisable so you can brand them any way you see fit. To help communicate the core principles, Rx Communications can also provide an interactive training module to assist the learning process which can be placed on your internet, intranet or on a CD-ROM. For more information contact duncan.dibble@rxcomms.com ; alternatively click here to view an interactive example of our first booklet.
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Next month
Another full issue, including: Why does healthcare cost so much?, Pros and cons of direct-to-consumer advertising, How to make ‘dismal science’ proactive and interesting.
If you have missed any of our earlier issues, email duncan.dibble@ rxcomms.com for a copy. See the HOC page on the Rx website for a full list of previous articles.
HOC is available for print in pdf format – free
You can of course print this e-newsletter straight from your inbox (for best results select landscape in your printer’s print set up), but HOC is also available as a professional 4-page A4 newsletter in pdf format for you to print and keep for reference. Simply email duncan.dibble@ rxcomms.com for past copies. If you would like to be sent a pdf version each month let us know and we’ll send one as soon as it is available.
Healthcare Outcomes Communicator is designed to help you explain and enhance your role and value as healthcare economists and outcomes researchers. But we need input from you – the professionals working "in the trenches". So we encourage you to give us your feedback about how we're doing – to communicate with us so that we can better communicate with you.
Yours sincerely
David Woods and the Rx Communications team
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