I don't know how many of you have seen the latest published, peer-reviewed outcomes report in the November issue of Pharmacotherapy, but it is perfectly timed for Halloween because if you belong to Kaiser, have cardiac problems and are relying only on your doctor for care, this outcome is scarier than Christine O'Donnell.

Let us leave aside the "finding" that in the study group drug use was 20% lower than in the control group even though the authors credit "early initiation of secondary drug therapy" and "aggressive use of secondary prevention drugs" with the savings of $21,000 (adjusted) per cardiac patient. And leave aside the fact that these severely ill patients, dying at a rate vastly in excess of the population as a whole, spent less on drug claims (about $1344) than I used to spend before Ambien went off-patent and Prilosec went OTC.

Focus instead on the poor schmucks who comprised the control group. Almost a third of them died (188 of 628) vs. 2% of the study group...all due to the lack of $1/day in nurse coaching — the intervention which was only alleged difference between the two groups. The control group's annual costs were $93,000, including $1900 on drugs..

So...here is what we know about the control group: They were incurring vastly more claims than the average patient, being hospitalized at a rate more than 3x that of the intervention group, dying at a rate more than 10x the intervention group (and half of their deaths were from non-cardiac causes)...and yet the doctors only prescribed $1900/year of drugs — only about 2% of these people's claims were spent on drugs even as they were dropping like flies from all sorts of cardiac and non-cardiac diseases.

It would seem that, if this study were valid, at least a few doctors should be getting fired, sued or charged with a crime...and yet this senseless slaughter could have been avoided if Kaiser had stopped the study and looked under a few sofa cushions to dig up $1/day to spend on their life-saving coaching intervention, which would have reduced their drug use by 20%, apparently saving many lives. Instead, a third of their patients died needlessly...

The only other conclusion is that the study was conceived, designed, executed and/or measured invalidly, but that never happens in our field. On those rare occasions when it does (only twice in the last three weeks), we are standing by to offer an Intelligent Design Award (for setting back the evolution of disease management), which we are more than happy to bestow.

Next Intelligent Design Award