The Pain of Knowing

Economists pretty much agree that one reason for all the waste in the health care system is a simple lack of information. We just don't know which doctors are good, which order too many tests, which order the wrong tests etc. And the doctors don't know, either.

One reader mentioned an area of medicine where the that kind of information exists: the treatment of cystic fibrosis. That reminded Laura here of this great New Yorker article by Atul Gawande called "The Bell Curve" from 2004.

It's a fantastic and moving piece of writing. Cystic fibrosis patients at the best facility were living to age 46, but at average places only to age 30. That information proved incredibly powerful. Facilities that weren't so good tried to figure out why they weren't.

But the knowledge also created agonizing situations. Families wondered if they should move to get the best care. Doctors had good reason to question their own performace. Toward the end of the article, Gawande — himself a physician — asks the hard question: "What if I turn out to be average?"

As a side note, if you haven't heard Laura Rothenberg's radio diary about having cystic fibrosis — "My So Called Lungs," — I highly recommend it. It's one of those pieces that sticks in your gut for years.

Here is the sad epilogue.

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