Another day, another phony survey. Most doctors favor socialized medicine according to a report from Reuters:
Of more than 2,000 doctors surveyed, 59 percent said they support legislation to establish a national health insurance program.
Seem counterintuitive? It should. The lead author of this “survey” is Aaron E. Carroll, a single-payer zealot on the Board of the activist group “Physicians for a National Health Program.”
This guy routinely produces “studies” and “surveys” that somehow always show that Americans in general and the medical community in particular want government-run health care. Here’s a typical passage from one of his articles:
Medicare-for-all could save enough on administrative waste ($350 billion) to cover all the 47 million uninsured and improve coverage for everyone else.
This character obviously has an ax to grind, and the PNHP crowd is notorious for producing tendentious studies. This one is particularly suspect because its basic claim is preposterous on its face.
Think about it: There are about 800,000 physicians in the U.S. and this guy claims 59% of them (472K) support a nationalized health care system. If this is true, why does PNHP only have 14,000 (less than 2%) members?
Yet there will be no shortage of gullible people to buy Dr. Carroll’s snake oil in the belief that it contains a cure for the ills of U.S. health care. Sorry, folks, this “survey” is obviously BS and should be relegated to the circular file.
UPDATE:
Lefty gadfly Marc Brown provides this link in a rather naïve effort to legitimize the shoddy methodology of this “study.” Here’s the relevant passage:
About 500 questionnaires were undeliverable, 197 were returned by physicians no longer in practice, and 2,193 were completed (51% response rate) and returned …
Anyone with a basic understanding of statistical samples will see a red flag here. Surveys of this type are worthless if the sample isn’t random, and this one doesn’t pass that test. The 2,193 respondents obviously constitute a self-selected group and, as such, are not representative of the larger population of physicians.
Dr. Carroll knows this, of course, yet he disingenuously foists this fraud on the public.
UPDATE II:
Greg Scandlen has posted a good parody of the “survey” questions that produced these preposterous findings.
Please check the box that is closest to your beliefs and return the form to me –___ Reporters are idiots___ Reporters are morons
The results will be published in the prestigious Annals of Internal Medicine.
Kinda captures the hard-hitting journalism that went into the Reuters article, does it not?
Comments 16
‘There are about 800,000 physicians in the U.S. and this guy claims 59% of them (472K) support a nationalized health care system.’
Stats 101 - once you get a statististically significant sample you can go on asking more people but the chances of the findings changing much diminish. In this case, the survey was acutally mailed to 5000 AMA members and just over half responded. Full details at:
http://www.pnhp.org/news/2008/april/physician_opinion_ti.php
Posted 02 Apr 2008 at 7:12 am ¶Yes, but selecting exclusively from AMA members introduces a selection bias. We do not all belong to the AMA, for very good reasons.
AMA membership has been generally declining for years (though with a few small blips in the 3-4000 range), and is less than half of the physician population in the US, around 30% or so.
So, while selection bias is not Stats 101 (it’s stats 102) it is real and significant. An no conclusion about physicians in general can be made by sampling only AMA members. AMA members are by no means representative, since the majority of physicians in the US do NOT belong to the AMA. All I know is that AMONG AMA members, there is a slight (59%) preference toward a national health program.
Reuters, of course, left this tidbit out of their report, and Marc just assumed that AMA members are representative of the population.
Shame on the sloppy Reuters report which begins:
“More than half of U.S. doctors now favor switching to a national health care plan and fewer than a third oppose the idea, according to a survey published on Monday.”
Posted 02 Apr 2008 at 11:40 am ¶Excellent point, Rich. That means this survey involves a self-selected subset of another subset of the general physician population.
Posted 02 Apr 2008 at 11:55 am ¶‘The 2,193 respondents obviously constitute a self-selected group and, as such, are not representative of the larger population of physicians.’
That’s right - but plenty of people said they were against universal care. And let’s see what surveys you can come up with. And here’s the real kicker - the AMA is of course not a supporter of a single payer system and indeed was once famously anti any universal care.
Posted 02 Apr 2008 at 4:08 pm ¶The AMA has has gone on record as supporting universal health care, although to it’s credit it does not (yet) support a single-payer system:
http://www.ama-assn.org/ama/pub/category/7834.html
But many physicians including myself (and many of my partners) specifically are *not* AMA members because of their leftist position on too many positions, including but not limited to “universal health care”.
Hence, Rich’s point about selection bias is quite on target.
Posted 02 Apr 2008 at 5:22 pm ¶Even more important than sample size is the wording of surveys. They are ALWAYS manipulated to “prove” what the pollster wants to find — why? Because surveys and polls are a MARKETING technique, not research.
Posted 03 Apr 2008 at 8:23 am ¶See Dr. Wes’ description of a survey conducted at ACC to prove doctors “want” P4P — it’s a hoot:
http://drwes.blogspot.com/2008/04/looking-in-mirror.html
“This guy routinely produces “studies” and “surveys” that somehow always show that Americans in general and the medical community in particular want government-run health care. ”
Please define “routinely” (inferring from pubmed, it means “twice, separated by five years”).
Your working definition of conflict of interest is probably not pragmatic (though laudable).
Posted 03 Apr 2008 at 2:06 pm ¶There is another interesting phenomenon in surveys of this type. The Colorado Medical Society had an online survey in 2007 to gauge physician attitudes about healthcare reform (General information about this so-called matrix). This was also a self-selected respondent pool with <5% of Colorado physicians participating. I began the poll myself, and became increasingly dissatisfied with the wording of the questions and possible responses, finding that my own opinions could not be expressed in that format. I quit less than halfway through the poll. Interestingly though, the CMS posted the results (subsequently they have removed the raw data from their website) and showed I was not alone. If you look sequentially at the number of responses reported by the CMS, item # 1 had 663 responses, item # 10 had 626, #20-
Posted 03 Apr 2008 at 5:52 pm ¶568, #30- 551, #40- 527, #50- 520, etc. By the final item only 516 responses were recorded.1 By my math, this would reveal that of 663 who started the questionnaire, 147 (22%) did not complete all 70 questions and 112 (16.8%) did not make it even halfway through! Ongoing selection bias during the actual poll? That says a lot to me about validity of the polling technique.
This survey is a scientifically-valid, peer-reviewed study published by the Annals of Internal Medicine, a journal noted for its adherence to the highest standards of academic excellence.
The survey was of physicians randomly selected from the AMA Masterfile. This is a list of all physicians in the United States irrespective of their membership in the AMA. Names are never removed from this list, even after death. A valid sample automatically would include some who are deceased and others who might not have a current address on file.
Only two questions were asked: (1) In principle, do you support or oppose government legislation to establish national health insurance? (2) Do you support achieving universal coverage through more incremental reform?
As to whether there was a self-selection bias over-representing supporters of national health insurance, it is known that opponents of national health insurance are very passionate in their views, so it is just as possible that opponents could have been over-represented.
Regardless, the study does confirm that a large percentage of physicians do support national health insurance, and that number is growing.
Posted 04 Apr 2008 at 4:15 am ¶Don, you either didn’t read the post or didn’t understand it. The statistical validity of the survey has nothing to do with how the original mailing list of 5,000 was derived.
All that matters is how the actual 2,193 respondents were selected. If that selection wasn’t random, and a child could see that it wasn’t, the sample isn’t representative of the larger physician population.
If AIM continues to publish this kind of shoddy material, it will lose all credibility among those of us who are capable of critical thinking.
Posted 04 Apr 2008 at 6:45 am ¶Don is correct that the study selected from the AMA masterfile and not the membership - in that I was mistaken, having taken another poster’s word for it. I read the actual letter in AIM, it states the AMA masterfile was used.
I still agree with Catron’s initial assessment, however.
Posted 04 Apr 2008 at 7:53 am ¶Catron, this was a RANDOM sampling of the AMA Masterfile of ALL physicians in the United States. You will have to point out to me what it is that a child can see that shows that it was not “representative of the larger physician population.”
You can attack the very large number of physicians who support national health insurance, but you cannot tell us what we believe.
Posted 04 Apr 2008 at 3:29 pm ¶“You will have to point out to me what it is that a child can see.”
OK, Don, I’ll try one more time. In order for the survey to be statistically valid, the 2,193 respondents must be randomly selected.
Posted 04 Apr 2008 at 5:20 pm ¶Much as it hurts me to say this, but Catron’s right. The respondents self-selected to answer the survey, as opposed to being called at random to answer it. However, for him to trash the study he’s assuming that pro-national insurance docs are more motivated to answer the survey than those against, for which of course there is no evidence. And the amazing standout of this survey is the response rate - over 50% is unheard of, certainly in more complex mailed out surveys. This was a very simple survey, but even so - there’s certainly something interesting here.
Posted 04 Apr 2008 at 6:49 pm ¶This study is 100% Bunk! The doctors who did this study also conducted one in 2002 and found that the majority of doctors did not want national health care, the problem with this is that the 2 question surveys drastically differ in there 2nd question. I found this article, 60% of Physicians Surveyed Oppose Switching to a National Health Care Plan, It’s worth a read.
Posted 09 Apr 2008 at 2:29 am ¶I think that with the years AMA membership losses its prestige and nowadays the question is not vital.
Posted 15 May 2008 at 11:20 am ¶Trackbacks & Pingbacks 4
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