Health Care BS

Comments 16

1. Marc Brown wrote:

   ‘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 ¶
2. Rich wrote:

   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 ¶
3. Catron wrote:

   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 ¶
4. Marc Brown wrote:

   ‘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 ¶
5. Paul Hsieh, MD wrote:

   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 ¶
6. Sandy wrote:

   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.
   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

   Posted 03 Apr 2008 at 8:23 am ¶
7. alexa-blue wrote:

   “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 ¶
8. Jim Schroeder MD wrote:

   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-
   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.

   Posted 03 Apr 2008 at 5:52 pm ¶
9. Don McCanne, MD wrote:

   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 ¶
10. Catron wrote:

    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 ¶
11. Rich wrote:

    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 ¶
12. Don McCanne, MD wrote:

    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 ¶
13. Catron wrote:

    “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 ¶
14. Marc Brown wrote:

    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 ¶
15. matt wrote:

    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 ¶
16. Ambulance Doctor wrote:

    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

1. From Democracy Project on 03 Apr 2008 at 6:04 pm ¶

   Skewed Poll Has Doctors Favoring Nationalized Care…

   The appropriately named blog Health Care BS looks at the widely reported poll of which Reuters, for example, says: More than half of U.S. doctors now favor switching to a national health care plan and fewer than a third……

2. From Bad Medicine » Pot, kettle, moo. on 03 Apr 2008 at 7:48 pm ¶

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3. From The second American Revolution - Page 9 - Truckingboards Truck Drivers Forum on 02 Apr 2009 at 5:23 pm ¶

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4. From The second American Revolution - Page 11 - Truckingboards Truck Driver Forum on 09 Apr 2009 at 7:16 pm ¶

   […] As far as our drs wanting socialized medicine, I assume you are referring to this biased article? Health Care BS - MOST DOCTORS FAVOR SOCIALIZED MEDICINE? Seems to me you have enough on your hands to work out with your own healthcare system. While […]

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