Ian Morrison

In most markets, and most industries, organizations are accountable to their customers. If you make a product that doesn’t work or doesn’t meet customer needs in some other way, then you won’t make money and your shareholders will be unhappy. The magic of market forces makes firms accountable. But markets fail in healthcare. (By the way, that’s why we have a whole branch of economics called health economics and we don’t have dog food economics or Sport Utility Vehicle economics). The major source of market failure in health care, according to the Nobel laureates, is asymmetry of information-in a nutshell, doctors know more than patients. Therefore we have created all kinds of societal institutions like professions, universities, government regulators, health plans and review organizations in an attempt to make doctors and their workshops more accountable.

With the rise of the Internet and the new sophisticated consumer, some are challenging the asymmetry of information argument and asking why can’t healthcare be like other markets, and be accountable to the consumer. These critics have a point. A hundred million Americans have surfed the net for healthcare information according to pollsters at Harris Interactive. At the same time, consumers are declaring their preferences for complementary and alternative therapy and paying good money for it, out of their own pocket. Isn’t that the ultimate accountability?

Before we all get too carried away, let me suggest that there are two types of consumerism, the first is what I would call naïve market consumerism (this is Milton Friedman on steroids). Many in the pharmaceutical, medical products, and emerging health insurance markets subscribe to the notion that that whatever the consumer wants to spend his/her money on in healthcare is fine (and by definition utility maximizing for the consumer). So it’s the consumer’s choice, if she decides to lower her cholesterol by getting Lipitor prescribed by her doctor or by purchasing herbal remedies called “The Fat Trapper” and “Exercise in a Bottle” after she saw the infomercial. (Please note, I am not making this up, stay up late enough watching cable TV and you will know of the “Fat Trapper”).

A second form of consumerism is what I would term evidence-based consumerism. This makes the consumer a partner in the process of accountability by providing them with the scientifically based support to make informed judgment. It addresses the asymmetry of information full-on and tries to level the playing field. The explosion in health-related websites and self-help resources is assisting the consumer in overcoming their anxiety about not knowing enough. But to date, we have not made these information purveyors accountable for their counsel. We lack a system of accountability for healthcare information.

There are some signs of improvement. The FDA regulates drug information and so pharmaceutical companies are a reliable source of information about their products, although skeptics may be leery of their aggressive advertising and promotion. Similarly, the professional medical societies are playing a more formal role on the internet and will bring their professional standards (and biases) to the information exchange. This is not enough. Consumerism needs to be evidence-based, where there is a seal of approval placed on the information, backed up by the same accountability that exists in the peer reviewed scientific literature. Consumers are showing an appetite for industrial-strength medical websites (the kind that real doctors use) that are evidence-based . New organizations such as Medrock (a medical concierge service aimed at helping patients with serious medical conditions), BMJ Unified (a new joint venture between United Healthcare and the British Medical Journal), Medem and Medscape (both web-based businesses with impeccable scientific credentials) may all evolve as pioneers in evidence-based consumerism.

Ian Morrison is an author, consultant and futurist based in Menlo Park, California. This essay was published in the July/August 2001 Issue of the Health Forum Journal.