One of the biggest challenges in teasing out possible causation or directionality of an exposure and an observed phenomenon, it’s essential to consider confounding by indication. Although it’s described in the Medical Studies Core Topic Key Concepts page, it’s such an important consideration in both evaluating medical studies and in formulating questions for them that it deserves a special call-out — again and again and again.
So I’m writing three blog posts with mini case studies of confounding by indication because I REALLY want to drive home how important it is that reporters covering observational studies think hard about all the possible reasons a correlation might exist between an intervention or exposure and a subsequent intervention, medical condition or negative effect. Continue reading
Courtesy of Neel Shah, M.D.Health reformers are grappling with how to bring down the high rate of cesarean section deliveries in the United States. The U.S. isn’t the only country in the world overusing the procedure, but it does have one of the highest rates.
I recently heard Neel Shah, M.D., an obstetrician at Beth Israel Deaconess Medical Center, the founder of Costs of Care, and associate faculty at Ariadne Labs (more about all of that here) speak about health care quality and delivering babies.
We’ve all heard about unnecessary cesarean sections (and elective induced early births, although that’s a related but not identical set of challenges). Many of us tend to think of it as a doctor-centered issue. Some doctors perform more C-sections than others and there are a host of reasons, ranging from how and where they were trained to how they assess and tolerate maternal risk to time management and financial considerations.
But Shah challenged me to think of unnecessary C-sections as a hospital management or system engineering problem – not just a problem created by individual doctors. Continue reading