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The Center for the Analysis of Health Practises: Milton Weinstein


Working with Herb Sherman
Howard Hiatt Physician
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I met Herb Sherman socially at a time when his wife had just undergone mitral valve surgery at one of the Harvard teaching hospitals. Herb told me that she had had her valve replaced with a porcine valve, and he had just come from the library where he looked at the experience with porcine valves. He said that he found a shocking paucity of experience in animals as well as in people, but in animals before the valves were used in people, and in people before the valves were widely advertized as an important advance. At that time Herb was in charge of the communications satellite program at the Lincoln Laboratories. He said to me, 'You know, I, I'm responsible for the team that puts up communications satellites'. He said, 'If I did as little research or if as a little research were done on a... a satellite as I find done in medicine on heart valves, if I really were to launch a satellite with as little basis on... in research', he said, 'I would lose my job without question'. We began a friendship at that time. Within a short period of time he took a leave of absence from the Lincoln Laboratories. He and his colleague Barney Reifen were convinced that computers had something to offer to medical care, and they came, fully funded by Lincoln Laboratories, as they worked with me at Beth Israel Hospital to explore the potential usefulness of communication satellites... potential usefulness of computers to... to medical care.

Our first experiment was to determine how useful a computer might be in making a specific medical diagnosis, and what Herb decided to look at was the accuracy with which doctors diagnose streptococcal... streptococcus as the cause of sore throats. It took very little time before Herb decided that a computer would not be nearly as useful as a pencil and a piece of paper for carrying out the experiment that he proposed. What the experiment involved looking at... training a group of high school graduates as to the symptoms and signs that are consonant with the diagnosis of strep throat, and then comparing what a team of people that he and Barney trained, where the... the success of that team as compared with doctors and nurses who were looking at the same group of patients. They proved to have an accuracy of something of the order of, of 80 or 85%. The doctors were closer to 60 or 65%. This is before the, of course, the tests were done to ascertain whether or not strep was the cause of the sore throat. But that was the first study that Herb and Barney were involved in, and subsequently they remained at Beth Israel and came to the School of Public Health with me. When we set up the Center for the Analysis of Health Practices, they were invaluable in terms of their work with physicians like Howard Frazier and Don Berwick, and with colleagues, other colleagues, at the School of Public Health.

Born in 1925, American Howard Hiatt set up one of the first medical oncology research and training units in the US and has headed up some of America's most prestigious medical institutions. Hiatt attended Harvard College and received his MD from the Harvard Medical School in 1948. He was a member of the team at the Pasteur Institute, Paris, that first identified and described mRNA, and he was among the first to demonstrate mRNA in mammalian cells. From 1991 to 1997, he was Secretary of the American Academy of Arts and Sciences, where he began and directs the Academy's Initiatives For Children program. He is also committed to helping disadvantaged people access decent health care.

Listeners: Milton C. Weinstein

Milton C. Weinstein, Ph.D., is the Henry J. Kaiser Professor of Health Policy and Management at the Harvard School of Public Health and Professor of Medicine at the Harvard Medical School. At the Harvard School of Public Health he is Academic Director of the Program in Health Decision Science, and Director of the Program on Economic Evaluation of Medical Technology . He is best known for his research on cost-effectiveness of medical practices and for developing methods of economic evaluation and decision analysis in health care. He is a co-developer of the CEPAC (Cost-Effectiveness of Preventing AIDS Complications) computer simulation model, and has conducted studies on prevention and treatment of HIV infections. He is the co-developer of the Coronary Heart Disease Policy Model, which has been used to evaluate the cost-effectiveness of cardiovascular prevention and treatment. He is an author of four books: Decision Making in Health and Medicine: Integrating Evidence and Values; Cost-Effectiveness in Health and Medicine,the report of the Panel of Cost Effectiveness in Health and Medicine; Clinical Decision Analysis; and Hypertension: A Policy Perspective.He has also published more than 200 papers in peer-reviewed medical, public health, and economics journals. He is an elected member of the Institute of Medicine of the National Academy of Sciences, and a recipient of the Award for Career Achievement from the Society for Medical Decision Making. Dr. Weinstein received his A.B. and A.M. in Applied Mathematics (1970), his M.P.P. (1972), and his Ph.D. in Public Policy (1973) from Harvard University.

Tags: Lincoln Laboratories, Herb Sherman

Duration: 5 minutes, 28 seconds

Date story recorded: September 2006

Date story went live: 24 January 2008