Science is facts; just as houses are made of stone, so is science made of facts; but a pile of stones is not a house, and a collection of facts is not necessarily science. Jules Henri Poincaré (1854-1912), French mathematician

Recently I was reminded that we often take our basic science skills for granted and how extremely valuable they truly are. Last week, on New Hampshire Public Radio's The Exchange, Tom Sherman, MD, a gastroenterologist and state representative from Rye, NH, spoke with clarity and reason to bring a scientific lens to the Medicaid expansion debate. (Listen to broadcast.)

Opponents of expansion repeatedly misrepresented two studies looking at the impact of Medicaid and Dr. Sherman helped piece the "facts" presented into a coherent and rational explanation of the findings. Perhaps naively, I assumed that people quoting medical literature would actually read it and get clarification from experts in the field before drawing conclusions. There clearly is a role for physicians to be vocal on issues that pertain to us.

Take a quick look at these two studies about Medicaid insurance coverage:

The Oregon study was a randomized controlled trial looking at the impact of Medicaid insurance on a variety of health and financial metrics over 17 months. Opponents said that there were high costs and no benefits to Medicaid; but what the study actually said was quite different. In the short span of the study, significant gains in mental health and financial stability were associated with Medicaid coverage and while they didn't reach statistical significance, Medicaid beneficiaries realized positive gains in their cardiovascular risk profiles. As with most research in prevention, the horizon for success is usually much longer than 17 months.

The Virginia study looked at surgical outcomes and particularly mortality across insurance status comparing private insurance to Medicare, Medicaid, and the uninsured. The study showed that privately insured patients had lower mortality rates than those who were uninsured or covered by Medicaid and Medicare. The study was actually poorly designed because the populations being compared were so different in socioeconomic factors. People with private insurance are younger and healthier in general than people without insurance or with Medicaid or Medicare coverage. This study simply showed that younger healthier people do better in surgery than older and sicker people, which the authors actually acknowledged. However, on the radio, opponents of Medicaid expansion asserted that the study showed that Medicaid is killing patients and that it would be better to be uninsured than to have Medicaid.

For both of these studies, Dr. Sherman presented a deeper understanding and gently corrected those with limited experience looking at the medical literature. Bringing reason and science to the discussion certainly elevated the discussion from a partisan point and counterpoint, sound-byte driven debate. The learning point for me is that medical school and residency gave me a skill set that is unique and is desperately needed in the forum of public debate on health issues. So the next time you hear or see something in the news that doesn't make sense or is inconsistent with the science as you understand it, speak up and use the skills you have to enrich the debate!

Truth will ultimately prevail where there is pains to bring it to light. -George Washington

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