Health Care Research: Centuries of Curiosity, Caring, Diligence and Hope

Curiosity about the human body has led physicians, biologists and their historical counterparts to conduct medical research for centuries. Today, pharmaceutical companies conduct research and clinical trials with the hopes of uncovering the next miracle drug to improve the health of those suffering from any number of life threatening diseases.

In addition to medical and clinical trial research, today market researchers use online surveys to ask physicians about their prescribing preferences and decision-making about pharmaceuticals to monitor industry trends. Market researchers also survey ailment sufferers about their symptoms, usage of various drugs, communications with physicians and the benefits received. We learn, through these efforts about patient health, adherence to health care protocols, and patient satisfaction.

However, long before online market research was even the proverbial twinkle in someone’s eye, the earliest pioneers of health care research were learning about patients and diseases and advocating to their peers about the benefits of statistical research versus anecdotal evidence. Let’s meet some of these early researchers; and then make our way to a review of the twentieth and twenty-first century:

Sir William Petty (1623 – 1687)
Sir William Petty is probably better known for his contributions to economic theory than medical research; but, according to Wikipedia, he had a penchant for proving his theories with statistics as opposed to relying on anecdotal evidence. He studied medicine at Oxford; and is thought to have challenged his colleagues in the Royal College of Physicians with the earliest of marketing research surveys. For example, according to Medical Statistics from Graunt to Farr, by M. Greenwood, he asked them: had they ingested as much medicine and remedies as the same number of people of any other society; whether of 1,000 patients of the best physicians, of any age, the death rate would be lower than that the same number of inhabitants who dwelled where no physicians were available; and finally among 100 patients sick of acute diseases who used physicians, would as many die and in misery, as those who do not use physicians. Not many years later Votaire wrote, “The art of medicine consists in amusing the patient while nature cures the disease.” Although not everyone regarded Petty’s work as unflawed, he was admired for his contributions to early statistical research.

Pierre Charles-Alexandre Louis (1787-1872)
Louis, a French clinician, applied statistical techniques to clinical investigations and introduced to the field of medicine what is referred to as the numeric method – which is the idea that knowledge about a disease, its history, clinical presentation and treatment could be derived from aggregated patients’ data. In addition, Louis’ contribution to medicine was the use of facts and statistics in place of the time’s vague theorizing and anecdotal evidence. Louis became so renowned for his methods that between 1820 and 1861 approximately 700 American physicians travelled to Paris to study under him.

It was from the influence of Louis and his numerical method that physicians and scientistics formed various medical societies, including the Statistical Society of London, in which its members discussed intensive scientific issues of a clinical and population based nature, as well as research methods in medicine.

The Epidemiological Society
In 1850, J.H. Tucker, a concerned physician practicing in London, formed The Epidemiological Society with the goal of coordinating efforts to protect the population against the spread of communicable disease; in particular at the time – cholera. The seal of the organization included the Latin phrase penned by the Roman poet Persius (34-64 AD), venienti occurrite morbo, translated into English as “confront disease at its onset.” The organization was a huge initiative for its time, involving not just physicians, but politicians and the public as well. The initial meeting comprised 200 attendees, mostly members of the medical profession; and was presided over by Anthony Ashley Cooper (1801-1885), a well-respected prominent politician and landholder. The Society is believed to have given birth to modern epidemiology; and was focused on promoting the use of medical data and statistics to help its members learn about and prevent the contagion of communicable diseases. The purpose of the organization was thus:

• to institute rigid examination into the causes and conditions which influence the origin, propagation, mitigation, and prevention of epidemic diseases;
• to institute...original and comprehensive researches into the nature and laws of disease; and
• to communicate with government and legislature on matters connected with the prevention of epidemic diseases.

Florence Nightingale (1823-1910)
It would seem that any article on health care research would be remiss if it did not include mention of Ms. Nightingale. Renown for her nursing skills, Nightingale was a passionate mathematician and statistician. In 1858 Nightingale was elected the first female member of the Statistical Society and she also became an honorary member of the American Statistical Association. Nightingale was convinced that if the right information was collected in a systematic way, it could improve the quality of health care. In 1863, Florence Nightingale wrote, “With fixed data, arrived at on these principles, we can readily obtain the proportionate mortality not only of the whole hospital, but of ever ward of it, and also the proportionate mortality and duration of cases for each age, sex and disease.”” Thus she established the contents of the first version of what is now know as the Uniform Hospital Discharge Data Set. Nightingale’s research led her to insist on cleanliness in hospitals. She was a proponent of the Miasma Theory of Disease – i.e., a belief at the time that diseases such as cholera or the plague were caused by a miasma, a noxious form of "bad air". Of course, today we know a lot more about how germs are spread than did health care practitioners of the mid-1800’s; but starting with hospital cleanliness was spot on.

The Twentieth and Twenty-First Centuries – North America
According to the website from the Library of Virginia, the history of collecting vital statistics about births, deaths, marriages, etc. goes back to 1632 when the General Assembly of Virginia passed a law requiring the registration of these events. However, in 1902 the U.S. Bureau of Census was formed to collect the first database of statistical information about the U.S. population. In fact, Herman Hollerith's electric tabulation machine, seen here in a 1904 photograph, was used to process data from the census. This automatic counting device tabulated census returns, opening the door for future advances in data processing. This might be the very early version of Greenfield Online’s technology platform. Perhaps Hollerith is a distant past relative of Greenfield Online’s CTO, David St. Pierre, in fact if you look closely, there even appears to be a slight resemblance.

In 1946, the US Public Health Service began collecting and publishing vital statistics on births and deaths. In 1960 the National Center for Health Statistics was established. Biomedical research and public health advances during the twentieth century brought about an age adjusted death rate decline of 74% and an increase in life expectancy of 56%.

Health care improvements and discoveries during the last one hundred years have been astounding: much safer and more varied medications, including antibiotics and antiviral therapies; as well as sophisticated blood tests, x-rays, the CT and MRI. The ECG, EMG and EEG are also products of the last century; not to mention techniques such as arthroscopy and endoscopy and the use of lasers.

But What About Health Care Marketing Research?
In the twentieth century, one of the early forms of health care marketing research was tracking the prescribing habits of physicians. This practice, although it has evolved with sophisticated technology, continues today and is a multi-billion dollar market. It helps pharmaceutical companies understand what drugs physicians are prescribing for various conditions. Although perfectly legitimate, the practice of collecting prescription information is in fact, under some scrutiny in certain states and in the news lately.

Health care has been a sector of American society that has been strangely slow in taking advantage of the wonders of modern information technology. Concerns about privacy; the difficulties of navigating through a payment system that involves a multitude of public, private, and individual payers; as well as a tradition of scientific rigor have contributed to making health care a laggard rather than a leader in utilizing the benefits of the Internet.

The United States is behind most other industrialized countries in the use and sharing of electronic medical records. In the U.S., health care lags behind other industries in utilizing the Internet for basic amenities such as appointment setting and communications between patients and their health care providers.

Similarly, health care research has been slower than consumer research to take advantage of the benefits of the Internet. It has taken until the last year or two before most physician - and patient- based research has moved to the Internet.

Today, Greenfield Online enables researchers around the world to conduct virtually every kind of research in the health care arena, including, but not limited to: recruiting patients for clinical trials; multi-national research of physicians; drug name validation studies: simultaneous studies of patients, physicians, nurses and pharmacists; tracking the results of physician detailing; medical records studies; and physician and patient segmentation studies.

Not surprisingly, the financial services industry now takes advantage of the enhanced capabilities of the Internet to help do its own forecasting of the market size and future value of products before they hit the market. In the last year, Greenfield supported the first study which resulted in FDA approval of claims validated through Internet-based research. The full range of analytic methods including highly sophisticated discrete choice modeling is now conducted utilizing data collected on the Internet. Virtually every group of interest to researchers including medical professionals, patients and their caregivers, and institutional purchasing decision-makers around the world are surveyed via the Internet.

New methodologies tend to both replace older ones and present new opportunities. The speed, targeting, and lower costs associated with utilizing the Internet have resulted in a burgeoning of both the speed and sheer amount of research that can be conducted and the creativity that is brought to developing new techniques.

Robert Leitman, General Manager Health Care Practice and Cindi Brockhoff, Editor GO Insights