Aug 23, 2023

Dr. Anupam Jena is an economist, a physician, a podcaster, and the Joseph P. Newhouse Professor of Healthcare Policy at the Harvard Medical School. He's also the co-author, along with Dr. Christopher Worsham, of the newly published book Random Acts of Medicine: The Hidden Forces that Sway Doctors, Impact Patients, and Shape Our Health. Anupam, also known as Dr. Bapu, combines his medical training with curiosity about cause and effect to explore explanations for failures and successes in providing healthcare and how chance occurrences affect our health. Of particular interest is the power of natural experiments to enhance understanding of the effect of a treatment or drug within a larger universe than traditional randomized clinical trials.  

Bapu elaborates, "One of the benefits of these natural experiments is that they are more generalizable. They tell us what might happen in a real world because you're exactly right. If a clinical trial is performed, it may be performed in a very particular geographic area, in a very particular type of patient that is not the same as the type of person who might take that medication in the real world."

"I don't think that we should be making whole-scale treatment decisions without randomized trials. So those are the gold standard, and we need them to be there. They provide an important foundation."

"But it's also important to know that they do have some limitations because we might not be able to do a randomized trial on every population person that we care about. That's where the natural experiments come in. I think they really are complements and not substitutes because once we have a sense that this medication does work based on randomized trials, then we can do natural experiments to say, "Well, they might work better or not as well in these particular populations of people."

"So it's no surprise to people that randomness or chance does affect our health in ways that we can appreciate. For example, a child drowns in the swimming pool because, just by chance, someone gets distracted in the moment, or someone is hit by a car. Again, totally random events. In many cases, a cancer, when there are no risk factors, that's unpredictable and it's a chance event."

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Random Acts of Medicine

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