Atul Gawande on the connection between farming and medical care

Atul Gawande is a Cancer surgeon at Brigham And Womens Hospital, a journalist for the New Yorker, a Harvard Associate Prof and a book author. Recently he published The Checklist Manifesto: How to Get Things Right. If you'd like to understand the US health care conundrum, and what's at stake in the new health care legislation pending in Congress then Gawande's writings would be a good place to start.

Check out his New Yorker article titled Testing, Testing. It playfully makes a few cross references between the agricultural revolution started by the USAID in the 1900s, and - startlingly enough - the role of government in health care today.

"At the start of the twentieth century, another indispensable but unmanageably costly sector was strangling the country: agriculture. In 1900, more than forty per cent of a family’s income went to paying for food. At the same time, farming was hugely labor-intensive, tying up almost half the American workforce. We were, partly as a result, still a poor nation. Only by improving the productivity of farming could we raise our standard of living and emerge as an industrial power. We had to reduce food costs, so that families could spend money on other goods, and resources could flow to other economic sectors. And we had to make farming less labor-dependent, so that more of the population could enter non-farming occupations and support economic growth and development.

"America’s agricultural crisis gave rise to deep national frustration. The inefficiency of farms meant low crop yields, high prices, limited choice, and uneven quality. The agricultural system was fragmented and disorganized, and ignored evidence showing how things could be done better. Shallow plowing, no crop rotation, inadequate seedbeds, and other habits sustained by lore and tradition resulted in poor production and soil exhaustion. And lack of coördination led to local shortages of many crops and overproduction of others.

"You might think that the invisible hand of market competition would have solved these problems, that the prospect of higher income from improved practices would have encouraged change. But laissez-faire had not worked. Farmers relied so much on human muscle because it was cheap and didn’t require the long-term investment that animal power and machinery did. The fact that land, too, was cheap encouraged extensive, almost careless cultivation. When the soil became exhausted, farmers simply moved; most tracts of farmland were occupied for five years or less. Those who didn’t move tended to be tenant farmers, who paid rent to their landlords in either cash or crops, which also discouraged long-term investment. And there was a deep-seated fear of risk and the uncertainties of change; many farmers dismissed new ideas as “book farming.”

"Things were no better elsewhere in the world. For industrializing nations in the first half of the twentieth century, food was the fundamental problem. The desire for a once-and-for-all fix led Communist governments to take over and run vast “scientific” farms and collectives. We know what that led to: widespread famines and tens of millions of deaths.

"The United States did not seek a grand solution. Private farms remained, along with the considerable advantages of individual initiative. Still, government was enlisted to help millions of farmers change the way they worked. The approach succeeded almost shockingly well. The resulting abundance of goods in our grocery stores and the leaps in our standard of living became the greatest argument for America around the world. And, as the agricultural historian Roy V. Scott recounted, four decades ago, in his remarkable study “The Reluctant Farmer,” it all started with a pilot program."

For the rest of the story, read here.

I am particularly interested in Gawande's take on how government fixed farm agriculture while maintaining it private - because elementary education finds itself in the same conundrum: a mass of schools and teachers that need guidance on which education techniques work and which don't. Gawande comes at this from the angle of the health care indiustry - but his analogies and conclusions may apply to precollege education as well.

Gawande was recently interviewed by Charlie Rose on Jan 5, 2010 the subject of health care. Watch it! It will be a good 1/2 hour well spent! You'll learn about Boeing's four-engine Flying Fortress planes and how they got their pilots not to forget to unlock the ailerons after take-off. You'll also see the connection with today's lengthy, convoluted medical procedures that lead to human and heart wrenching treatment mistakes made by doctors.

As a bonus, Gawande talks at length in the Charlie Rose interview about what worked and what didn't in the Universal Healthcare reform in Massachusetts initiated two years ago, and what the implications are for the upcoming US health care bill.