The recent surge of emerging physicians with expertise outside of clinical medicine indicates a promising future for U.S. healthcare. As a result of these new academic hybrids, powerful research that bridges the gap between medicine and economics, sociology and public policy is now reaching the community, and clinicians are making previously unimaginable discoveries.

This trend is consistent with Harvard’s establishment of the joint MD–MBA program, along with the brisk diffusion of joint degree programs through other medical schools across the country. Three particular contributions borne from this trend stand out as illuminating examples of the possibilities inherent in interdisciplinary work.

Dollars and Data

David Meltzer, an associate professor of medicine at the University of Chicago, completed his internal medicine residency at Brigham and Women’s Hospital and earned a PhD in economics at the University of Chicago. He has argued persuasively for a revision of the methods researchers use to perform cost-effectiveness studies.

This research exemplifies the gold standard for technology assessment in healthcare and is typically performed by considering only health-related costs. Costs outside of the health field, such as lost earnings or expenditures on goods like groceries, clothing and housing, are ignored. Researchers have cited many reasons for omitting these costs. One argument is that they can be ignored under certain theoretical conditions without altering the results of the analysis; another is that their inclusion provokes controversial ethical questions about how to adjust for discriminatory differences in the earnings of women, minorities and the elderly.

Meltzer has shown that their omission can lead to other types of bias, including the undervaluation of innovations that improve quality of life but don’t extend life, and he has proposed approaches to ameliorate some of the concerns about discrimination. His proposals could alter the results of cost-effectiveness studies, thereby shifting the debate over insurance reimbursement and coverage in countries that rely more heavily on cost-effectiveness analysis to make health policy decisions, such as the United Kingdom.

“Though the United States does not formally use cost-effectiveness analysis to ration medical spending at present,” Meltzer said, “basic insights from cost-effectiveness can suggest that highly beneficial and cost-effective medical interventions should receive greater priority.”

Health Connections

Nicholas Christakis, HMS professor of medical sociology, has opened new frontiers in the way physicians think about social networks and their impact on human health. After completing residency, he studied sociology at the University of Pennsylvania and now sees patients at Mt. Auburn Hospital, where he specializes in palliative care. His many significant research contributions include the discovery that chronic health problems—including obesity and tobacco addiction—can be partially acquired or ameliorated through sociological connections, with people more likely to gain weight or quit smoking, for example, when their spouses, friends or relatives do. He has suggested that social networks may be partially responsible for epidemic trends in chronic disease, opening up new ways of thinking about health policy interventions that leverage social connections to improve clinical outcomes.

Reflecting on his work, Christakis said, “Our health depends on more than our own biology or even our own choices and actions. Our health also depends quite literally on the biology, choices and actions of those around us…. Our unavoidable embeddedness in social networks means that events occurring in other people—whether we know them or not—can ripple through the network and affect us.”

A for Effort

In a promising example of academic and government collaboration, Jack Tu, professor of medicine at the University of Toronto, and his colleagues performed a study of hospital report cards and whether their public release changes how hospitals provide care. Controversial but popular, hospital report cards on outcomes and performance are part of the growing interest in pay-for-performance payment models, and they have been debated in newspapers from The Wall Street Journal to USA Today.

Controversy has stemmed largely from doubts about their effectiveness. Randomizing a group of Canadian hospitals to either early or late release of public report cards, the authors found that these report cards did not affect hospital performance across major quality indicators. The study is not the last word on hospital report cards, but it does provide useful data—and serve as a model for how to effectively mobilize multiple stakeholders to take on a challenging and complicated question. According to Tu, “I’m hopeful that our study will encourage others to undertake rigorous, large populationbased evaluation studies of various quality improvement strategies and public policy issues such as public report cards, as opposed to simply adopting policies without any formal evaluation.”

These three studies are just a glimpse of the future that awaits us as a result of the growth in multidisciplinary work. The possibilities are exciting, and they will introduce us to new ways of thinking about and solving U.S. healthcare problems.

Joseph Ladapo, HMS ’08, is an intern in internal medicine at Beth Israel Deaconess Medical Center.

The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions or Harvard University.