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Earlier this month, I wrote briefly on how the relationship between high cholesterol and heart disease is growing murkier than has been traditionally assumed. Today, by way of Gary Schwitzer’s Health News Blog, I came across a recent BusinessWeek article by John Carey that cracks this story wide open—in part by addressing an incredibly important, but often misunderstood and misused—statistic: the “number needed to treat.”

The succinctly titled piece, “Do Cholesterol Drugs Do Any Good?,” notes that “Americans are bombarded with the message from doctors, companies, and the media that high levels of bad cholesterol are the ticket to an early grave and must be brought down. According to these ubiquitous messages, statins [cholesterol-lowering drugs like Lipitor] “are the most potent weapons in that struggle.” Carey notes that Lipitor advertisements claim that the drug “reduces the risk of heart attack by 36 percent…in patients with multiple risk factors for heart disease.” Sounds pretty effective, right?

Hold the phone—there’s more to that number than meets the eye. Carey notes that the 36 percent is accompanied by an asterisk stating that “in a large clinical study, 3 percent [or three out of every hundred] of patients taking a sugar pill or placebo had a heart attack compared to 2 percent [or two out of every hundred] of patients taking Lipitor.”

Now, Pfizer’s number isn’t an outright lie. Pfizer, Lipitor’s manufacturer, says its potion reduces risk by  36 percent because the difference between two patients getting a heart attack on Lipitor and three patients getting a heart attack on placebos is one patient—or about a third the number of heart attacks that would have happened without Lipitor.

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Do we know enough about measuring the quality of healthcare to pick out the best doctors?

When I asked Don Berwick that question last week, he spread his hands: “You’re looking at the cream of crap. The system is so broken,” he explained, “that even the high performers are far away from optimal performance.  Most measures of quality are simply measuring the system that the doctor is trapped in, not the doctor himself.”

Who is Don Berwick, and why is he saying such terrible things about our healthcare system?

Dr. Donald Berwick, President and Chief Executive Officer of the Institute for Healthcare Improvement (IHI), is widely recognized as one of the world’s most respected experts on healthcare quality. In 2005, Modern Healthcare, a leading industry publication, named Berwick the third most powerful person in American medicine.  In contrast to others on Modern Healthcare’s list, Berwick “is not powerful because of the position he holds,” noted Boston surgeon and author Atul Gawande. (Former Secretary of Health and Human Services Tommy Thompson ranked no. 1 on the list while Thomas Scully, the head of Medicare and Medicaid Services, captured the second spot).  “Berwick is powerful,” Gawande explained, “because of how he thinks.”

When Berwick thinks about the U.S. healthcare system, the word he uses is “bloated.” There’s a myth that American healthcare is the best in the world,” he noted at a Families USA conference last week. “It’s not,” he said bluntly. “It’s not even close.”

“It’s thought to be the best because we have the most healthcare,” Berwick told his audience. But in fact, although we spend twice as much as the average developed country providing more care than any other nation in the world “40 percent of the care that Americans actually need is not received.” Why?

“Cost is the barrier.”

“Here is a question I often ask my students,” added Berwick, who is a Professor of Pediatrics at Harvard. “When you meet a new patient, what is the one test that you could do that would tell you how long that patient is likely to live?

Typically, students answer: “Ask them if they smoke,” or “Test their blood sugar.”

“No,” says Berwick, “Just look at the color of their skin.”

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