The Wallet Allocation Rule

Chapter 5New Metrics That Matter for Growth

In God we trust, all others bring data.¹

—W. Edwards Deming, American engineer, statistician, author, and esteemed quality consultant

An astonishing 50 percent of the 3,000 medical treatments that have been studied around the world in controlled, randomized trials are of unknown effectiveness—in other words, we have absolutely no idea how well they work, or if they work at all!² Worse still, this doesn't mean that the other 50 percent actually work. A study by Clinical Evidence, a project of the British Medical Journal, finds that only one-third of treatments are likely to be beneficial: Specifically, 11 percent have been shown to be beneficial, and 23 percent are likely to be beneficial. Of the remainder, 7 percent have trade-offs between harms and benefits, 6 percent are unlikely to be beneficial, and 3 percent are likely to be ineffective or even harmful.³

These numbers are shockingly bad. How is it possible that an industry filled with highly educated individuals and whose success can be objectively observed in the health of its customers (i.e., patients) would rely on so many unproven treatments? The reality is that ideology and tradition get in the way of medical evidence all the time.⁴ In fact, research indicates that an abysmal 15 percent of doctors' decisions are based on factual evidence.⁵ To quote Dr. David Newman, director of clinical research at Mt. Sinai School of Medicine:⁶

Treatment based on ideology is alluring. ...