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More Operations Research in Business Week

Business Week coverOperations research is on a roll. The May 29th issue of Business Week has a cover story on the use of simulation and other methods to take the guesswork out of medical care. The key person for this article is Dr. David Eddy, described as a “heart surgeon turned mathemetician and health-care economist”, who was the 1980 recipient of the INFORMS-awarded Lanchester Prize. This prize is given for the “awarded for the best contribution to operations research and the management sciences published in English”. The award citation to Dr. Eddy included the following:

The rapidly growing cost of health care is of great concern to many citizens. Our health care system and policies in the U.S. might be described as the product of many good intentions but only modest analysis. This year’s Lanchester Prize goes to a book: Screening for Cancer: Theory, Analysis and Design by Dr. David M. Eddy, published by Prentice-Hall, Inc., Englewood Cliffs, 1980, which is a significant and welcome contribution to the quality of analysis in the health care field.

In its general form, the problem studied by Dr. Eddy is an old one in the operations research literature, namely, the monitoring and repair of a probabilistic deteriorating system. This dry sounding phrase takes on special meaning when the system is the human body and the deterioration is cancer.

The principal concerns of Dr. Eddy’s work are: which screening tests should be used and with what frequency for various classes of people. The notable feature of Dr. Eddy’s analysis is the thoroughness with which account is taken of such things as the cost of administering a test, the cost of processing false positives from a test, the fact that a test may cause the disease it is attempting to detect, the fact that more frequent testing detects disease earlier and gives the illusion of prolonged life expectancy even in the absence of a cure, and the fact that if the disease may sometimes go into remission naturally, then more frequent testing gives the illusion of a higher cure rate. Also, Dr. Eddy’s analysis was one of the first to make the useful distinction between modeling the state of a patient as his cancer screening history to date, which is observable, as opposed to the state of the disease, which is only partially observable.

The style of Dr. Eddy’s work is in the best operations research tradition of interdisciplinary analysis. The remarkable feature is that in this case the varied disciplines are all embodied in one person.

From the Business Week article, it seems that 26 years later, Dr. Eddy continues this path:

The human brain, Eddy explains, needs help to make sense of patients who have combinations of diseases, and of the complex probabilities involved in each. To provide that assistance, Eddy has spent the past 10 years leading a team to develop the computer model that helped him crack the diabetes puzzle. Dubbed Archimedes, this program seeks to mimic in equations the actual biology of the body, and make treatment recommendations as well as figure out what each approach costs. It is at least 10 times “better than the model we use now, which is called thinking,” says Dr. Richard Kahn, chief scientific officer at the American Diabetes Assn.

I hope it won’t take 26 more years before the medical community starts taking operations research (in our sense: much of the use of the term in medical work means nothing more than analysis of field experiments) seriously.