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Reflecting on one little paper in Science 40 years ago – Jack Wennberg’s legacy

This week, Dartmouth celebrated the publication of a paper 40 years ago that it seemed no one wanted to publish.

It was Jack Wennberg’s Science magazine paper, “Small Area Variations in Health Care Delivery.”

In the Los Angeles Times today, Dartmouth’s Gil Welch writes:

“Similar populations living in different regions of the United States get exposed to wildly different amounts of medical care.

If that sounds like an old story, it is. It’s now four decades old. But it is an important story to reflect on as we consider the path forward for our medical care system. …

(Wennberg) concluded the 1973 Science article with a decidedly different take: “the possibility of too much medical care and the attendant likelihood of iatrogenic illness is as strong as the possibility of not enough.”

Following the #wennberg13 Twitter hashtag, you can see what’s been tweeted from the Dartmouth “Location as Destiny” event – from people like Glyn Elwyn, Harlan Krumholz, Shannon Brownlee and others.

I first met Jack when I interviewed him for a CNN story in 1984 – 30 years ago.  Then I had the honor of working right down the hallway from him throughout the 90s at Dartmouth Medical School. He was co-founder of the Foundation for Informed Medical Decision Making, for whom I produced shared decision-making programs. That foundation was the sole sponsor of my project from July, 2005 to July, 2013.

As I’ve said before, it was from Jack that I learned the unforgettable lesson to question conventional wisdom in health care. That should be the starting point for any health care journalist.

Addendum on October 17:  Dartmouth announced that it has established a John E. Wennberg Distinguished Professorship.


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