Medical science lost one of its giants this past week. While you may have never heard of him, Dr. Paul Meier was a pre-eminent population health scientist whose work shook the very core of medical thinking.
Among his legacies is survival analysis, the principal tool used by health researchers to understand how treatments influence survival. More importantly, he was the foremost scientific advocate of the randomized-controlled trial—the conceptual framework medical scientists use to assess the effects of treatments on health outcomes. The entire discipline of “comparative-effectiveness research” whereby treatment strategies are compared, head-to-head, in terms of efficacy and cost, and a hallmark of the recent healthcare reform legislation, is founded in his work. So fundamental was his thought to modern medical decision-making that nearly every paper published in a clinical journal today features a stamp of his influence.
The notion of the importance of randomization in clinical trials (the random assignment of patients in trials to treatment or placebo) now taught as dogma to public health and medical students, was a revolution in its time. Prior to this point, researchers would routinely (even if sub-consciously) bias their studies by assigning the treatment they were studying to healthier patients who were more likely to show positive results, while assigning the placebo (against which the treatment was being measured) to a less healthy patient pool more likely to show negative results. By elegantly and persistently calling this practice into question, Dr. Meier forced the medical establishment to appeal to objectivity and analytic precision in medical decision-making.
The effect? Randomization has saved countless lives by guiding clinicians to treatments that actually work.
Ultimately, Meier’s work undergirds any effort to improve healthcare quality and lower healthcare costs–to make healthcare more sustainable. The next time you or a loved one goes to the doctor, takes some medication or another, or visits a hospital, remember Paul Meier, whose work ensured that that experience would be as safe as it could be.