Past Awards
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.
Finally, we are gratified to note that the recommendations of this study have already been adopted by the American Cancer Society and are under serious consideration by other national health organizations.
Dr. Eddy, formerly a Professor of Engineering-Economic Systems at Stanford University, is now the Director of the Center for the Study of Health and Clinical Policy, Duke University, Durham, North Carolina.