Test the Remedy Before You Buy the Cure

Every society is flooded with remedies. New drugs. New policies. New weapons systems. New software platforms. New consulting frameworks. New “solutions” to education, housing, inflation, cybersecurity, public safety, and public health. Everyone has a fix. Everyone claims urgency. Everyone says their remedy must be adopted now.

That is exactly why empirical testing in pilot studies should be mandatory before remedies are rolled out at scale.

A remedy is not good because it sounds intelligent, morally urgent, technically impressive, or politically fashionable. A remedy is good only if it works. And in most cases, whether it works depends on finding the sweet spot. Too little intervention does nothing. Too much creates damage. Too narrow misses the problem. Too broad causes collateral harm. The right answer is usually not maximal force, maximal spending, or maximal complexity. It is calibrated action.

Medicine understands this better than most fields. A drug can be ineffective at one dose and toxic at another. But the same principle applies everywhere. Too little economic stimulus may fail to revive demand; too much may fuel inflation and dependency. Too little cybersecurity hardening leaves systems exposed; too much can cripple usability and productivity. Too little military deterrence may invite aggression; too much force may trigger escalation, backlash, and long-term instability. In every domain, the question is the same: what level, timing, duration, and target actually works?

You cannot answer that question with slogans. You cannot answer it with expert status alone. And you definitely cannot answer it with lobbying.

That is where the problem gets uglier. Remedies are rarely abstract ideas. They usually involve buying something: products, services, contracts, systems, consultants, vendors, professional staff, agencies, or programs. Once money enters the picture, organized interests appear. Small groups with a lot to gain from a particular remedy will lobby for it, market it, dramatize the crisis, and pressure decision-makers to approve it. They have every incentive to get the remedy purchased whether it works or not.

When an ineffective remedy is pushed primarily because it generates profit, budget growth, prestige, or political advantage, that is classic rent-seeking. In some cases it may remain technically legal. In worse cases it can slide toward corruption, fraud, procurement abuse, or influence-peddling. Either way, the public pays for failure while the sellers cash the checks.

Pilot testing is one of the best defenses against this.

A pilot study forces advocates to prove results before demanding large-scale adoption. It shifts the argument from promises to evidence. It gives decision-makers a chance to observe real-world effects, unintended consequences, costs, compliance problems, and measurable outcomes before locking themselves into expensive commitments. It also makes it harder for self-interested actors to hide behind hype, fear, or political theater.

Just as importantly, pilot testing creates intellectual honesty. Sometimes the pilot shows the remedy works, but only for a narrow group or under strict conditions. Sometimes it shows the dose needs adjustment. Sometimes it reveals that the proposed cure is worse than the disease. That is not failure. That is learning before the damage becomes national, permanent, or irreversible.

We should stop treating remedies as virtuous simply because they are proposed in response to a real problem. Problems are real. But so are bad fixes. Before we spend billions, mobilize institutions, or hand power to vendors and bureaucracies, we should ask one question: where is the evidence from the pilot?

The rule should be simple: no large remedy without small-scale empirical proof. Test first. Purchase later. That is how you find the sweet spot—and how you protect the public from both honest error and organized rent-seeking.

Reply to the Montgomery County Medical Society Call for More Physician Particiaption in Policy Making

 Subject: Barriers to Physician Engagement and Patient Safety Advocacy

Thank you for the invitation to become more involved in the Pennsylvania Medical Society. I believe it is important to explain candidly why many physicians remain disengaged.

The Society is widely perceived as politically unbalanced. Many Pennsylvania physicians hold conservative or nonpartisan views, yet Society positions and public advocacy consistently align with one ideological framework. This discourages participation and contributes to low membership penetration.

Equally problematic is the Society’s limited defense of clinical care against external pressures from the legal profession and insurance industry. Defensive medicine, insurer interference, and post-hoc liability distort patient care daily, yet the Society rarely confronts these forces directly or forcefully.

The internal resolution process compounds the problem. Requiring sponsorship by senior leadership before consideration ensures that dissenting or minority viewpoints—particularly from frontline clinicians—rarely reach debate. This structure suppresses meaningful discussion and policy innovation.

Most concerning is the absence of serious leadership on patient safety reform. Pennsylvania experiences an estimated ~2,000 deaths annually associated with medical error. Yet the current system prioritizes liability avoidance over learning. Immunizing internal root-cause investigations from civil discovery would encourage honest analysis, reduce repeat errors, and improve outcomes.

Finally, the Society has not adequately challenged licensing practices that disproportionately penalize physicians—often ethnic or immigrant doctors—for being labeled “disruptive” when advocating strongly for patient care, while systemic failures remain unaddressed.

Physicians need a Society that defends clinical judgment, welcomes ideological diversity, and places patient safety above institutional risk management.

Respectfully,

David Behar, MD

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Here is a resolution you will never allow to come up for discussion, and that will find no sponsor from your hierarchy. Please, explain why your hierarchy is qualified to select resolutions anyway.

Formal Resolution Proposal — 

Resolution: Protection of Patient-Safety Root Cause Analyses

WHEREAS, Pennsylvania experiences an estimated ~2,000 deaths annually associated with medical error; and

WHEREAS, effective patient-safety improvement requires candid, multidisciplinary root-cause analysis of adverse events; and

WHEREAS, the discoverability of internal safety investigations in civil litigation discourages honest analysis and perpetuates repeat errors;

THEREFORE, BE IT RESOLVED, that the Pennsylvania Medical Society advocate for legislation granting privilege and immunity from civil discovery to bona fide patient-safety root-cause investigations, while preserving accountability for willful misconduct and gross negligence; and

BE IT FURTHER RESOLVED, that the Society opposes the use of professional discipline based solely on speech or tone when a physician is advocating in good faith for patient safety or care quality. Harassment of physicians by the Licensing Board is intended to drive them out of the profession. Drive a doctor out, save $6 million a year in medical costs.