Early Struggles

By Karen Southwick  |  Posted 04-17-2003 Print Email

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Early Struggles

But Eddy has always been a bit of an upstart: Friends recall that, as a Ph.D. student in mathematics at Stanford, Eddy wrote a monograph that pointed out errors in physician decision-making. None of the leading medical journals would publish it, but others who had been nurturing ideas that would develop into the concept of managed care sat up and took notice. At a cocktail party, Enthoven gave a copy of Eddy's monograph to an advisory board member at the National Cancer Institute, who later invited Eddy to speak at an NCI meeting. Eddy's impassioned, outraged case against the unquestioned judgment of doctors so impressed Arthur Holleb, then executive director of the American Cancer Society (ACS), that a few weeks later, the ACS sought Eddy's help in designing new cancer-screening guidelines, foreshadowing his later work. In the research for his thesis, he had built a general mathematical model for "intermittent inspections," essentially a screening regimen for potential health problems. His work for the ACS expanded upon that, inspiring changes in cancer screening that are still in use today, such as when to do Pap smears for cervical cancer and sigmoidoscopies for colon cancer. For this research, the Operations Research Society of America awarded Eddy its prestigious Lanchester Prize in 1980, in recognition of the most important contribution to the field from applied mathematics.

In the years that followed, Eddy kept up his pressure on traditional medicine, lecturing at Stanford and Duke universities about the application of mathematics to medicine (he was a full professor at Stanford and the J. Alexander McMahon Professor of health policy and management at Duke), and in 1990, he was asked to join the nonprofit Kaiser Permanente system, headquartered in Oakland, Calif.—the largest HMO in the country. It proved to be a critical alliance: Eddy, with his desire to create practice guidelines, and Kaiser, spearheading the drive to deliver better care at better prices.

To help him develop the sophisticated mathematical models he'd need, he turned to Len Schlessinger, an assistant vice president of applied physics at a local consulting firm. Though Schlessinger's work involved mathematical modeling of physical phenomenon like radio waves and electrical fields, Eddy convinced Schlessinger that he could apply the same thinking to healthcare. During their first meeting in 1993, Schlessinger recalls, he was so excited by Eddy's vision that he joined Kaiser on the spot. "I had this long experience in building mathematical models and applying them to physical situations," he says. "Here was an opportunity to apply that to a brand-new field where it could have a gigantic impact."

Together, Eddy and Schlessinger, often spreading out their work across the broad, empty tables of Kaiser's first-floor cafeteria in Pasadena, began hashing out the concept of Archimedes and how it would incorporate the physical characteristics of people with a disease, plus the progression of the disease itself, creating a virtual representation of an affected population—say, diabetics or heart patients.

There were obstacles. For starters, they needed massive computer power to run the complex model, but supercomputers leased from Sandia National Laboratories weren't up to the job, and the lab's personnel didn't have the modeling skills needed. They tried Argonne National Laboratory next, but it, too, could not produce the needed algorithms. At that point, Eddy and Schlessinger decided to go it alone. They made two critical decisions: In place of a supercomputer, they would employ a series of PCs to run the mathematical model—using so-called grid computing—and they would bring the simulation research completely inside Kaiser and do it themselves. "I'd heard at one of the defense labs about a mathematical model of the European war theatre used by the U.S. Defense Department in WWII," Eddy says. "They'd model every jeep, every town, every hill, even every round of ammunition and whether the roads were asphalt or concrete because that would affect the speed of vehicles in the rain or shine. It was incredibly detailed, and Len and I said to ourselves, 'That's exactly where we want to go with healthcare.'" Schlessinger did the math, and the pair was on its way.


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