Imagine this – a room full of baby strollers waiting to be beaten up, rolled, roughly tilted, and tested in the harshest conditions and all this in order to make sure that when a baby is taken for a walk, she will be safe and protected against any potential harm. This is how our tour started at the watchdog of American consumers.
To broaden our public health horizon, we, Larry Marsh, Yossi Schwartz, Brad Wilken and Eliane Schwartz from the executive MPH program, at the Mailman school, were invited by our very own Paige Amidon, for a visit at the Consumer Reports’ facility in Yonkers, NY. Paige, who is the VP in charge of the Consumer Report’s Health Rating Center, planned a fascinating visit in this facility, which tests thousands of products for us consumers. Everything from fabric, baby products, home appliances, electronics, to blood glucose measurement devices (glucometers), and home blood pressure monitoring devices are tested here, by an enthusiastic group of engineers that even create their own testing devices by themselves.
We started with an overview of the organization, which was founded in 1936 in NYC by a radical group that was involved with unionized workers. The main focus at that time was safety. Safety is still the main passion here but with the years, value testing was done and consumers were placed at the center of attention. One of the first products that they tested was Alka Seltzer, and they found it didn’t do much more than “plop plop fizz fizz”. Consumer Reports is a not for profit organization, and funding comes mostly from selling publications and subscriptions. The organization doesn’t allow advertisement in their publications and currently 4.3 million people read Consumer Reports magazine, 3.3 million people subscribe to the website, and 800,000 subscribe to the Consumer Reports on Health newsletter.
The quiet pristine building in Yonkers is the home of 50 (!) labs that tests almost every product you can think of, except cars and car seats that are tested by Consumer Reports at their auto test facility in Connecticut. The labs test batches of products at one time and over 4000 unique products yearly. The testers are subject matter experts – including electrical engineers, mechanical engineers, statistians and social scientists . Each groups checks products within their expertise. The tested products are chosen after a detailed market interest analysis. After choosing the products, an employee buys, anonymously, a few units of it and brings it back for testing. This is to avoid biases. The products go through a series of testing protocols that are intended to break, tilt, tear, or make the product unsafe and not usable. Other products, like medical devices are checked for measurement precision. No stone is left unturned.
There we went, from one lab to another, to see how cribs are tested with forty pound weights thrown at them from different angles and how strollers, appliances, fabrics and various electronics are tested. Did you know that dryers are not only tested for their impact on your clothes at the thread level, but also for the impact they have on your floor tiles? Every product is not only tested for safety but also for performance, ease of use, durability, and quality.
The highlight of the labs for me was the anechoic chamber. A fully sound proof room that allows testing of sounds systems. Paige and Mike our tour guide took us in, closed the door behind us, and … you hear nothing except your own heart beat.
What struck us were the enthusiastic faces of the employees in the labs. They almost looked like kids in a theme park, waiting for the next adventure.
We asked our hosts: how do the companies that produce the tested products respond to the testing? Apparently, some of the companies try to recreate the testing devices that the engineers at Consumer Reports develop. These are kept secret so the testing will be as objective as they are. If a company that makes elliptical machines like the ones we saw tested, know how the Consumer Reports testing is done – they may improve only the functions that are tested.
However, after seeing the testing of the elliptical, I think they have nothing to worry about. If the elliptical manufacturer mimic the testing and their product processes – nothing will go wrong. The testing is detailed even to the level of the gender of the user. Different norms are used for males and females users.
The doctors were very interested to learn about the medical device testing that is done here, like the blood pressure monitoring and the blood gluco-meters. The testing of the meters is done by six willing diabetic employees that try them at home for ease of use and consistency of results. In addition, precision and credibility is compared to venous blood testing in the lab by a nurse. The allowed error is marginal.
Five years ago, the health division of Consumer Reports started their health rating initiative. The initiative focused on value , which is derived from efficacy as well as price. Paige surprised us with a delicious lunch in the company of the health rating and impact group that leads this initiative. In addition to Paige Amidon the group consists of Dr John Santa, Director of the Health Ratings Center (HRC); Dr. Doris Peter, Associate Director of the HRC and PI for Consumer Reports Best Buy Drugs; and Tara Montgomery, Director of the Health Impact Team. Dr Santa shared his experience working for Govenor Kitzhaber in Oregon with us. By evaluating efficacy and value, with head-to-head information comparisons of drugs, a coalition of states including Oregon worked together to prove that saving can be done without compromising quality in health care.
The “Choosing Wisely” initiative was launched in April to educate health consumers regarding drugs, tests, and medical practices. They not only need to educate the patients to choose the most effective, least harmful health care product, but they also need to convince the physicians to deliver such care. This is how the “Choosing Wisely” campaign was born in collaboration with the American Board of Internal Medicine Foundation. The campaign is to advocate for the safe and effective choice to be made by the doctor in consultation with the patient, leading to the just and cost effective distribution of finite sources. A just distribution of finite resources calls on physicians to be responsible for the appropriate allocation of resources and to avoid superfluous tests and procedures. One of the first professional societies that came up with a list of five unnecessary procedures is the American Academy of Family Physicians. I must say that I agree with their choices. If you want to read more about the Choosing Wisely campaign, go to http://consumerhealthchoices.org/campaigns/choosing-wisely/.
While munching on a delicious food, this enthusiastic group told us about their work, the obstacles they face relaying their efforts and outcome to consumers, as well as the professional medical societies and pharmaceutical companies. They also discussed their efforts to keep the brand unbiased by not accepting funds from outside commercial sources. After creating multiple health related publications, the group is working on market penetration. The health publications concentrate on consumer education that will empower patients to have discussions about quality and cost with their providers. They are also pushing for cost transparency to patients and providers. Although the majority of the cost is often paid by the health insurance companies, showing the price to the patients may change their preferences. According to the Consumer Reports experts, patient’s behavioral changes may follow such price transparency and education regarding potential harm by drugs and tests. Changing consumers’ behavior may result in a more cost effective health care with less harm to patients.
It was a very exciting visit that opened our eyes to the work behind the scenes of this important consumer advocacy group. With the changes that are occurring now in the healthcare scene, aiming for cost effective health care is essential to maintaining the quality of care the insured American people are used to getting while extending coverage to the uninsured. It is reassuring to know that the consumers have a voice in the process.
Thank you Paige for sharing your professional world with us, we hope to be able to visit again and perhaps invite your group to share your experience with us in our “public health of the future” salon.