December 2009

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Health Stories of the Decade?

December 31, 2009 in Current Events | 2 comments

Dr. Richard Fogoros of the Covert Rationing blog has a series of posts listing the most overblown stories of the decade.  The stories are listed below with my commentary.

  1. The Pandemic of the Century: This is the only area where I disagree with Dr. Fogoros. SARS, Avian Flu and H1N1 (Swine) Flu were all less serious than initially feared. Dr. Rich accurately points out that having a ‘pandemic of the century’ every 3.3 years risks desensitizing people to the risk. However, a pandemic is one of the few things that can truly bring down society, and ex ante, no one knows if a serious infectious disease will end out quickly or kill millions of people. It is right to be fearful and cautious.
  2. Demonizing Obesity: Although my own research shows that marriage causes an increase in weight, the health threats of obesity are likely overblown.
  3. Preventive Medicine Saves Money.
  4. Uninsured Patients Cause ER Overcrowding: The truth is overcrowding is caused by insured Americans who cannot get in to see their primary care physicians.
  5. Vaccines and Autism: Not true.
  6. Healthcare Reform Will Lead To Rationing.  The Truth: we’re already rationing.
  7. Crocodile Tears For Primary Care.
  8. An Epidemic of Epidemics: Are heart attack epidemic, an obesity epidemic, a hypertension epidemic, crime epidemic really epidemics?  They are not contagious and all things that are bad are not ‘epidemics’.
  9. Health Insurance Companies Are Against Healthcare Reform.
  10. Mad Cow Disease: Did we clean up the food supply or was there never truly a link between eating beef and variant Creutzfeldt-Jakob disease (vCJD)?  

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Last Cavalcade of Risk of 2009

December 30, 2009 in Carnivals | No comments

The last edition of the Cavalcade of Risk for 2009 has been posted at Jaan Sidorov’s Disease Management Care Blog.

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In Defense of Capitalism

December 30, 2009 in Economics - General | No comments

Capitalism has taken a beating the past few years.  From the mortgage crisis to Bernie Madoff’s ponzi scheme, from a falling stock market to rising unemployment, capitalism does not seems like the best economic system at present.  In fact, Michael Moore even made a movie satirically titled Capitalism: A Love Story.

Yet now is not the time to abandon capitalism.  It offers the best hope to jump start the economy and–more importantly–generate long term progress.  The Economist offers 3 reasons why capitalism must be praised:

  1. Creates cooperation between sometimes antagonistic parties.  ”…companies in fact depend on persuading large numbers of people—workers and bosses, shareholders and suppliers—to work together to a common end. This involves getting lots of strangers to trust each other.”
  2. Increases innovation.  ”Business people do not just invent clever products that solve nagging problems, …[t]hey also create organisations that manufacture these products and then distribute them about the world.”
  3. Maintains political pluralism.  ”Only 202 of the 500 biggest companies in America in 1980 were still in existence 20 years later.”

Most importantly, however, is that capitalism is provides a more open society.  Anyone can earn a living, even if you don’t come from money or are a recent immigrant.  Although of course, privileged individuals do better in any society, capitalism doesn’t preclude individuals from occupations if they are from certain backgrounds or castes.  Further, capitalistic governments tend to meddle less in individuals affairs and uphold individual freedoms.  Least we forget, the Nazi’s were from the National Socialist party. [Although to be fair, socialist governments can uphold individual freedoms and capitalist countries can also oppress minorities as well.]

A paper by the Indepenent Instiute claims that businessmen are more honest than preachers, politicians, and professors.  Although businessmen can make untrue claims just like these other professions, because customers can “test drive” the products sold, the truth regarding the  product will come out eventually. This gives the businessmen an incentive to be honest up front in order to maintain long term relationships with customers and suppliers.

In the words of Winston Churchill, ”The inherent vice of capitalism is the unequal sharing of blessings. The inherent virtue of Socialism is the equal sharing of miseries.”

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2009 Year-End Links

December 29, 2009 in Current Events | No comments

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Quotation of the Day

December 29, 2009 in Uncategorized | No comments

With the business world hurting, the MBA is falling out of favor.  In truth, the MBA has been useful for only a few things. Learning basic accounting and statistics skills is helpful in business, but one could learn these skills elsewhere.  The MBA is most useful for networking with other future business leaders.  Thus, the better MBA school you attend, the stronger network you will construct around you.  Many of the other tools are can either learned by doing (e.g., marketing) and may not be useful unless applied with a specific business in mind (e.g., management).  This leads to our quotation of the day:

“The decline of the MBA will cut off the supply of bullshit at source.”

  • Lucy Kellaway, columnist, Financial Times.

Pay-for-performance programs in the United Kingdom

December 28, 2009 in Health Care Around the World, P4P, Quality | 1 comment

Pay-for-performance is a hot topic in the health policy world. However, one of the largest pay-for-performance programs has already been implemented in the UK’s National Health Service. A paper by Doran et al. (2006) reviews the overall implementation of the NHS’s P4P program as well as how some physicians used exceptions to greatly increase their scores and bonuses.  Some excerpts from the paper are below:

In 2004, the National Health Service committed £1.8 billion ($3.2 billion) in additional funding over a period of three years for a new pay-for-performance program for family practitioners (the sole type of primary care physician in the United Kingdom). This program was intended to increase family practitioners’ income by up to 25 percent, depending on their performance with respect to 146 quality indicators relating to clinical care for 10 chronic diseases, organization of care, and patient experience.9 For the clinical indicators, practices claim points that generate payments according to the proportion of patients for whom they achieve each target…For example, for asthma indicator number 6, practices gain points for clinically reviewing at least 25 percent of patients with asthma in the previous 15 months. The maximum of 20 points is gained if at least 70 percent of patients with asthma are reviewed.

Evidence-based quality indicators should not be applied unthinkingly, since patients have coexisting conditions that affect their optimal care. It is inappropriate, for example, to strive to control the cholesterol level of someone terminally ill with cancer. Consequently, the new U.K. pay-for-performance contract allows family practitioners to exclude patients from eligibility for specific indicators in the performance calculations….However, exception reporting also provides an opportunity for family practitioners to increase their income by inappropriately excluding patients for whom they have missed the targets (a practice known as gaming).

To evaluate P4P in the UK, the authors analyzed family practice data extracted from clinical computing systems in England in the first year of the pay-for-performance program (April 2004 through March 2005).

Exception reporting by practices was not extensive (median rate, 6 percent), but it was the strongest predictor of achievement: a 1 percent increase in the rate of exception reporting was associated with a 0.31 percent increase in reported achievement…A small number of practices appear to have achieved high scores by excluding large numbers of patients by exception reporting

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Senate Passes Health Care Reform Bill

December 24, 2009 in Current Events | 3 comments

The Senate passed a healthcare reform bill 60 (all democrats) to 39 (all republicans).  To summarize it’s contents:

“The bill would require most Americans to have health insurance, would add 15 million people to the Medicaid rolls and would subsidize private coverage for low- and middle-income people, at a cost to the government of $871 billion over 10 years, according to the Congressional Budget Office.”

This does not mean that health reform has passed.  The Senate and House must both agree to pass the bill, something that has not yet happened.

Key items in the bill are provisions for guaranteed issue and community rating.  This means that “ insurers could not deny coverage because of a person’s medical condition; could not charge higher premiums because of a person’s sex or health status;  and could not rescind coverage when a person becomes sick or disabled.”

While the Senate reform bill does a good job of extending insurance coverage to many Americans, it will not decrease the cost of health insurance.  In fact, the guaranteed issue and community rating provisions mean that the cost of health insurance will likely increase.

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Is Santa a bad role model?

December 24, 2009 in Miscellaneous | No comments

Santa Claus is bad for your health.

At least this is what researchers from the British Medical Journal conclude. Why is this?  Let me summarize:

  • Smoker: Santa often smokes a pipe on holiday cards.
  • Drunk Driver: The tradition of leaving Santa a cup of brandy led one mother to worry “that my kids are going to think I am encouraging drink driving.”
  • Infectious Disease Vector: When Santa goes from house to house delivering gifts, he may also be delivering some unwanted gifts…diseases.
  • Obesity: Santa’s fat.

How can we save Santa?  BMJ doctors suggest eating carrots instead of cookies, and leaving the reindeer at home and making his rounds by bicycle.

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Links for December 23

December 23, 2009 in Current Events | No comments

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The creation of a blockbuster drug

December 22, 2009 in Pharmaceuticals | 1 comment

NPR’s All Things Considers documents the creation of the blockbuster drug Fosamax.  Physicians use Fosamax to treat patients with osteoporosis and the less severe osteopenia.  To summarize what took place:

  1. Pharmaceutical companies start lobbying to expand Medicare coverage for bone density tests.
  2. Medicare expands coverage to include bone density tests.
  3. Physicians purchase equipment to test for osteoporosis.
  4. If the physicians find evidence of osteoporosis, they prescribe the drug.
  5. Pharmaceutical companies market the drug to people who do not have the disease (osteoporosis), but who have the potential for developing the disease (osteopenia).
  6. Physicians recommend that marginally ill or healthy patients with osteopenia take the drug.
  7. Patients notice their peers are taking the drug, physicians notice other physicians prescribing the drug, and a tipping point occurs
  8. A blockbuster drug is born.

“…drug companies produce incredible drugs that can greatly relieve suffering. But one way they profit from those drugs is to extend their use to as many people as possible, which frequently means that medications are used in populations with milder and milder versions of a disease, so that the risks of medicating can come to outweigh the benefits.”

People who hate the American health care system will say, look at all this wasteful spending.  There are no long-term studies that look at what happens to women with osteopenia who start Fosamax in their 50s and continue treatment long-term.  Those who like the American healthcare system will say that all the wasteful spending helped induce Merck to bring Fosamax to market and the drug truly does help patients with severe osteoporosis.

Neither camp is incorrect.

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