Conflict of Interest

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Health Care in the NFL

October 21, 2011 in Current Events, Supply of Medical Services | No comments

The National Football Post has an interesting article on health care for NFL players.  Like all individuals, health care for NFL players takes on two broad forms: preventive and treatment. Unlike most individuals, the forms of prevention are different.

When the NFL union and teams argue over preventive care, this does not revolve around vaccinations or PSA tests.  Players who want to maintain their health ask for limiting off-season workouts and full contact practices.

The latest collective bargaining agreement (CBA) also gives players enhanced treatment options as well.  The CBA mandated that players have access to their own medical records, the rights to a second opinion and the rights to their own treatment options.

Yet there are still problems with the health care NFL players receive.  For instance, some patients may worry that financial incentives may affect a doctor’s treatment decisions.  NFL players have additional reasons to worry.

“Trainers and doctors are paid by the team to do what’s in the best interests of the team…While there are brilliant doctors and trainers in the NFL, many players seek treatment outside of their trainers reach and have little confidence in the team doctor.”

Additionally, signalling to your employer that you are not healthy is often bad for your job prospects.

“…several old school thinking coaches make it clear that they don’t want to see their players in the training room.  Some have gone so far as to make direct fun of them in front of the entire team…So his conundrum, like every single young player not drafted in the first round has to battle through, was to keep playing through the injury and thus medicating heavily while his quality of play suffers. Or, tell the trainers and coaches, get treatment, miss practice time and risk losing his position and job security.”

NFL based health care is far from egalitarian as well.

“If you are not a high profile starter you won’t get the best treatment a team can offer. The superstars get treated better in most training rooms. On the contrary, players bringing up the bottom of the roster are expected to take as little time and resources from the trainers. ”

In short, health care for players in NFL is far from perfect.

 

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Medical Societies and Industry Sponsorships

May 12, 2011 in Pharmaceuticals | No comments

Maybe money can’t buy you love…but can it buy you influence over physician treatment choices? That’s what many pharmaceutical and medical device firms are betting on.

Concerns about the influence of industry money have prompted universities [10] [10] such as Stanford and the University of Colorado-Denver to ban drug sales representatives from the halls of their hospitals and bar doctors from paid promotional speaking.  Yet, one area of medicine still welcomes the largesse: societies that represent specialists.

…Nearly half the $16 million the heart society collected in 2010 came from makers of drugs, catheters and defibrillators used to control abnormal heart rhythms, the group’s website disclosed.  Officials of the Heart Rhythm Society say industry money does not buy influence and is essential to developing new treatments.

Are these sponsorships a mechanisms for disseminating information to providers on new treatment options or a method of convincing physicians to change their treatment patterns. The distinction between physician education and marketing is often blurred.

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Don’t always believe your local economist

December 4, 2007 in Economics - General | Permalink

The N.Y. Times ran an interesting pair of articles Sunday regarding how economists “got it wrong.”

Conflict of Interest

Ben Stein (in “The Long and Short of It at Goldman Sachs“) comments on the economic analysis conducted by economist Jan Hatzius of Goldman Sachs. Dr. Hatzuis concludes that the sub-prime mortgage ‘crisis’ will not only hurt the stock market, but adversely affect overall growth. Is Dr. Hatzius’ doomsday scenario going to happen?

Mr. Stein believes Dr. Hatzius’ assertion “…is a conclusion that is an estimation based upon a guess.” Economists, especially macro-economists, have had a very poor track record predicting the future. This is likely because the entire U.S. economy is extremely complex and even if it were to be modelled, it would be non-linear in nature and subject to the consequences of chaos theory.

More troubling, is Mr. Stein’s hypothesis of why Dr. Hatzius’ analysis is gaining prominence:

Perhaps as a token of Dr. Hatzius’s genuine intelligence, which is fine. But to me, his paper seemed like a selling document in the real Wall Street sense of selling — namely, selling short. (Dr. Hatzius notes that he has long been bearish on housing, since faraway 2006, but I respectfully note that that is a lot different from predicting a credit catastrophe. The spokesman for Goldman also noted the company’s bearishness on housing since 2006. He also noted that in the recent past, Goldman Sachs has moved to a considerably larger short posture and that the firm is net short.)

…But what leaps out at me from this story is that Goldman Sachs was injecting dangerous financial products into the world’s commercial bloodstream for years.

My pal, colleague and alter ego, the financial manager Phil DeMuth, culled data from a financial Web site, ABAlert.com (for “asset-backed alertâ€?), that Goldman Sachs was one of the top 10 sellers of C.M.O.’s for the last two and a half years. From the evidence I see, Goldman was doing this for years. It might have sold very roughly $100 billion of the stuff in that period, according to ABAlert…

…The point to bear in mind, as Mr. Sloan brilliantly makes clear, is that as Goldman was peddling C.M.O.’s [Collateralized Mortgage Obligations], it was also shorting the junk on a titanic scale through index sales — showing, at least to me, how horrible a product it believed it was selling.

Dr. Hatzius likely honestly believes in his analysis, but one can not doubt that there is a serious conflict of interest being that Goldman Sachs pays his–likely very large–salary.

Do-gooders gone wrong

In an article on famine in Malawi (“Ending Famine, Simply by Ignoring the Experts“), economists once again got it wrong.

  • World Bank Economists advised Malawi “…to adhere to free market policies and cut back or eliminate fertilizer subsidies, even as the United States and Europe extensively subsidized their own farmers.”  The result was Malawi has been dependent on food aid from rich nations and international organizations.
  • Malwai’s solution was to begin subsidizing fertilizer to increase crop yield.  The result is that “… this year, a nation that has perennially extended a begging bowl to the world is instead feeding its hungry neighbors. It is selling more corn to the World Food Program of the United Nations than any other country in southern Africa and is exporting hundreds of thousands of tons of corn to Zimbabwe.”

Some claim that that the recent positive result was due to good rains over the last 2 years.  Nevertheless, the results are indisputable.  While I am generally in favor of more freer markets, here is one example of where economists got it wrong again.  Most World Bank economists are idealistic and want to improve the world for the poorest of the poor.  However, it seems that an international bureaucracy–despite having some of the smartest minds in the world on its payroll–is not doing a great job.

Conclusion

What should we take from these stories?  First, is that one must always be on the lookout for conflicts of interest that may bias a given piece of economic analysis.  Any one piece of economic analysis should not be sufficient to persuade you of the veracity of a theory; multiple analyses who reach the same conclusion are needed in order to have an adequate degree of reliability.  Secondly, top-down governing does not work, even if the people enacting policy are extremely bright economists.

This leads us to a new motto: Don’t always believe your local economist…except the Healthcare Economist, of course.

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