• I can’t even

    I just can’t. From Fox News, a doctor from Memorial Sloan Kettering – where they treat CANCER – is arguing that because people aren’t penalized with higher premiums and worse coverage when they’re sick, they’re not inclined to be healthy. She’s basically arguing that guaranteed issue and community ratings because of the ACA have led to worse outcomes. Just watch.

    Where to start? How about this – I’m not at fault for having ulcerative colitis. I didn’t cause it. It’s not my fault. I shouldn’t have to pay more for my health insurance because of it. I wrote about this at Vox a few years ago.

    What about kids? Should they have to pay more if they’re sick? Is it their fault?

    Even if you think it’s their “fault”, social determinants of health come into play here. Should we penalize poorer people with higher premiums or reduced coverage?

    Most Americans get private insurance through their jobs. They’ve been getting community-rated, guaranteed issue insurance for years. It’s really only in the exchanges where things changed in 2014. The logical conclusion from this argument isn’t that we should get rid of the ACA. It’s that we should get rid of ALL community-rated, guaranteed issue insurance, right? Is that what she’s advocating?

    Pretty much every other country, even the ones that have really private insurance systems, do community-rated, guaranteed issue insurance. Is there any evidence at all that this is hurting their outcomes?

    I’m just baffled. And I’m annoyed. I bet this physician gets community-rated, guaranteed issue insurance from her job. Does she think it’s bad?

    While we’re at it, is she advocating that Medicare should be individually rated?

    I wrote this a few years ago, too, when a Congressman made a similar argument. It still stands:

    I expect that this Congressman will soon be issuing a statement saying he was “taken out of context”. Something along the lines of “he misspoke”. But maybe not. Maybe he does believe what he said, that people who did things the right way are the ones who are healthy. If that’s the case, then I have just one question for him.

    What did the baby born prematurely, the one with congenital heart disease, or the toddler with sickle cell disease, or the child with autism, or the little girl with leukemia, or the boy with asthma, or the adolescent with juvenile arthritis, or the young woman with lupus, or the young man with testicular cancer, or the new mother with breast cancer, or the new father with inflammatory bowel disease, or the woman with familial heart disease, or the man with early onset Parkinson’s disease, or the retiring woman with Alzheimer’s disease, or the elderly man with lymphoma – what did they do wrong?

    Did they lead bad lives?

    I guess I had two questions. Take your time answering. I’ll wait.


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  • Healthcare Triage Podcast: From DNA to Diagnosis

    Aaron talks to Dr. Tatiana Foroud about her career and her current work in genetics and genomics. Her work spans from the early days of searching for DNA markers for rare disorders to today’s search for genetic causes and potential treatments around Alzheimer’s disease. Dr. Foroud’s career relates a story about how the technology and techniques have developed over decades, and how these breakthroughs could lead to new treatments. We’ll also get into the explosion in home genetic testing, and how this trend has changed public perception of genetic testing and treatments.

    The Healthcare Triage podcast is sponsored by Indiana University School of Medicine whose mission is to advance health in the state of Indiana and beyond by promoting innovation and excellence in education, research and patient care.

    IU School of Medicine is leading Indiana University’s first grand challenge, the Precision Health Initiative, with bold goals to cure multiple myeloma, triple negative breast cancer and childhood sarcoma and prevent type 2 diabetes and Alzheimer’s disease.

    As always, you can find the podcast in all the usual places, like iTunes.


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  • New stuff on red meat

    I’m sure you’ve seen that everyone is screaming about red meat again. I’m going to save myself some time and point you to this Twitter thread I posted. Go read some stuff!


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  • Health Facts Aren’t Enough. Should Persuasion Become a Priority?

    The following originally appeared on The Upshot (copyright 2019, The New York Times Company)

    In a paper published early this year in Nature Human Behavior, scientists asked 500 Americans what they thought about foods that contained genetically modified organisms.

    The vast majority, more than 90 percent, opposed their use. This belief is in conflict with the consensus of scientists. Almost 90 percent of them believe G.M.O.s are safe — and can be of great benefit.

    The second finding of the study was more eye-opening. Those who were most opposed to genetically modified foods believed they were the most knowledgeable about this issue, yet scored the lowest on actual tests of scientific knowledge.

    In other words, those with the least understanding of science had the most science-opposed views, but thought they knew the most. Lest anyone think this is only an American phenomenon, the study was also conducted in France and Germany, with similar results.

    If you don’t like this example — the point made here is unlikely to change people’s minds and will probably enrage some readers — that’s O.K. because there are more where that came from.

    A small percentage of the public believes that vaccines are truly dangerous. People who hold this view — which is incorrect — also believe that they know more than experts about this topic.

    Many Americans take supplements, but the reasons are varied and are not linked to any hard evidence. Most of them say they are unaffected by claims from experts contradicting the claims of manufacturers. Only a quarter said they would stop using supplements if experts said they were ineffective. They must think they know better.

    Part of this cognitive bias is related to the Dunning-Kruger effect, named for the two psychologists who wrote a seminal paper in 1999entitled “Unskilled and Unaware of It.”

    David Dunning and Justin Kruger discussed the many reasons people who are the most incompetent (their word) seem to believe they know much more than they do. A lack of knowledge leaves some without the contextual information necessary to recognize mistakes, they wrote, and their “incompetence robs them of the ability to realize it.”

    This helps explain in part why efforts to educate the public often fail. In 2003, researchers examined how communication strategies on G.M.O.s — intended to help the public see that their beliefs did not align with experts — wound up backfiring. All the efforts, in the end, made consumers less likely to choose G.M.O. foods.

    Brendan Nyhan, a Dartmouth professor and contributor to The Upshot, has been a co-author on a number of papers with similar findings. In a 2013 study in Medical Care, he helped show that attempting to provide corrective information to voters about death panels wound up increasing their belief in them among politically knowledgeable supporters of Sarah Palin.

    In a 2014 study in Pediatrics, he helped show that a variety of interventions intended to convince parents that vaccines didn’t cause autism led to even fewer concerned parents saying they’d vaccinate their children. A 2015 study published in Vaccine showed that giving corrective information about the flu vaccine led patients most concerned about side effects to be less likely to get the vaccine.

    A great deal of science communication still relies on the “knowledge deficit model,” an idea that the lack of support for good policies, and good science, merely reflects a lack of scientific information.

    But experts have been giving information about things like the overuse of low-value care for years, to little effect. A recent studylooked at how doctors behaved when they were also patients. They were just as likely to engage in the use of low-value medical care, and just as unlikely to stick to their chronic disease medication regimens, as the general public.

    In 2016, a number of researchers argued in an essay that those in the sciences needed to realize that the public may not process information in the same way they do. Scientists need to be formally trained in communication skills, they said, and they also need to realize that the knowledge deficit model makes for easy policy, but not necessarily good results.

    It seems important to engage the public more, and earn their trust through continued, more personal interaction, using many different platforms and technologies. Dropping knowledge from on high — which is still the modus operandi for most scientists — doesn’t work.

    When areas of science are contentious, it’s clear that “data” aren’t enough. Bombarding people with more information about studies isn’t helping. How the information contained in them is disseminated and discussed may be much more important.


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  • Healthcare Triage: Doctor Choice Can Be Limited with Medicare Advantage

    Medicare Advantage are plans with private companies that contract with Medicare to deliver services. Some of these plans work great, but many of them have limited lists of approved providers, which can make finding a doctor difficult for some patients.

    This video was adapted from a column Austin wrote for the Upshot. Links to souces can be found there.


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  • Healthcare Triage News: Residency and the 80 Hour Work Week

    Performative overwork is more and more common in the United States, and long hours have long been the norm in medicine. During residency, doctors have traditionally been asked to work for up to 100 hours per week. A rule in 2003 capped residents hours at 80 hours per week. Older docs claim this practice skimps on training, and might be worse for patients. A new study indicates that there is no discernible reduction in quality of care across a number of metrics. Maybe the good old days weren’t so great.


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  • JAMA Forum: Averting Alert Fatigue to Prevent Adverse Drug Reactions

    Although various electronic health records (EHRs) have different features, nearly all seem to have alerts for potential problems with drug prescribing. It’s one thing that many believe that EHRs do very well. However, a recent study warns that when it comes to opioids and benzodiazepines, we shouldn’t always assume such alerts work as intended.

    That’s the beginning of my latest piece over at the JAMA Forum. Go read it!


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  • Healthcare Triage: Does Better Education Mean Better Health?

    Many, many studies have associated better and more education with better health outcomes? But which way does the causality go? Do people attain more education because they’re healthy? Or maybe those who are in an economic position to attain education also tend to be able to afford good healthcare? We’re here to sort out the studies.

    This video was adapted from a column Austin wrote for the Upshot. Links to souces can be found there.]


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  • Healthcare Triage: The Implications of “Public Charge” on Immigrant Children

    The Trump administration has put forth a rule change for immigration saying that if an immigrant gets one of a number of benefits from the government, it could lead to their being denied legal permanent residency or entry to the US. Will such a rule lead to some immigrant parents disenrolling their families from safety-net programs? How will this affect children? We’ve got data.


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  • Healthcare Triage: The Malpractice System Doesn’t Deter Malpractice

    Research indicates that the malpractice system in the United States doesn’t do a lot to deter malpractice. There are several recent studies about malpractice that look at how many doctors have malpractice claims against them, and what happens to their careers after they have a problem.

    This episode was adapted from a column I wrote for the Upshot. Links to sources can be found there.


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