• Yeah, but you should see the apps!

      11/30/2013
      Austin Frakt

    Stuart Sumner tweets, “Norwich council takes delivery of its first computer.”

    first computer

    @afrakt

     
      For Fun
      information technology
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  • Happy Thanksgiving

      11/28/2013
      Aaron Carroll

    I imagine there will be light posting for a few days. Happy Thanksgiving to all of you and yours. We appreciate your coming here!

    @aaronecarroll

     
      Uncategorized
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  • JAMA Forum: BITWMA

      11/27/2013
      Aaron Carroll

    I’m off to see family for Thanksgiving. But I left you a piece in The JAMA Forum to read. “OECD Report Offers a Contrast in Perception vs Reality in US Health Care“.

    Go read!

    @aaronecarroll

     
      Health Policy
      OECD, quality, spending
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  • Quote: Medicaid is expanding faster than you may think

      11/27/2013
      Austin Frakt

    [The Supreme Court ruling that made the Medicaid expansion a state option] lead to constant speculation regarding which states would exercise the ability to opt-in or opt-out of Medicaid. Fed by the high profile case, national media have been tracking the expansion through color-coded maps that tend to rely on a five category sorting. States that have been categorized as not participating, leaning toward not participating, or alternative have been in constant flux over the last several months. The majority of these states have performed or are engaging in studies, negotiations, and other processes that move them toward participating in the Medicaid expansion. Though the media have reported that only half of states are participating, of the remaining states categorized as not participating or leaning toward not participating, all but about six are actively debating and planning to expand. The future of Medicaid expansion is not nearly as bleak as the media suggests. If anything, the Medicaid expansion is beginning to expose an animated set of political choices at both the state and the federal level that feed a dynamic federalism story that has so far evaded the Court’s understanding. The story of the Medicaid expansion is just beginning, and it will take time to fully develop the research I have begun to analyze here, but the preliminary enquiry indicates strong prospects for Medicaid expansion.

    – Nicole Huberfeld, “Dynamic Expansion,” a Social Science Research Network working paper. See also Huberfeld’s blog post.

    @afrakt

     
      Health Policy
      Medicaid expansion
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  • We have gone insane

      11/27/2013
      Austin Frakt

    Inbox:

    Your password must:

    • be 15 to 30 characters long
    • contain at least two uppercase letters (A-Z)
    • contain at least two lowercase letters (a-z)
    • contain at least two numbers (0-9)
    • contain at least two of the following special characters: #@$%^!*+=_
    • change at least four characters from your previous password

    Your password cannot:

    • contain spaces
    • be one of your last ten previous passwords

    @afrakt

     
      Life
      information technology, passwords
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  • *Giving* thanks

      11/27/2013
      Austin Frakt

    Like many of you, I have a lot to be thankful for. You can probably imagine what some of those things are: family, friends, their good health and mine (or the courage and strength to manage when that’s not the case), a decent job, and so forth.

    Not to diminish all those things, I’m going to focus for a moment on something else that, in the grand scheme of things, is relatively insignificant. But it’s significant to this blog and comes from a philosophy I admire.

    Ashish Jha offered, and we have accepted, some in-kind support for TIE from one of his research assistants, Dan Liebman. For this, I am thankful, both to Ashish and Dan. With Dan’s help, we can do so much more and better. Soon, you’ll begin to see what I mean. So, this is a little thing you can be thankful for too.

    When Ashish and I discussed this arrangement, I asked him why he was willing to contribute the time of one of his RAs that could otherwise be used to further his own research program. His answer was that when he sees something of high quality, something he values and that is also, in his view, good for the world, he wants to help make it better, if he can. He wants to make a tangible contribution. What he was saying was that lending a hand in this way to TIE was not a hard choice for him. He did it with joy and confidence that his contribution would be put to good use. It’s a way for him to express gratitude with more than words, with a gift. It’s not just saying “thanks,” it’s literally giving thanks.

    Giving in this way is how Ashish lives. It’s wonderful and worthy of emulation.

    I expect Dan’s contribution, facilitated by Ashish, will make a large impact on what we do here. But gifts of thanks that help this blog can be small too. For example, many readers help TIE when they share our content with their network. It’s a small gesture that doesn’t take much time. But, I’m grateful for it. Thank you! And keep doing it. If you read something here you find valuable, please retweet it or post it on Facebook or email it to some friends, etc. When you do so, you’re giving thanks right back.

    Now, as I said, this blog and our sharing of it is not the most significant thing we could be thankful for. But in my life it has been and is significant. It’s worth a moment of reflection to recognize that readers like Ashish and you help make that happen.

    I hope you (and I) spend today, tomorrow, the weekend, and beyond giving thanks to things of value in our lives and our world — big and small. Happy Thanksgiving!

    PS: It goes without saying, but I’ll say it anyway: blogging will be light through the weekend.

    @afrakt

     
      Uncategorized
      blogging, Thanksgiving
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  • On the effectiveness of emergency contraception: weight matters, but dosage probably does, too

      11/26/2013
      Adrianna McIntyre

    Yesterday morning, Mother Jones reported that the morning-after pill—which is a higher-dose version of traditional contraception—may not be effective for women heavier than a certain weight (emphasis added):

    The European manufacturer of an emergency contraceptive pill identical to Plan B, also known as the morning-after pill, will warn women that the drug is completely ineffective for women who weigh more than 176 pounds and begins to lose effectiveness in women who weigh more than 165 pounds. HRA Pharma, the French manufacturer of the European drug, Norlevo, is changing its packaging information to reflect the weight limits. European pharmaceutical regulators approved the change on November 10, but it has not been previously reported.

    This development has implications for American women. Some of the most popular emergency contraceptive pills sold over the counter in the United States—including the one-pill drugs Plan B One-Step, Next Choice One Dose, and My Way, and a number of generic two-pill emergency contraceptives—have a dosage and chemical makeup identical to the European drug. Weight data from the Centers for Disease Control and Prevention (CDC) suggests that, at 166 pounds, the average American woman is too heavy to use these pills effectively.

    These findings could impact on a significant slice of the female population. The chart below illustrates weight-for-age among white women in the US (there are also charts for black and Hispanic women). Eyeballing it, almost a quarter of women of childbearing age weigh more than 166lbs.

    WomenWeightWhite

    The actual research that this is based on is a little more nuanced and has some limitations. The focus on “weight” may be a bit misleading: though the study does examine weight as a variable, the authors focus more on BMI (weight for height). Risk of pregnancy is higher in women who are overweight or obese; some women are within a normal BMI range at the weight thresholds provided, though they’d need to be 5’9” or taller.

    The number of pregnancies observed in the sample was small, and the number of overweight/obese women make up an even smaller fraction of that, which means that there are some statistical limitations. And it’s worth noting that this is a single analysis of two prior studies; its findings aren’t necessarily definitive.

    Here’s an excerpt from the study’s discussion:

    How should those of us who are advising women about EC interpret these findings? It is easy to identify women who are overweight, and we can advise them that they may be more at risk of EC failure and may suggest they use [more effective methods of emergency contraception, like an IUD]. In this study, in addition to exploring the effect of BMI on the risk of pregnancy after EC use, we have presented the results for weight since most women know their weight, while few would be able to tell a health provider their BMI. Moreover, a woman who weighs over 70 kg may have a low BMI if she is tall, but she would, nonetheless, be advised that she may be at greater risk of EC failure. It might be tempting to suggest doubling the dose of EC for women over 70 kg (as is advised for women on enzyme-inducing anticonvulsant drugs), but data are necessary to support such practice.

    I want to key in on that last part. See, we already know that typical low-dose contraceptives—most birth control pills are “low-dose” now, to reduce side effects—are less effective in women who are overweight or obese. To address this, providers will prescribe formulations with higher hormone levels.

    It’s a reasonable hypothesis that we’d  see a similar mechanism at work with emergency contraception. “Plan B doesn’t work for women who are overweight, full stop”—which is how the Mother Jones story might be read by a layperson—is probably an oversimplification of the science. More likely (and less newsy): “We should reassess recommended dosage of emergency contraceptives to see if those recommendations should vary by weight.”

    As the study authors note, we need more research before we can conclusively say as much, but it’s an important distinction. Remember: keep calm and collect more data.

    Adrianna (@onceuponA)

     
      Health Policy
      contraception, emergency contraception
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  • Quote: “Where the powerful feed upon the powerless.”

      11/26/2013
      Bill Gardner

    From the Apostolic Exhortation Evangelii Gaudium of the Holy Father Francis:

    52. In our time humanity is experiencing a turning-point in its history, as we can see from the advances being made in so many fields. We can only praise the steps being taken to improve people’s welfare in areas such as health care, education and communications. At the same time we have to remember that the majority of our contemporaries are barely living from day to day, with dire consequences. A number of diseases are spreading. The hearts of many people are gripped by fear and desperation, even in the so-called rich countries. The joy of living frequently fades, lack of respect for others and violence are on the rise, and inequality is increasingly evident. It is a struggle to live and, often, to live with precious little dignity. This epochal change has been set in motion by the enormous qualitative, quantitative, rapid and cumulative advances occuring in the sciences and in technology, and by their instant application in different areas of nature and of life. We are in an age of knowledge and information, which has led to new and often anonymous kinds of power.

    No to an Economy of Exclusion

    53. Just as the commandment “Thou shalt not kill” sets a clear limit in order to safeguard the value of human life, today we also have to say “thou shalt not” to an economy of exclusion and inequality. Such an economy kills. How can it be that it is not a news item when an elderly homeless person dies of exposure, but it is news when the stock market loses two points? This is a case of exclusion. Can we continue to stand by when food is thrown away while people are starving? This is a case of inequality. Today everything comes under the laws of competition and the survival of the fittest, where the powerful feed upon the powerless. As a consequence, masses of people find themselves excluded and marginalized: without work, without possibilities, without any means of escape.

    And if I may suggest a verse for opening a Thanksgiving dinner, from Shantideva’s Bodhisattvacharyavatara (Guide to the Bodhisattva’s Way of Life):

    May I be the doctor and the medicine

    And may I be the nurse

    For all sick beings in the world

    Until everyone is healed.

    @Bill_Gardner

     
      Economics, Health Policy, Life, Medicine
      bioethics, justice, Religion
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  • Narrow networks are not new

      11/26/2013
      Aaron Carroll

    From Kaiser Health News:

    Officials in at least a half dozen states are pushing back against health plans in the new insurance markets that limit choice of doctors and hospitals in a bid to control medical costs.

    The plans don’t start offering coverage until January but they’re facing regulatory action, possible legislation, and in at least one case involving a high-profile children’s hospital, litigation.

    The pushback against “narrow” provider networks recalls the backlash against managed care and health maintenance organizations  in the 1990s. Protests from consumers and hospitals eroded those attempts to restrain expenses by narrowing provider networks.

    Now criticism of limited networks has risen as consumers realize that, despite President Barack Obama’s pledge that they could keep their doctors, their Affordable Care Act insurance may not include the physicians or hospitals they’ve been seeing.

    I’m seriously amazed people are amazed by this. Narrow networks are not new. Networks are not new. I’ve never had a plan that didn’t differentiate between “in network” and “out of network”. I imagine the only plans that don’t have such networks are… government plans.

    Has no one heard of an HMO? Seriously?

    Do you know why such plans exist? Cause they’re cheaper:

    Broader choice comes with a price. The ability to sell less-expensive plans with limited choices of doctors and hospitals helps contain medical inflation, health economists argue. Looser networks could. mean higher prices.

    Is this really news?!?!?!

    @aaronecarroll

     
      Health Policy
      insurance, networks
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  • Bloomberg View: Get used to Obamacare as “a Trojan horse for conservative health-care reform”

      11/26/2013
      Austin Frakt

    In a new column at Bloomberg, I suggest that even liberals should accept some aspects of conservative health reform. You’ll regret not reading it! If nothing else, it’ll give you something to say about health care policy to both your conservative uncle and your liberal sister-in-law at Thanksgiving.

    @afrakt

     
      Health Policy
      Bloomberg View, conservatives, health reform
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