Latest Blog Posts & Articles

Got Pneumonia? It’s probably a Virus

A team from the CDC recently published an implicit study cataloguing the pathogens – the evil foreign organisms – that cause Americans to find themselves in hospitals with pneumonia. And the worst offenders? Viruses!

Photo Credit: New England Journal of Medicine

Photo Credit: New England Journal of Medicine

Moral of the story – get your annual flu shot, and then cross your (sanitized?) fingers that some other bug doesn’t come your way.


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Does Having Too Much Money Make Us Stupid?

As a science, economics does not always succeed at predicting how humans behave. The discipline assumes a level of rationality, and an ability to process complex information, that far exceeds human capacity. But as a standard for how people ought to behave, economics provides an excellent set of lessons. Consider the economic principle of consistency in financial trade-offs. If you are purchasing an appliance at a chain store, for example, and find out the product you are buying is $50 cheaper at the store across town, rational economic choice would ask you to ponder whether the time and expense and hassle of that cross town trip is worth the $50 in savings. That pondering – that economic decision – should be unchanged regardless whether the appliance you are purchasing will cost you $100 or $1000.

But of course when faced with this scenario, people are not economically or logically consistent. When imagining the purchase of a $100 appliance, far more people report being likely to travel to save $50 (a 50% savings!) than when they are asked to imagine that the original purchase price was $1000, and the $50 reduction feels barely noticeable.

Aren’t people cute? Isn’t inconsistency and sloppy economic reasoning adorable?

You might even wonder whether the people who exhibit this kind of inconsistent behavior simply do not understand the value of time and money. Maybe they don’t have enough economic savvy to think carefully about trade-offs, like this one between time/effort and money.

Or maybe they simply have too much money to bother to be consistent! According to an article by Anuj Shah and colleagues, people’s economic reasoning – their consistency in the face of economic trade-offs – is improved when they are faced with scarcity.   Over a series of scenarios, they found that people with little money to spare proved to be much more consistent in making economic decisions.

Here’s one of their scenarios, a famous one in the behavioral economics literature.

(To read the rest of this article, please visit Forbes.)

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How Much Does Health Insurance Cost?

Want to buy health insurance for your family? Last year, that would have cost you almost $18,000. In 1999, the cost would have been closer to $6,000. Here’s a table showing the steady rise in prices:

how much does health insurance cost

Surprised at the $18,000 number? That’s because much of that cost is being picked up by your employer. You aren’t paying $18,000 out of your paycheck for insurance. But you are the one paying. Rising insurance costs are a major reason for stagnant wages.

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Using Behavioral Economics to Design Smarter Physician Incentives

Last year, I joined Zeke Emanuel and some other great people in publishing an article on how to use the insights of behavioral economics to nudge physicians towards providing high-value care. Here is a link to that article. To give you a teaser, here are some of the principles we drew upon:

Using Behavioral Economics to Design Smarter Physician Incentives 1

And here are ways to make use of the principles:

Using Behavioral Economics to Design Smarter Physician Incentives 2

Eager to see these ideas put into practice!

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Are Your Healthcare Prices Outrageous? Here’s What Happens When Prices Come Out Of The Dark

They both had shoulder pain, persistent despite weeks of physical therapy. Both received MRI examinations at reputable radiology facilities, looking for things like rotator cuff tears, labral disruptions and other anatomical abnormalities. What was different was the price they paid for the MRI, with one patient paying $1000 more than the other. Welcome to the crazy American medical marketplace!

Health care prices in the US vary substantially across providers, in part because those prices are so often opaque. When primary care physicians order MRIs for their patients, for example, few patients shop around for affordable radiology centers. There is no reason to shop, because most probably wouldn’t find out what the price was anyway.

That may soon change, if promising results from a recent experiment hold true. The experiment was launched by AIM Specialty Health, an insurance-like company that tries to manage the cost of expensive tests and procedures. The company decided to call patients up on the phone whenever the patients had scheduled MRIs that were either substantially more expensive than competing providers, or were going to be performed by a radiology group rated as significantly lower in quality than its competitors.

After receiving these phone calls, some patients shrugged their aching shoulders and went to whichever facility they felt like going to, realizing they weren’t going to pay out-of-pocket for their MRIs anyway. For example, if a patient had reached her out-of-pocket maximum for the year, then going to a high priced MRI facility would not affect her pocketbook. So she might stick with her originally scheduled test. But other patients, once they learned about the price and quality of alternative providers, canceled their originally scheduled scans and rescheduled with a competitor.

(To read the rest of this article, please visit Forbes.)

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The History of Tobacco Control — In One Picture

Came across this cool graphic, showing the rise and fall of U.S. cigarette consumption. The picture also shows when various policy levers were pulled, and how those levers track to consumption. WARNING: No proof of cause and effect. But still quite interesting.

History of Tobacco Control




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Chew on This: Willpower Predicts How Quickly You Respond to the Taste of Food

Taste versus health: That’s a trade-off we are often faced with when deciding what to eat. Some foods are bad for our health but happen to taste quite good. All of us have limited willpower, and when we are exhausted those unhealthy foods become harder to resist. But did you know that when willpower is depleted, the relative speed with which our brains process information on taste versus healthiness changes?

When you run out of self-control, the part of your brain that tells you to eat healthily lags behind the part telling you to eat junk food.

This conclusion follows from research using what behavioral scientists call a mouse lab – not a facility where researchers experiment on mice but, instead, a lab where people respond to computer-based surveys and the researchers track the movement of the mouse controlling the computer cursor. In a study led by Nicolette Sullivan from Caltech (safety school!), researchers placed participants in front of computer screens and gave them pictures of two foods, asking them which one they would most like to eat. Instead of looking only at which food people eventually chose, they looked at the wandering of the cursor – a participant might first start directing the cursor towards the donut before swerving it in the direction of the salad. That pattern would suggest that the person’s early preferences were for the donut, but were later overridden by other considerations.

Here’s what they found.

(To read the rest of this article, please visit Forbes.)

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How to Keep Santa from Making Our Kids Fat –Three Ways to Reduce Childhood Obesity

The holidays are upon us. It’s a time to celebrate with loved ones, maybe even enjoy a well-earned vacation. But it is also a time that many of us gain weight, with children developing eating habits that could set them on a trajectory towards being overweight or obese.

It is really crucial to help our children avoid gaining too much weight. Because once people become obese, a myriad of biologic factors conspire against their efforts to lose weight. Consider a study that came out last year showing what happened to contestants on the Biggest Loser – most of whom gained back most of the weight they lost while participating on the television show. Or look at the difficulty even wealthy people with great willpower have sustaining weight loss, people like Mike Huckabee and Oprah Winfrey.

That’s why the key to combating America’s obesity problem is to prevent children from developing obesity.

But how can we keep our children from becoming obese? All of us with children can do our best to serve our kids healthy, appropriately portioned meals, while encouraging them to be physically active. But what about us as a society – what can we do? What policies can we embrace that will reduce the rate of childhood obesity?

(To read the rest of this article, please visit Forbes.)

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A Two Picture History Of The Randomized Control Trial

Many people consider the randomized control trial the gold standard for assessing medical interventions. The US government has been a major funder of such trials, as illustrated in this picture which shows that the government funds just about as many RCTs as private industry:

A Two Picture History Of The Randomized Control Trial 1Despite so much US funding for RCTs, the location of such trials has steadily moved to other countries:

A Two Picture History Of The Randomized Control Trial 2For some reason, the United Kingdom seems to have gone by the clinical trial wayside. Even before Brexit. Go figure!


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Surprise – Here’s What Happens When You Try to Help Your Spouse Lost Weight


Ever wonder why your spouse eats too much even when you warn him or her not to eat too much? It could be because your admonitions put your spouse into a state of reactance, causing them to go against your advice just to prove their independence.

Reactance is a state of mind that arises when people feel that their freedom is being restricted. Reactance can be triggered by random events–when a food is not in stock at a grocery store, some people will be upset that they’ve lost the ability to purchase that food, even if they didn’t care that much about the item previously. Public service announcements, or PSAs, can trigger reactance, too–lecturing people on what they should or shouldn’t do can create backlash, where people do the bad thing just to prove they can’t be controlled.

When I first learned about psychology reactance, I thought about my older brother. It was a cold Minnesota day (sorry for the redundancy), and my then nine-year-old brother was staring longingly at a ribbon of ice that had wrapped itself around a metal railing. My parents, reading his mind, warned him not to lick it. He promptly took a lick and his tongue stuck to the frozen metal like it planned to remain there until April. My parents rescued him by pouring lukewarm water over the railing.

The lesson? Sometimes the worst way to keep people from engaging in harmful behaviors is to tell them to avoid those behaviors.

(To read the rest of this article, please visit Forbes.)

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