Recently I have posted several entertaining pictures revealing the dangers of assuming that correlation implies causation. A lot of these pictures are housed on this fascinating website. Meanwhile, here’s another one I had to pass along:
My patient had been feeling unusually irritable lately. Nothing had changed in his home or work life to bring on such a shift in mood. He wasn’t taking any medicines that could cause such symptoms either, being a strappingly healthy young guy. A weightlifter in fact. “Are you taking any kind of steroids?,” I asked him non-judgmentally. I knew that such chemicals could affect mood.
“Nope. Wouldn’t touch the stuff. Just some nutritional supplements,” he told me.
I asked him to bring the supplements in at his next appointment. When he did that, I discovered that one of the supplements listed “ground bull testes” as an ingredient. My patient was unwittingly ingesting testosterone. How much? Impossible to know. The label was as vague as middle school prose… (Read more and view comments at Forbes)
In a wonderful article on deep cave exploration, Burkhard Bilger shows how powerful comparison can be in putting an unfamiliar topic into context. He is describing the arduous work involved in deep cave exploration. He is describing the risks of being far, far inside the cave when a heavy rain on the surface begins to flood the cave. There’s no quick way out, you see:
To climb straight back to the surface, without stopping to rig ropes and phone wire, would take them four days. It took three days to get back from the moon.
That last little detail, about coming back from the moon, is a beautiful piece of writing, and a wonderful way to remind people of how difficult it can sometimes be to travel in unexplored part of our own planet.
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I came across an interesting quote in the New Yorker recently, reflecting on the US banking system. It reads:
The power and the growth of power of our financial oligarchs comes from wielding the savings and credit capital of others. The fetters which bind the people are forged from the people’s own gold.
Pretty timely thoughts, given what’s happened in the US recently, with a banking system that brought us to the edge of financial ruin, only to have us bail it out. But these words aren’t reflections on the modern American economy. They were penned by Louis Brandeis in 1914, in a book titled “Other People’s Money and How the Bankers Use It.”
History repeating itself?
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Oscar Wilde is one of the most quotable people in history of the English language. He even had ideas about robots, many decades before people had any idea what robots could achieve. And in typical Wildean fashion, he provocatively tied it together with his attitudes on the advantages of slavery:
“Unless there are slaves to do the ugly, horrible, uninteresting work, culture and contemplation become almost impossible. Human slavery is wrong, insecure, and demoralizing. On mechanical slavery, on the slavery of the machine, the future of the world depends.”
Or as a Steely Dan might put it: we’d be fools not to have robots do our dirty work, oh yeah!
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Leibniz once described music as an “occult exercise in mathematics performed by a mind unconscious of the fact that it is counting.”
As someone currently working through some late Beethoven piano masterpieces, this description makes a lot of sense to me. Now if I can only find enough practice time to make my performances more unconscious!
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Interesting picture on the Vox website from Sarah Kliff, showing an increase in the number of health insurance companies planning to compete on the exchanges next year:
So much for the rumors that Obamacare will quickly kill the health insurance industry.
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“The mistake is to think that communications will solve the problems of communication, that better wiring will eliminate the ghosts.”
—John Durham Peters
A great cartoon from the Kaiser Health News website that pithily captures the “wonders” of the American health insurance system.
I have been writing a bit lately on the need for healthcare providers to talk with their patients about healthcare costs, if for no other reason than to enable patients to determine whether they can afford to pay for the healthcare that their doctors are recommending them to receive. I have been criticized for this position, on the grounds that I am rationing care from people with less money and connections than I have, a criticism that I have explained as being misguided.
But I have faced another more reasonable criticism too, one I want to write about today. I have been reminded that doctors and other healthcare providers cannot easily discuss healthcare costs with patients because those costs are often unknown. Lisa Rosenbaum made this point in an excellent New Yorker essay:
“The first problem with financial disclosure from doctor to patient is a practical one. Doctors rarely know how much their patients actually pay. Patients are covered by a variety of insurers, all of whom offer several plans, for which any individual patient has a different copayment and deductible, which he may or may not have met.”
In this post, I will lay out a fuller version of this criticism and then explain why I still think doctors need to hold these conversations, and also why I think these conversations will become much more common in the near future… (Read more and view comments)