Latest Blog Posts & Articles

HIV – The Epidemic Isn’t Over

We have great medications to treat HIV infections today, but the best medicine is to not need medicine – to not get infected in the first place. But according to an article in JAMA, HIV transmission is rising among gay and bisexual men, compared to the rest of the population:











And clinicians aren’t doing a good job of reminding high risk patients to get tested for HIV:










We can’t afford to relax and let this epidemic get out of control!

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Is Peer Pressure to Increase Physician Performance Overrated?


It has become trendy in health policy circles to believe that behavioral economic interventions are the key to health system improvement. After all, traditional economic interventions like pay per performance have generated underwhelming results, with little or no change in physician behavior. Why not try a non-financial, psychological intervention—like performance feedback!

Well, a study conducted in the last couple years in Switzerland raises questions about the effectiveness of such feedback. In the study, researchers randomized physicians to either receive feedback every three months (on how many antibiotics they prescribed compared to their peers), or receive no feedback. They hoped that such feedback would shame over-prescribers into prescribing more parsimoniously. The physicians in the intervention group received a one-page letter every three months, with a nice picture showing them their relative rate of antibiotic prescribing.

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

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Not the Media Coverage I Expected


I was recently quoted in an article about opioid addiction in what looks like a far-right website. Not surprisingly, they took my quote out of context. They quote me, quoting some other people I disagree with, and then use that as evidence for the thing I quote.

Here’s an excerpt of the article in case you are interested in it:

Why is opioid use skyrocketing among youth and our nation? There are a host of reasons, including a few valid ones like genuine chronic pain relief. But among those reasons that are invalid is a restless, weak, discontent and hedonistic nation unable to weather tough times and difficulty without an instant high or stress and pain reliever – a “happiness pill.”

Dr. Peter Ubel, a physician and behavioral scientist, posits this explanation: “Even though many addicts are miserable, this misery doesn’t mean that their use of heroin or crack is irrational. As Becker and Murphy put it: ‘People often become addicted precisely because they are unhappy. However, they would be even more unhappy if they were prevented from consuming the addictive goods.’”

If a lack of happiness is contributing to the core of addictions to opioids and other drugs – and I believe it is – then I highly encourage people everywhere to master the art of being happy and content by reading the bestselling book, “Happiness,” by my friend and prolific author, Randy Alcorn. (It’s available right now at half off through his website.)

“Happiness” is one ginormous resource to discover yours and others’ true happiness and regain health and balance in our souls, households, communities and nation. I also encourage people to listen to Randy’s Happiness audio and video messages, and check out the resources on his Happiness blog, where his series of Happiness articles are available free of charge.

In light of the epidemic drug use in our nation, Randy couldn’t have put it better when he addressed how we are hardwired for happiness but with one serious flaw: “I argue in the book the problem isn’t they’re trying to be happy. Rather, God wired us to seek happiness. The problem is we seek happiness in the wrong places …”

America’s founders also knew this key to human happiness. It is the reason they embedded in our nation and our founding document the words: We are “endowed by [our] Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

Now, that’s a happiness we can stand on, will strengthen our country and will also lower addiction rates and death sentences from opioids.

If you feel the need to read more, click here.

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The Primary Care Doctor Is Not In

In a clever study, secret shoppers called primary care offices in an attempt to make a new patient appointment. People with Obamacare insurance, or “marketplace plans” in the below figure, had a hard time finding appointments. But so did people with traditional insurance.

But there’s a bigger takeaway, one slightly obscured by the misleading y-axis, that doesn’t go all the way up to 100%. So here’s my over-simplified version of the study results:

That’s right – only 30% of people were able to make a doctor’s appointment.


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More Medical Marijuana, Less Narcotics


Legalizing medical marijuana is controversial. Physicians have not always prescribed controlled substances wisely, as a look at our narcotic epidemic confirms. But marijuana is much safer than narcotics and, according to a recent study, might even save us money, by reducing people’s need for other, often more expensive medications.

Most notably, marijuana can be an effective part of comprehensive pain management. Millions of Americans suffer from chronic pain, caused by a wide range of disorders—inflammatory arthritis, irritable bowel, metastatic cancer, to name a few. Many medications used to manage such pain are expensive and carry substantial risk of substantial side effects (see above—re: narcotic epidemic). Marijuana can help alleviate pain, thereby reducing the need for those other medications.

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

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Doctors with Strong Financial Ties to Pharma Are Found More Likely to Prescribe Brand-Name Drugs


Generic cholesterol pills are probably better for most patients than brand-name medications because the lower cost of generics increases the chance the patients will take the pills every day.

Yet some physicians primarily prescribe expensive brand-name drugs like Lipitor and Crestor. According to a recent study of physicians in Massachusetts, about a quarter of cholesterol prescriptions are for brand name drugs.

Why are physicians so enthusiastic about prescription drugs? For starters, some patients may have taken generic drugs already without achieving adequate cholesterol reduction or, perhaps, with side effects. In addition, some patients may prefer brand names over generics and request them from their physicians. Some physicians, too, might prefer brand-name drugs, perhaps because of advertising.

Or is it because they have gotten financially entangled with the pharmaceutical industry in ways that cloud their clinical judgment? That’s a possibility posed by a research team out of Harvard. The team evaluated the percentage of brand-name cholesterol pills physicians prescribed, as a function of how much money the physicians made through interactions with the pharmaceutical industry.

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

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Outrageous Hospital Expenses

Getting relatively simple procedures is much more expensive in the US than elsewhere.

Take the cost of an appendectomy:

Or having a baby:

Or having a baby by C-section, a more invasive procedure that is not only more expensive in the US than elsewhere, but is often more common:

These prices beg for government regulation!

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Imagine the Cost of Imaging

Keeping with my recent theme on US healthcare prices, from the people at Vox media, here’s an illustration of how expensive it is to get an MRI in the United States versus other countries:

And the cost of a day in the hospital:



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If “Low-T” Killed Your Sex Drive, Your Television Might Be to Blame


There are some sad truths about being an aging male. Your muscle mass usually declines. You start feeling tired more easily. And there’s a good chance either you start losing interest in sex, or start experiencing a decline in sexual performance.

Here’s another truth—your testosterone level probably ain’t what it used to be. Which raises a question—would testosterone supplementation restore some of your youthful vitality?

That is certainly what manufactures of testosterone treatments wanted people to think when they began purchasing TV time to play ads encouraging men to get their testosterone level checked. But since the early onslaught of these “Low T” ads, medical science has taught us that testosterone replacement is often unnecessary. Moreover, unnecessary replacement can potentially lead to heart disease. That makes it likely that those television ads, rather than restoring people’s vitality, shortened their lives.

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

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More on US Healthcare Prices

In a recent post,  I showed two drugs that were much more expensive in the United States than elsewhere. One was  for rheumatoid arthritis and the other for hepatitis C. Today we get to look at a cancer drug, Avastin, and just how much more Americans pay for it than people in other countries.

This is not acceptable.

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