Latest Blog Posts & Articles


Would Better Risk Communication Reduce Fear of Flying?

With so much recent news about airplane disasters, it’s easy to become frightened about flying. I wonder if a risk graphic like the following will do much to help?

Am I Going Down AppAs reported on recently in The Economist, the risk graphic comes from a new iPhone app called Am I Going Down?

I’m skeptical this will work. But I still love the way their display puts this risk information into a context we can all relate to. Hurrah!

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When Helpful Nudges Aren’t Helpful

Gerald Ashley (twitter handle @Gerald_Ashley) recently tweeted a photo of what was SUPPOSED to be a helpful nudge, reducing the odds that people would bump into each other going up and down the stairs. Can you see what might not be helpful here?

When Helpful Nudges Aren't Helpful

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Health Insurance Is About Financial Security Too

People like me, trained to be physicians, have pushed hard to promote health insurance in the United States because we believe, with some evidence to back up our claims, that good health insurance promotes better health. When people don’t have insurance, they delay necessary medical care for too long, and their health suffers as a consequence.

But probably the most direct benefit of health insurance is financial. When people have good health insurance, they are less likely to be burdened by medical costs. That is one of the findings revealed in a recent survey published by The Commonwealth Foundation. Here is a wonderful info graphic illustrating some of their results:

Health Insurance Is About Financial Security Too

Posted in Health Policy | Tagged , , , ,

If You Look for Cancer, You’ll Find It

Korea Thyroid Cancer PicWhat would you like first: the good news or the bad news? Let me start with the bad. Life expectancy among patients in the U.S. with thyroid cancer lags behind that in Korea. In fact, the vast majority of patients diagnosed with thyroid cancer in Korea are cured of that illness, a statement I can’t as easily make about the U.S.

The good news? Life expectancy among patients in the U.S. with thyroid cancer lags behind that in Korea.

Okay, I kind of pulled a fast one on you. I tried to mislead you into thinking it is bad when cancer patients in another country out-live cancer patients in the U.S. On the surface, living longer after experiencing a cancer diagnosis seems to be a good thing. All else equal, it is better to survive cancer than to die from it.

But all else is far from equal when it comes to thyroid cancer in the U.S. versus Korea. (To read the rest of this article, please visit Forbes.)

Posted in Health & Well-being, Health Policy, Medical Decision Making, Uncategorized | Tagged , , ,

The Things We Do To Lose Weight

Want to lose weight? Then what are you going to do to try to accomplish your goal? Specifically, what will you do to change your eating habits?

Probably the best thing you can do – eating habit wise – to lose weight is to eat less food. But as you will see from this picture below, which I learned about thanks to Pierre Chandon (@pierrechandon, on Twitter), that’s not the primary strategy most people pursue. Instead they think about specific type of food ingredients, and try to cut down on them – ingredients like fats and sugar. Or they try to eat more healthy foods – foods like fruits and vegetables.

And while there are some interesting differences in approaches across the world, what I find even more interesting is how consistent these behaviors are almost no matter where you live:

Things We Do To Lose Weight

The bottom line: people seem to think a lot more about what they eat rather than how much they eat. Which is a shame, because when it comes to dieting, less really is more.

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Millions To Be Made On…Generic Drugs?

Photo Credit: Policy and Medicine

Photo Credit: Policy and Medicine

It is well accepted among health economics wonks that the lion’s share of pharmaceutical company profits come when these companies hold exclusive rights to their products. Once their blockbuster pills go “generic,” competitors enter the marketplace and profits plummet. Consider captopril, a groundbreaking heart failure medication introduced in the early 80s by Bristol-Myers Squibb under the trade name Capoten. After making a fortune for the company, captopril went generic in 1996. By 2013, you could purchase a captopril pill for the lofty price of…hold your breath…1.4 cents.

Not many fortunes to be made at that price.

Of late however, the well-accepted cheapness of generic drugs has come under question, in the face of surprising price hikes for long time medications. As reported in the New England Journal of Medicine by Jonathan Alpern and colleagues, captopril has experienced a 2800% price hike. Okay that still leaves the pill pretty affordable, at 40 cents a pop, but that’s still a pretty hefty price hike for a generic pill that competes against other generic medications.

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

Posted in Health Policy, Medical Decision Making, Uncategorized | Tagged , ,

The Hidden Psychology of Antibiotic Prescribing

Experts in decision psychology and behavioral economics have conclusively shown that humans, those silly creatures, are not always rational decision makers. They let unconscious forces influence their thinking, and not always for the better.

But of course, doctors aren’t human. Right?

Well, here is some evidence of just how human we doctors are. The odds of us prescribing antibiotics to our patients varies by the time of day, as we become more or less fatigued:

Hidden Psychology of Antibiotic Prescribing

Posted in Behavioral Economics and Public Policy, Medical Decision Making | Tagged ,

Calling Obesity A Disease Dooms Dieters

Obesity US News

Photo Credit: US News

In June of 2013, the American Medical Association officially recognized obesity as a disease. The organization had its reasons. For starters, obesity leads to heart attacks, strokes, diabetes, early-onset degenerative arthritis…and just about every other illness on the planet. In addition, people with obesity face a very difficult time overcoming their condition: Short of highly invasive stomach procedures, very few treatments succeed in helping people lose weight and maintain that weight loss. Finally, the organization may have been motivated by the desire to reduce stigma surrounding obesity; by labeling obesity as a disease, it hoped to signal that people with obesity cannot be wholly blamed for their affliction.

But will deflecting blame from obese people backfire? Now stricken with a “disease,” will obese people be less motivated to lose weight?

This is the question Crystal Hoyt and colleagues set out to answer in a study published in the prestigious journal, Psychological Science. Their concern? As they put it: “The term disease suggests that bodies, physiology, and genes are malfunctioning. By invoking physiological explanations for obesity, the disease label encourages the perception that weight is unchangeable.”

To see whether this concern was justified, they decided to run some studies. In one, they asked people how concerned they were about their weight. They also asked these people to select a sandwich for a hypothetical lunch. And they varied whether people in the study were exposed to a message that obesity was a disease. (To read the rest of this article, please visit Forbes.)

Posted in Health & Well-being, Health Policy | Tagged ,

Celebrating Colorful Language

whiskeytangofoxtrotI realize that I do not have the most focused blog in the world. Some people blog about nothing other than, say, capital punishment or new developments in whiskey. I write about psychology, behavioral economics, ethics, the doctor-patient relationship, health policy, political partisanship… a relatively wide range of things, but topics often linked by the connections I make between them and the weird way we humans make judgments and decisions. On occasion, however, I go even further afield to celebrate great writing. And I just finished reading a fun, new novel called Whiskey Tango Foxtrot, by David Shafer. And I felt compelled to share some tidbits to give you a flavor for his writing style.

For starters, he can’t help himself from commenting on the name of the country one of his characters is working in at the beginning of the novel:

“Myanmar, which sounded like a name cats would give their country .”

And then, for anyone who’s ever traveled to a country in Southeast Asia, there is his wonderful description of a ceiling fan:

“There was a ceiling fan in her two-room flat; it was on now. But it whorled and kerchonked around at such an unstable and idiotic rate that what it gave in breeze it took back in worry.”

Or this wonderful description of one of the characters in his book:

“He drove an old Saab. He read and read and read. It was like being a professor but with no students, which he understood from professor acquaintances was pretty much the way you wanted it. He had a wicker lampshade over his kitchen table; stalagmites of magazines and journals grew in his living room.”

His hilarious take on chemical ingestion gone bad:

“The one banana he’d eaten at seven a.m. fought bravely against the double whiskey, the two chardonnays, and the Xanax. Or what he’d thought was a Xanax. But when he didn’t fall into a dry-mouthed slumber, he’d realized that, in his stupid drunk, he had fished out the wrong pill—a Nuvigil—from the bottom of his Dopp kit, and he went into a kind of fugue, and his mind kept running, and he kept drinking (the Nuvigil in valiant neurochemical conflict with airplane whiskey) until the flight attendant cut him off, and then he and the ghoul driving his body deplaned together, and the turquoise carpet in the Portland airport nearly made him ill, and the beach-themed restaurant in the concourse had quit serving so his ghoul got them a taxi and got them to the hotel and there was a fridge in the room and more pills in Mark’s Dopp kit and then they went out together, his ghoul and he, Mark as blank as a bodhisattva, but also gross and reeling.”

And I leave you with one final thought, a simple little description which takes a third of the verbiage of my set up:

“He just lay there, half out of his sleeping bag, like a banana begun.”

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Podcast on the Challenge of De-adoption

GW Clinical Practice Innovation PodcastHere is a podcast I participated in, put out by folks at GWU. A quickish interview on the challenge of getting doctors to stop doing things they ought to stop doing.

You can also listen to it on iTunes, or on Stitcher.

Posted in Health Policy, Medical Decision Making