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Doctors Without Appointments

Doctor and patient photocredit: Getty

Jill Ladkin was already having a terrible autumn. It began with a seizure that put her in the hospital with what seemed like scores of unfamiliar physicians attending to her state of health. The brain scan revealed a mass in the lining of her brain, a location usually signifying a benign tumor; but, given her seizure, the tumor was hardly what you would call a harmless growth. The surgeon had a theory of what was going on; the neurologist had a different theory. The resident, a trainee, was not even convinced that Ladkin’s seizure was a consequence of the tumor. But Ladkin’s primary care physician soon clarified the situation, telling the resident to stop speculating about some non-tumor potentially causing her seizures. “Occam’s razor,” he said, reminding the resident to never look for a second diagnosis when one diagnosis suffices. “She has a f#@$%’g brain tumor.”

That is the kind of doctor he was. Her primary care physician did not content himself with only her primary care needs, like checking her cholesterol and making sure she got her annual flu shot. Nor did he defer to specialists when she got seriously ill. Instead, he got right down into the thick of the details. There in the hospital, he settled by Ladkin’s side and helped her figure out what to do about her tumor. He looked over her scans, pulling up medical articles about seizure-causing meningiomas. Ladkin was used to such attention; he had been her primary care doctor for 15 years, never once making her feel like he did not have all day to address her needs. They debated the pros and cons of her treatment alternatives and settled on a course of therapy – surgery followed by radiation. He said he would follow up with her in his clinic, once she had recovered from the surgery.

That is when Ladkin’s autumn got even worse. After she left the hospital, she called into the office to confirm a follow-up appointment with her primary care doctor and learned that he no longer worked at that office. He disappeared, retiring from medical practice for reasons Ladkin never discovered.

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

Posted in Behavioral Economics and Public Policy, Health & Well-being

Great Coverage of Our Calorie Count Research

Photographer: Justin Sullivan/Getty Images

Cass Sunstein just posted a really nice write-up of the calorie count research I was lucky enough to conduct with Steven Dallas (now a law student at Duke) and Peggy Liu (a marketing Professor at University of Pittsburgh).  Thought I’d give you a flavor of the write-up:

A provision of the Affordable Care Act that is strongly supported by Donald Trump’s administration requires calorie labels at U.S. chain restaurants. The basic idea is that if consumers are informed, they will reduce their calorie consumption — and improve their health.

Unfortunately, it isn’t clear that calorie labels are doing much good. Some studies find that consumers are not influenced by them. They eat what they like, and they don’t care about calories. While other studies do find a real impact on people’s behavior, specialists question whether and to what extent the labels are promoting healthier eating.

New research finds that a small and simple fix might make a big difference: Put the calorie labels on the left side of menu items, rather than the right. That’s an intriguing finding, because it has implications for design choices by the private and public sectors in countless domains.

To read the rest of this piece, please visit Bloomberg.


Posted in Uncategorized

Come Work With Us!

Our Medical Decision Making Research Group is looking for an Associate in Research to join our team.

Please see the job description below and the link to apply.


The Associate in Research (RA) will support investigators on multiple research projects related to patient decision making and health communication. The RA will contribute to the research process in both operational and scientific ways. In particular, the RA will help design studies; pilot test studies; gather and compile research data; visit local retailers for the conduct of experiments; perform data entry; do preliminary data cleaning and analyses; draft, proofread, and edit research documents, including manuscript sections, presentations, and reports; maintain a reference library in EndNote; and facilitate the human subjects (IRB) approval process by preparing and submitting accurate documents in a timely fashion, in accordance with all regulations. This position will also support project investigators by conducting literature searches and doing other tasks for the creation and submission of project-related reports and manuscripts. Most importantly, the duties and responsibilities of the position will grow in accordance with the interests and talents of the RA. We want this job to be fun and challenging!

Posted in Uncategorized

Podcast on How to Discuss Out-of-Pocket Costs with Patients

I had the pleasure of recording a podcast organized by the Robert Wood Johnson Foundation and Avalere Health. Here is a link to the episode.

You should also check out other episodes.


Posted in Uncategorized

If You Want to Avoid a C-Section Choose Your Hospital Wisely

photocredit: Getty

We have an epidemic of C-sections in the US, now accounting for almost 1 in 3 births. That represents a 50% increase since the mid-90s, despite all the advances we’ve seen in obstetrical care.

Sometimes C-sections are critical to saving the life of either baby or mother. But C-sections are major surgical procedures, with commensurate risks. They are also 30% more expensive than vaginal deliveries.

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

Posted in Behavioral Economics and Public Policy, Health Policy

In Countries That Invest In Long Term Care, People Are Less Likely To Die In The Hospital

In the U.S., we do a lousy job of paying for long-term care. We don’t help people cover the costs of nursing homes or home-health aids when they have chronic, life-threatening illnesses. As a result, more Americans die in the hospital than they would if we covered long-term care more generously. At least that’s the conclusion suggested by a recent study of more than two dozen European countries. As shown below, the researchers found that the more countries spent on long-term care (as a percent of their GDP—the x-axis), the fewer of their residents died in the hospital (shown on the y-axis):

The U.S. needs to find ways to help people cover the cost of long-term care. The quality of their deaths may depend on it.

Posted in Uncategorized

Your Risk Of Prostate Cancer Just Dropped Precipitously. Here’s Why

photocredit: Getty

Most men diagnosed with prostate cancer don’t die of the disease. Between 2011 and 2015, 112.6 per 100,000 men per year were diagnosed with prostate cancer in the U.S., but only 19.5 per 100,000 men per year died of the disease over that same period of time. That is still far too many deaths. But the huge disparity between deaths and diagnoses arises in large part from overdiagnosis of prostate cancer in elderly men, as a consequence of screening tests that find cancers that, if they had never been diagnosed, would not have progressed to life-threatening illnesses.

Fortunately, such overdiagnoses are beginning to decline, because physicians are backing off on screening older men for prostate cancer.

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

Posted in Behavioral Economics and Public Policy, Health Policy, Medical Decision Making

The Greediest Companies In American Healthcare Are Not Who You Think

photocredit: Getty

There’s plenty of price gouging in American healthcare.

The pharmaceutical industry has gotten plenty of (well deserved) bad press for its pricing practices. At the extreme are people like “Pharma Bro” (and convicted felon) Martin Shkreli, who hiked the price of an important medication to treat infections in AIDS patients by over 5000%. But high and rising prices are the norm in pharma. New cancer drugs routinely cost more than $100,000 per patient, even when they bring only modest benefits. And some generic medications are going up in price rapidly, 10% or more per year, as the number of generic manufacturers declines.

But it’s not the pharmaceutical industry I’m worried about today.

What about insurance companies? They, too, are routinely criticized for high prices. Premiums continue to rise faster than inflation. And while Americans struggle to find affordable plans, leading insurance company executives report staggeringly high annual incomes. Since passage of the Affordable Care Act, David Cordani, CEO of Cigna, has taken home more than $140 million of compensation. Yet he feels poor compared to Stephen Hemsley, the CEO of UnitedHealthGroup, who has made almost $300 million.

But it’s not insurance companies that are making me anxious right now.

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

Posted in Uncategorized

The Surprising Truth About The Rising Price Of Generic Medications

In recent years, it feels like we’ve been inundated by stories of greedy pharmaceutical companies jacking up the price of important generic medications. In 2015, “Pharma Bro” Martin Shkreli, recognized that no other generic companies were manufacturing Daraprim, a drug used to treat infections common among people with AIDS. So he raised the price of that generic medication from $13.50 a pill to $750, confident that no competitor was around to cut into his market share. The media had a field day with Shkreli’s story, as well as other notorious examples of generic drug manufacturers raising the price of their products by an astonishing amount; consider the ten-fold increase in the price of generic Digoxin (a heart medicine) and Doxycycline (an antibiotic). In fact, worried about such price gouging, Massachusetts Senator (and presidential candidate) Elizabeth Warren has called for the US government to go into the business of manufacturing generic medications.

Just how greedily have generic manufacturers been gouging the American public of late? The truth is surprising. In the last 10 years, the price of generic medications in the US has actually fallen.

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

Posted in Uncategorized

Want to Reduce Opiate Overdoses? Legalize Medical Marijuana

I have written about medical marijuana before, relaying research findings showing that the legalization of medical marijuana is associated with a reduction in use of pain medications.

Here’s another piece of evidence leading to a similar conclusion, from a study by the research team of Bradford and Bradford out of the University of Georgia. (Athens, Georgia being famous for its music scene, I wonder if Bradford and Bradford have ever formed a band. But I digress.)

The researchers found that in states that legalized medical marijuana, there was a reduction in medication use among Medicaid enrollees, across a wide range of medications. This reduction was especially notable for pain medications, which plummeted in those states:

We have an epidemic of opioid abuse. Record numbers of Americans will die of narcotic overdoses this year. It is time to legalize and strictly regulate the use of medical marijuana. Opiates are known to kill people from overdoses. Pot doesn’t.

Posted in Health Policy, Uncategorized