Latest Blog Posts & Articles

The High Price of Free Lunch

Once again: correlation does not equal causation. And it is possible that companies give lunches to physicians who are already inclined to prescribe their products, or who are already high prescribers. But why should we leave any of this up to doubt?!?

Physicians should not accept gifts from drug companies.

High Price of Free Lunch


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Rare Diseases Are Becoming Too Common. Sound Impossible? Here’s Why It’s Not

It is hard to make money treating rare diseases. There simply aren’t enough customers to generate many profits. That’s why the U.S. government passed the Orphan Drug Act in 1983, a law which created a series of incentives to encourage drug companies to develop treatments for rare or “orphan” diseases – conditions affecting less than 200,000 people in the U.S. Thanks to longer patent protection, tax reductions, and fee waivers, the orphan drug industry has become quite profitable.

Are rare orphan diseases now becoming too common?

In the 1980s, the pharmaceutical industry received orphan drug status for about 3 or 4 products per year, with most of these drugs being either the first treatments available for the diseases in question or major improvements over prior treatments. From 1983 through 2010, the pharmaceutical industry never received approval for more than 10 orphan drugs in a given year.

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


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Good and Bad News about Physician Pay

I’ve got some good news for all of you: there’s no racial disparity in pay among female physicians. African-American physicians in the United States make just as much money as Caucasian women. Unfortunately, this good news is largely a result of dismal news – neither group of women make as much as white male physicians. And of course, sadly, African-American male physicians lag behind white men, too:

Good and Bad News about Physician PayThese results come from a study in the British Medical Journal.

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Americans Love Their Healthcare But Hate Their Healthcare System — Here’s Why


There’s lots to love about American healthcare. We have some of the best clinicians in the world, as evidenced by the huge number of people who come to the U.S. from other countries when they are sick. Yet the American people are less satisfied with their healthcare system than are citizens of the majority of other developed countries.

Why do people in the land of the Mayo Clinic and Mass General Hospital hate their healthcare system so much? In short, many Americans are upset that they cannot afford to make use of all this high quality care when they need it.

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

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Don’t Blame Obamacare for High Insurance Costs

Many people have warned us that Obamacare will drive up the cost of healthcare insurance, but recent evidence suggests that the problem is bigger than that. According to the Commonwealth Fund, healthcare insurance costs are rising even more quickly outside of the Obamacare exchanges than inside them:

Don't Blame Obamacare for High HC Costs


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Out Of Control Healthcare Spending

Wondering where all your spare cash is going lately? Probably to healthcare:

Out Of Control Healthcare Spending


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Do You Overeat? Blame Childhood Stress

Lots of us eat when we are stressed. But did you know that even when we are not currently under stress, the amount of food we eat might be influenced by the stress we experienced as children? That’s the conclusion Sarah Hill, a psychologist at TCU, wants us to draw from several studies she ran with colleagues from the Universities of Arizona and Minnesota. In the research, Hill brought college students into her lab and left them in front of snack food while they were taking a break between two parts of a research study. She then looked at how much food people ate during this break, as a function of whether they experienced significant financial stress as a child – e.g. whether they reported “having enough money for things growing up.” Hill also asked people how long it had been since they ate and whether they were hungry. She found that among people with more privileged backgrounds, the amount of food they ate depended largely on how hungry they were. On the other hand, for those from less lofty socioeconomic backgrounds, they ate the same amount of food regardless of their hunger, a.k.a. their “energy needs:”

Do You Overeat Blame Childhood Stress 1

In an even more convincing part of her research, she brought people to the lab after all of them had fasted.

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

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How to Stop Over-Eating — Lessons from Brain Science

Put our brains into the modern food environment, and you have a recipe for disaster. Our brains are hardwired to crave calorie-dense foods, this craving no doubt arising from our evolutionary time spent on the Tundra where calories were often scarce. But our modern food environment surrounds us with calorie-dense foods, forcing us to deplete limited willpower trying to keep our cravings from turning into over-consumption. Fortunately, brain science hints at several ways to reduce this pattern of craving and consumption.

Let’s start with a part of the brain called the left dorsal lateral prefrontal cortex, a region important for helping restrain ourselves from engaging in unwanted behaviors. Do something to disable the dlPFC (as the cool kids call it), and you will lose self-control or willpower. For example, psychologists often measure self-control using something called the Stroop effect, in which people are asked to quickly state, say, the color of a series of fonts. This seems like it should be pretty simple.

How to Stop Overeating 1

In the Stroop task, however, every once in a while people get something like the following:

How to Stop Overeating 2

When people see this word they are supposed to say “red” because the word is in a red font. But many people blurt out “green” instead, unable to inhibit the impulse. As it turns out, when researchers use a clinical stimulator to zap the dlPFC, people’s performance on the Stroop task declines. Here, in case you are interested, is a picture of one of these stimulators – don’t let a stranger persuade you to place one on your head!

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

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The Relentless Rise of Healthcare Expenditures

The Relentless Rise of Healthcare Expenditures

Need I say more?

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Turmoil in the Obamacare Exchanges

Photo Credit: Wall Street Journal

Photo Credit: Wall Street Journal

Here is a nice story from a NC news station explaining the turmoil in the exchanges, with Aetna pulling out of many markets. Worth a quick read.

North Carolina consumers buying broadly subsidized health insurance policies on the online marketplace created by the Affordable Care Act will have fewer options after a major insurer pulls out.

State Insurance Commissioner Wayne Goodwin said Tuesday that health insurer Aetna’s decision to drop out of the ACA marketplace came as his office was reviewing the company’s request to raise premiums by about 24 percent next year.

“I am shocked and disappointed that Aetna and its executives have chosen to abandon their Exchange members,” Goodwin said. “We at NCDOI were in the middle of reviewing Aetna’s rate requests for 2017. Never during the review did the company indicate any concern that the requested rates would not solve.

I am angered by the impact Aetna’s decision will have on Tar Heel families and our market,” he added.

The move leaves Blue Cross and Blue Shield of North Carolina alone in selling marketplace policies to residents of all 100 of the state’s counties. A company spokesman says a final decision on 2017 policies is pending. The state’s largest health insurer is seeking Goodwin’s approval to raise premium costs by an average of almost 19 percent.

Cigna plans to sell ACA policies in Raleigh.

“New marketplaces are messy. The health of people in the Obamacare exchanges is uncertain,” said Dr. Peter Ubel, a physician and professor at Duke University’s Fuqua School of Business. “But even though insurance companies are in the business of uncertainty, these new marketplaces bring more uncertainty than they can handle. When a brand new insurance market opens up, they don’t know who’s going to buy insurance and they don’t know how healthy or sick their customers are going to be, so they have to guess at the price. And so far, the people buying insurance through the exchanges are sicker than expected.”

North Carolina is just one of many states affected as Aetna said it will abandon Affordable Care Act insurance exchanges next year in more than two-thirds of the counties where it now sells the coverage, the latest in a string of defections by big insurers that will limit customer choice in many markets.
Dwindling insurer participation is becoming a concern, especially for rural markets, in part because competition is supposed to help control insurance price hikes, and many carriers have already announced plans to seek increases of around 10 percent or more for 2017.

“This is really going to be felt in Southern states and rural areas,” said Cynthia Cox, associate director of health reform and private insurance for the Kaiser Family Foundation, which studies health care issues.

Experts say it is too soon to determine how shrinking insurer participation will affect rates beyond next year, but fewer choices generally contribute to higher prices over time.

Aetna, the nation’s third-largest insurer, says it will limit its participation in the exchanges to four states in 2017, down from 15 this year. The announcement late Monday came several weeks after UnitedHealth and Humana also said they would cut their coverage plans for 2017 and after more than a dozen nonprofit insurance co-ops have shut down in the past couple of years.

“Time might fix this as more people buy insurance,” Ubel said. “But Aetna might have pulled out anyway to show their displeasure with the Obama Justice Department, which is in the process of blocking their merger with Humana. It’s not clear when the controversy over health care reform will end.”

Aetna covers about 838,000 people on the exchanges and has said it has been swamped with higher than expected costs, particularly from pricey specialty drugs. It will sell coverage on exchanges in 242 counties next year, down from 778. The Hartford, Connecticut-based insurer will sell on exchanges in Delaware, Iowa, Nebraska and Virginia next year.

The enrollment period for 2017 coverage starts Nov. 1.

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