Latest Blog Posts & Articles


Love This Picture

I had the great pleasure of talking about out-of-pocket healthcare costs at Periodic Tables: Durham’s Science Café, a speaker series run by The Program for Science and Society at Duke University. The crowd was absolutely awesome, and much larger than I expected, given that I was speaking at the same time that Duke’s number one rated men’s basketball team was taking on Michigan state’s number two ranked team.

I also love the advertisement they put together for the program. I wonder if I should use this art on my next book.

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Obesity Nation!

Here is a picture, courtesy of the Financial Times, showing obesity rates among OECD nations. Only 5% of people living in Korea and Japan qualify as obese. Yet obesity rates are drastically higher in the United States; if someone’s in American, there is practically a 4 in 10 chance they are obese.

Not something to be proud of.

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Why Investing in Better Primary Care Failed to Save Money

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We have a huge healthcare problem in the U.S., spending way more than other wealthy countries, expenses that not only burden state and federal governments, but that also take money out of American pockets.

Some people hope that better primary care will reduce U.S. healthcare spending. They point out that a small number of chronically ill patients—super-utilizers—account for half of healthcare spending. The hope is that taking better care of these super-utilizers, with more robust and improved care coordination, will improve their health and reduce healthcare spending.

Or perhaps not. When the Palo Alto VA tested an intensive primary care program for its super-utilizers, healthcare spending and utilization didn’t budge. One iota. Except for primary care utilization which, unsurprisingly, rose significantly among people receiving intensive primary care.

The Palo Alto study was well-designed. The researchers targeted patients who were in the top 5% of healthcare utilization. These patients were typically elderly, and on average had 10 chronic health conditions. Two-thirds carried mental health diagnoses, and a quarter had a history of homelessness. The population included people I am very familiar with from my almost 20 years in the VA: older men with PTSD and anxiety; hypertension, diabetes, coronary artery disease, congestive heart failure, emphysema, and a touch of renal failure; recent hospitalizations for pneumonia, leg wound infections, or maybe a mild stroke.

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

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Generic Doesn‘t Mean Affordable

Generic meds are supposed to be relatively cheap; multiple companies can make the same molecule, leading to price-lowering competition.

But that’s not always what happens in the US market. Look at the prices of these generics, in the US vs Canada:

We need to take regulatory or legislative steps to reduce the price of generic medications.

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Got a Big Belly? (Why Big Sugar Is to Blame)

Growing up Republican, I have long believed in personal responsibility. In junior high school, when I observed close relatives who struggled with obesity, I vowed to never let myself get out of shape. (“Junior high” is what we called middle school back in the day.) When hip surgery gone wrong dramatically reduced my level of physical activity two and a half years ago, I cut back on what I ate to keep from gaining weight. In fact, I believe that much of our nation’s obesity epidemic comes down to personal responsibility—if people ate less and exercised more, we’d be a healthier nation.

But there is another culprit who deserves blame for American obesity—the sugar industry, which, for decades, bamboozled the American public about the dangers of its product .

My ire at big sugar was stoked by a study published in JAMA Internal Medicine analyzing correspondence from the Sugar Research Foundation (SRF) in the 1960s and 70s. In the late 50s, the sugar industry recognized that people’s concerns about the connections between cholesterol and heart disease provided them with an opportunity to tout the “no fat” benefits of sugar. By 1962, however, the industry recognized that high sugar intake could increase cholesterol levels, too.

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

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The Biggest Problem with Obamacare? People Didn’t Know What the Law Accomplished!

Obamacare dramatically reduced the number of people in United States who lack health insurance. Reduced as in: brought the proportion down to historical lows. Yet very few Americans knew this about the law, which is part of the reason why so many people didn’t like Obamacare. Here’s evidence to back up that connection, from the Kaiser Family Foundation:

Hard to like a law that hides its best features.

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What do people want Trump to do with our healthcare system?

Here’s a picture from the Kaiser Family Foundation from late last year, showing what people want done to improve the US healthcare system:

Plenty of work to do!

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Medical Malpractice – Who’s Being Sued and What Is It Costing

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A baby is born. The delivery was rocky, with the infant’s heart rate showing occasional signs of distress. Later, the parents learn that their child has cerebral palsy, and may never walk normally. Was the obstetrician to blame and, if so, should the parents sue?

American medical care is burdened by a flawed and expensive malpractice system. Too many doctors are being sued not because they make mistakes, but because their patients experience bad outcomes.

A fascinating study lays out recent trends in malpractice, offering good and bad news for physicians. First, the good news: malpractice claims are declining. The rate of paid claims, in fact, went down more than 50% from the early 90s until now.

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

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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?

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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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