Category: Research

Healthcare Inequity Will Not Disappear “Automatically”

Check this out. A few days ago, I did a post on the important and growing roles that algorithms play in our lives. Here’s another angle on the same theme. Pay special attention to the paragraph that starts with the blue print. What you will see there is the goofy result that resulted from a model using healthcare expenditures as a proxy for severity of sickness. Turns out that although the researchers were trying to discover ways to reduce racial healthcare disparity, the model that they developed actually perpetuated it. How? Lack of money and access to healthcare resulted in Black patients being much sicker than White patients with the same expenditure score. In the researchers’ own words, “The bias arises because the algorithm predicts health care costs rather than illness, but unequal access to care means that we spend less money caring for Black patients than for White patients.”

Bottom Line. Like we said in our previous post, “Garbage in, garbage out!”  

Saving Lives Saves Money

Check this out. What you will see is an interesting, if somewhat odd, computation. As set forth in this working paper, social distancing in the U.S. for 3-4 months would save 1.7 million lives by October 1, 2020. Given the average statistical value of a life, that translates to a positive financial impact of $8 Trillion!!!

Bottom Line. One of the strange impacts of the COVID-19 pandemic has been the myriad strange statistical computations that have been put forth. Frankly, this strikes me as one of the strangest. I am still trying to figure out what I should do with this information, and with the drill down reporting that 90% of these financial benefits “accrue to people age 50 and older.” Where do we go to collect the $8 Trillion?  

Call me crazy but I am guessing that an additional 1.7 million lives being saved, with the vast majority of those being in my advanced age group, is benefit enough without the financial argument layered on top.  

Want to convince people that social distancing is worth practicing? Tell them that it can save their life, not that it saves money!  

No Data vs “Bad” Data

Here’s a multi-layered discussion of the problem with “data” about doctors’ performance. In this case, complications resulting from surgery. The first issue discussed is one we have covered before. Small sample sizes in numbers of procedures, significant differences in the risk patterns of different doctors’ caseloads, etc. BUT. There is another problem. More specifically, the study reported here indicates that the patients who are supposed to benefit from these data by using them to help them to choose surgeons cannot appropriately interpret them. AND. Those patients who could theoretically benefit most by using the data are least able to make appropriate interpretations and are most likely to be swayed by other issues like insurance coverage. Bottom Line. I continue to be amazed that our society increasingly believes that simply blurting out “data” to consumers is going to yield better decision making. I see this magical thinking in articles like this, in DTC advertisement with laundry lists of side effects and warnings, etc. It is a shame that with all of the great work done by Tversky and Kahneman on Behavioral Economics, clearly demonstrating that most decisions are made via short cuts and rules of thumb rather than by well-informed consideration of all of the facts, we continue to hold on to this vision of the rational decision maker.  Get real!!!

Healers vs. Pencil Pushers

Healers Check out this post from the physician/author pictured above. Interesting at a couple of different levels. First, Suneel’s point is clearly that the number of medical administrators in the U.S. is growing much faster than the number of physicians. I’m guessing that this is correct. BUT. I did a double take, and noticed that the ordinate (Y axis) here is in percentages, not in raw numbers. SO. If back in the 1970’s there were very few administrators compared to physicians, OF COURSE their percentage growth will be much higher as both professions grow over the decades. Bottom Line. I often think that in many discussions that matter, percentages are specifically designed to screw with our minds. Tricks like taking a percentage of a percentage. For example, 10% of the population has condition X. That is 10 out of every hundred people. Smoking causes 1 more person in that group of 100 to have that condition. Is that a 1% increase or a 10% increase. The latter interpretation requires you to take a percentage of a percentage. Such thinking can lead us to jump to many bad conclusions. Politicians do things like that all the time!

Evolutionary Medicine

Screen Shot 2017-07-28 at 3.39.39 PM Check out this NYT article. In it, you will see an interesting discussion of “evolutionary medicine.” Huh? Meaning, the study of other cultures, and the history of other cultures, to gain insights as to what “natural” genetic factors and remedies might contribute to diseases and their resolution. In other words, the study of human beings in urban environments in the U.S. and other developed countries doesn’t give us the whole picture. Not by a long shot! Bottom Line. Compared to screening millions of molecules in the laboratory in hopes of finding a cure for such conditions as Alzheimer’s, this cross-cultural research might prove to be very efficient! 

The “LIFE EXTENSION COMMUNITY”

Screen Shot 2017-07-13 at 3.04.42 PM You know. That’s the gang of scientists involved in research that will help us to live longer. Maybe forever. Lots of different approaches being taken here. Sci-fi techniques being funded by Silicon Valley billionaires. Injecting old people with the blood of teenagers. And of course, stem cells. BUT. This article reports on the experimental use of metformin. A classic drug generically available, for life extension. FDA approval and additional funding, as you might imagine, are critical elements of developing this approach that have yet to be assembled. Bottom Line. Fascinating stuff. I remember early work in this area, wherein luminaries like Walt Disney had their corpses frozen so that they would be in good shape (?) when a truly life extending procedure or product is actually developed.  How long will this take? I’m thinking Walt will have to stay frozen for quite a while yet!  

Disclosures!?!?

FDA study Yup! Here comes another FDA study. This one is going to try to determine the extent to which medical professionals are misled by advertisements for oncology drugs, and the impact that various forms of “disclosures” have on doctors’ understanding of the drugs. The description of this study would actually be pretty funny if it weren’t such a silly use of taxpayer money. Let’s see now, which of these questions do we really need research to answer?
  1. Do disclosures mitigate potentially misleading presentations of preliminary or descriptive data in oncology drug product promotion?
  2. Does the language (technical, non-technical) of the disclosure influence the effectiveness of the disclosure?
  3. Does the presence of a general statement about the clinical utility of the data in addition to a specific disclosure influence processing of claims and disclosures?
  4. Do PCPs, oncologists, and mid-level practitioners (nurse practitioners, physician assistants) differ in their processing of claims and disclosures about preliminary or descriptive data?
  5. Which disclosures do physicians prefer?
I am guessing that the answer to number 1 is Yes, if the preliminary or descriptive data were misleading to begin with, and the disclosures are clear and understandable. DUH! As to number 2, samesies. Language that is clear and relevant is the best language to use in a disclosure. Whether clear is “technical” or “non-technical” is in the eye of the beholder. Holy smokes! As I made my way through these questions and potential answers, I realized they were all the same. #4 is admittedly different, but do we really care if PA’s view oncology data the same way Oncologists do? I am guessing that no, they don’t, but we won’t really care until the “mid-level practitioners” start deciding on courses of chemotherapy. Here’s the deal. The prelude to the description of the upcoming study acknowledges that oncology drugs are marketed, and yes, that means the sponsoring company presenting the product in the best possible light. Marketing materials are likely to do that. Other sources of information, like medical journals, peer discussions, etc. exist to balance things out more objectively. It has always been thus. And always will be. Bottom Line. Does anything here really need to be studied? I am going with NO!

Antibiotic Stewardship Works!

NEJM Don’t you just love it when things turn out the way they are supposed to. LIKE. Everybody knows that reserving antibiotic use for cases of actual infections, and then ensuring that patients actually complete the drug regimen, lowers the risk of developing drug-resistant infections. RIGHT???  But has that ever been scientifically demonstrated? Yup! As this piece summarizes, that study has now actually been done. Bottom Line. You are probably all aware of the phrase “demonstrating the obvious.” Sort of a pejorative term. Sounds like a waste of time.  BUT. Maybe things that are “obvious” are exactly what need to be demonstrated! Something is “obvious” if everybody believes it, and if everybody believes it we should damn well make sure it is, in fact, true!  

Real World Applications Of Real World Evidence

Vent Check out this piece! Yes, we all know that Real World Evidence (RWE) has become increasingly important to health insurers and others who have to pay the bills. While academic, double blinds studies are interesting, and are still (appropriately!) the critical path to FDA approval, RWE is now increasingly the yardstick by which decision makers decide if a specific treatment is “worth it.” So what’s the big deal about this little article? Simple. It is a report of a workshop run by InVentiv not for typical healthcare decision makers, but for Investors. Quite simply, whether a company is worth investing in is now not just a matter of whether its therapy will receive FDA approval, but rather is primarily driven by how and where RWE will dictate the product will be used. Bottom Line. Fascinating! Think for a few moments about the preceding paragraph, and the paradigm shift that it represents for health care investors. And realize how much greater rationality and precision this new way of thinking brings to those decision makers!

You Can Look It Up

Seth Godin Yup. Another insightful blog from the treasure trove of Seth Godin. As I always say when I direct you to one of Seth’s posts, you could go to his blog every day and be well served. BUT. Some posts are more important to us than others. Take this one for example. Briefly, Seth uses a few paragraphs to outline the history, and the future, of information searches. First, before writing was invented, was oral history. You couldn’t look things up. With writing came mechanical searches for information. For readers as old as I am, the memory of “card catalogues” in libraries, organized using the Dewey Decimal system, probably makes you shutter as to how laborious such searches were. Funny thing is, with Google (etc.) searches, we now believe that we can look things up with lightning speed. We can, but we have to know what to look up. Bottom Line. As Seth notes, the next step in this progression is already here but, like most of the future, it is not yet widely distributed. In the future, a system will automatically recognize something of import in the information sets it monitors, and spontaneously report it out to those who would be interested. No need to look anything up. Or even to know that you need to look something up.  Think how valuable such a system would be to someone charged with monitoring a particular area of endeavor, such as health care or pharmaceutical marketing.   And think how useless my blog will become when such a system becomes available!!!