Medicine

This passage is from Gao Wenqian’s Zhou Enlai: The Last Perfect Revolutionary:

Doctors in China could not conduct major medical procedures on top leaders without the approval of the Politburo Standing Committee.  Such was the long-standing rule.  Thus, in 1975, Deng Ziaoping and Marshal Ye Jianying, leaders among the old CCP cadres who had generally despised the Cultural Revolution and had shown little enthusiasm for the political style of the mercurial Jiang Qing, now had to negotiate emergency surgery for Zhou Enlai with her allies Wang Hongwen and Zhang Chunqiao.  For once, these tough political adversaries managed to see eye-to-eye.  They all gave their consent to surgery and sent their decision to Mao, who always had the final say.

Zhou Enlai had four operations before dying of cancer.  For the last two operations, however, Mao instructed the doctors to tell Zhou that in fact he was being cured and the tumors were removed.  He ceased to believe that when the unbearable pain arrived.

Is it up to three cynical tapes about Obamacare now?   I’ve lost track.

I’m not so interested in pushing through the mud on this one.  It’s a healthy world where academics can speak their minds at conferences and the like without their words becoming political weapons in a bigger fight.  Or how about blogs?: do we want a world where no former advisor can write honestly about the policies of an administration?  I’ve disagreed with Gruber from the beginning on health care policy and I thought his ObamaCare comic book did the economics profession — and himself — a disservice.  But I’m simply not very interested in his proclamations on tape, which as far as I can tell are mostly correct albeit overly cynical.  (If anything he is overrating the American voter — most people weren’t even paying close enough attention to be tricked.)  Criticisms of Gruber are not criticisms of a policy, and it is policy we should focus upon and indeed there is still a great deal of health care policy we need to figure out.  It’s hardly news that intellectuals who hold political power, even as advisors, very often do not speak the truth.  If anything, I feel sorry for Gruber that he has subsequently felt the need to so overcompensate by actively voicing such ex post cynicism, it is perhaps the sign of a soul not at rest.

In the meantime, I’d like to see more open discourse, not less.  Perhaps we should subsidize people who end up looking foolish, rather than taxing them.

Scott Sumner directs us to this passage from Michele Martinez Campbell:

A fascinating new national poll from Quinnipiac University shows that men and women disagree markedly on the question of marijuana legalization.  While men surveyed strongly favor legalization by a margin of 59 to 36 percent, women oppose it by a clear majority of 52-44 percent.  This 15-point gender gap in support for marijuana legalization –let’s call it the “pot gender gap” — is not quite as large as the 20-point gender gap in support for President Obama in the 2012 presidential election, but it is striking.  What’s most interesting, though, is how it confounds the expectations set by the voting gender gap.  In voting, women trend more liberal and Democratic, while men trend more conservative and Republican.  Yet with the pot gender gap, we see women taking the more conservative, law-and-order approach.

The article is here, Scott’s post, with commentary, is here.

Here is the new paper by Michael Reay in Social Forces:

Analyses of the multiple cognitive structures and social effects of humor seldom look at why these tend to center on particular topics. The puzzle of how humor can be highly varied yet somehow constrained by its source “material” is explored using a corpus of over 600 incidents, not of deliberate jokes, but of the “wilder,” unplanned laughter that occurred during a set of interviews with economists—professionals who at the time (1999–2000) enjoyed an unprecedented degree of status and influence. The analysis finds that the source material for this laughter typically involved three kinds of socially structured contradiction: between ideals and reality, between different socially situated viewpoints, and between experiences occurring at different times. This illustrates how particular kinds of content can have a special laughter-inducing potential, and it suggests that wild laughter may at root be an interactional mechanism for dealing with social incongruity—even for members of relatively powerful groups. It is argued that this could not only help solve the larger puzzle of simultaneous variety and constraint in deliberate comedy, but also explain why the characteristic structures of humor are associated with a particular range of social effects in the first place.

Reading that abstract caused me to engage in some unplanned (silent) laughter.

For the pointer I thank the excellent Kevin Lewis.

From Diana Carew at the Progressive Policy Institute:

…the number of ‘restrictions’ on drug companies increased by 767, or 40% since 2000. This represents a substantial rise in the overall regulatory burden of pharmaceutical companies, which must allocate resources to ensure regulatory compliance. The word “restriction” refers to command clauses such as “shall” and “must,” as contained in sections of the Code of Federal Regulations related to the FDA.

The full study is here (pdf).

I don’t myself care about the event, I just liked the headline.

A related study is here, and I thank CK for the pointer.

Sentences to ponder

by on October 30, 2014 at 7:28 am in Current Affairs, Medicine | Permalink

Here is Jody Lanard and Peter M. Sandman on the risks of an Ebola pandemic in the developing world:

The two of us are far less worried about sparks landing in Chicago or London than in Mumbai or Karachi.

Do read the whole thing, via Andrea Castillo.

Loren Adler and Adam Rosenberg report:

…the disproportionate role played by prescription drug spending (or Part D) has seemingly escaped notice. Despite constituting barely more than 10 percent of Medicare spending, our analysis shows that Part D has accounted for over 60 percent of the slowdown in Medicare benefits since 2011 (beyond the sequestration contained in the 2011 Budget Control Act).

Through April of this year, the last time the Congressional Budget Office (CBO) released detailed estimates of Medicare spending, CBO has lowered its projections of total spending on Medicare benefits from 2012 through 2021 by $370 billion, excluding sequestration savings. The $225 billion of that decline accounted for by Part D represents an astounding 24 percent of Part D spending. (By starting in 2011, this analysis excludes the direct impact of various spending reductions in the Affordable Care Act (ACA), although it could still reflect some ACA savings to the extent that the Medicare reforms have controlled costs better than originally anticipated.) Additionally, sequestration is responsible for $75 billion of reduced spending, and increased recoveries of improper payments amount to $85 billion, bringing the total ten-year Medicare savings to $530 billion.

The full piece is here, via Arnold Kling.

Ebola plush toys have been selling so fast in response to this year’s outbreak that a Connecticut manufacturer, Giantmicrobes Inc., can’t keep them in stock.

The company, which was founded a decade ago, makes stuffed toys based on the appearance of microbes like Ebola, Chicken pox, bed bugs, and even non-harmful microscopic organisms things like brain and red blood cells.

The items are meant to be educational tools for young children, Laura Sullivan, vice president of operations, told CBS News.

There is more here, and for the pointer I thank James Lynch.  Via Tim Harford, here is GiveWell on whether you should donate to Ebola response causes.  Here is how Nigeria and Senegal beat back Ebola, let’s hope we can do the same.  It is a good example of how developing economies can innovate based on cheap labor costs and lots of available labor resources.

Hi future, competency-based learning

by on October 21, 2014 at 9:40 am in Education, Medicine | Permalink

From Inside Higher Ed:

The University of Michigan’s regional accreditor has signed off on a new competency-based degree that does not rely on the credit-hour standard, the university said last week. The Higher Learning Commission of the North Central Association of Colleges and Schools gave a green light to the proposed master’s of health professions education, which the university’s medical school will offer. In its application to the regional accreditor, the university said the program “targets full-time practicing health professionals in the health professions of medicine, nursing, dentistry, pharmacy and social work.”

The link is here, via Phil Hill.

The Ebola risk premium

by on October 19, 2014 at 1:48 am in Current Affairs, Economics, Law, Medicine | Permalink

Underpaid or overpaid?:

They’re looking for the few, the proud — and the really desperate.

For a measly $19 an hour, a government contractor is offering applicants the opportunity to get up close and personal with potential Ebola patients at JFK Airport — including taking their temperatures.

Angel Staffing Inc. is hiring brave souls with basic EMT or paramedic training to assist Customs and Border Protection officers and the Centers for Disease Control and Prevention in identifying possible victims at Terminal 4, where amped-up Ebola screening started on Saturday.

EMTs will earn just $19 an hour, while paramedics will pocket $29. Everyone must be registered with the National Registry of Emergency Medical Technicians.

The medical staffing agency is also selecting screeners to work at Washington Dulles, Newark Liberty, Chicago O’Hare and Hartsfield-Jackson Atlanta international airports.

There is more here, via Matthew E. Kahn.  How much does the regular (non-Ebola) staff earn?

Terrence McCoy reports:

Schultz wants $150,000 for Ebola.com — a price he thinks is more than reasonable. “According to our site meter, we’re already doing 5,000 page views per day just by people typing in Ebola.com to see what’s there,” said Schultz, who monitors headlines the way brokers watch their portfolios, to gauge his domain’s worth. “We’re getting inquiries every day about the sale of it. I have a lot of experience in this sort of domain business, and my sense is that $150,000 is reasonable.”

The full story is here, and for the pointer I thank Michael Rosenwald.

Neil Cummins has a new paper of interest, the abstract is this:

I analyze the age at death of 121,524 European nobles from 800 to 1800. Longevity began increasing long before 1800 and the Industrial Revolution, with marked increases around 1400 and again around 1650. Declines in violence contributed to some of this increase, but the majority must reflect other changes in individual behavior. The areas of North-West Europe which later witnessed the Industrial Revolution achieved greater longevity than the rest of Europe even by 1000 AD. The data suggest that the ‘Rise of the West’ originates before the Black Death.

For the pointer I thank the excellent Kevin Lewis.

IBM on Tuesday revealed details of how several customers are putting Watson to work, showing that cognitive computing has garnered at least an initial interest among different sorts of businesses. Naming customers also helps other businesses feel more at ease about trying the new technology.

In Australia, the ANZ bank will allow its financial planners to use the Watson Engagement Advisor to help answer customer questions. The idea is that the bank can then better understand what questions are being asked, so they can be answered more quickly.

Also in Australia, Deakin University will use Watson to answer questions from the school’s 50,000 students, by way of Web and mobile interfaces. The questions might include queries about campus activities or where a particular building is located. The service will be drawn from a vast repository of school materials, such as presentations, brochures and online materials.

In Thailand, the Bumrungrad International Hospital will use a Watson service to let its doctors plan the most effective treatments for each cancer patient, based on the patient’s profile as well as on published research. The hospital will leverage research work IBM did with the Memorial Sloan Kettering Cancer Center to customize Watson for oncology research.

In Cape Town, South Africa, Metropolitan Health medical insurance company will be using Watson to help provide medical advice for the company’s 3 million customers.

Watson is also being used by IBM partners and startups as the basis for new services.

Using Watson, Travelocity co-founder Terry Jones has launched a new service called WayBlazer, which can offer travel advice via a natural language interface. The Austin Convention and Visitors Bureau is testing the WayBlazer app to see if it can increase convention and hotel bookings.

Veterinarian service provider LifeLearn of Guelph, Canada, is using Watson as the basis of a new mobile app called LifeLearn Sofie, which provides a way for animal doctors to research different treatment options. The Animal Medical Center in New York is currently testing that app.

Watson is also being incorporated into other third-party apps serving retailers, IT security and help desk managers, nonprofit fund-raisers, and the health care industry.

There is more information here.

Average is Over: Physicians

by on October 6, 2014 at 11:18 am in Economics, Medicine | Permalink

Important new research from Fletcher, Horwitz and Bradley:

Like teacher value added measures that calculate student test score gains, we estimate physician value added based on changes in health status during the course of a hospitalization. We then tie our measures of physician value added to patient outcomes, including length of hospital stay, total charges, health status at discharge, and readmission. The estimated value added varied substantially across physicians and was highly stable for individual physicians. Patients of physicians in the 75th versus 25th percentile of value added had, on average, shorter length of stay (4.76 vs 5.08 days), lower total costs ($17,811 vs $19,822) and higher discharge health status (8% of a standard deviation). Our findings provide evidence to support a new method of determining physician value added in the context of inpatient care that could have wide applicability across health care setting and in estimating value added of other health care providers (nurses, staff, etc).

As with teacher value-added measures, which I strongly support, the gain here is not simply that we discover who the best teachers and physicians are it’s that by discovering who the best teachers and physicians are we can discover why they are the best–what techniques are they using that others are not? And from there we can begin to scale and apply those techniques more widely.