“I had to learn over and over again that extreme conviction requires extraordinary evidence, and the evidence we have is usually far from extraordinary. For instance, our frontline anti-depression drugs are supposed to work by changing serotonin levels in the brain, but a review published last year found that there’s no consistent evidence that serotonin has much to do with depression at all. (Maybe that’s why antidepressants don’t seem to work that well, especially in the long term.) It seems obvious that sunscreen should protect you from skin cancer, but a 2018 meta-analysis could not confirm that this is true … Read More
[NYT’s David Wallace-Wells]: [..] The way most people think about a virus like, say, RSV, or chickenpox, is that a single exposure, while potentially worrisome, does deliver lifelong protection. Is it really the case that, as babies, we are fighting off those viruses hundreds of times? [Immunologist and epidemiologist Michael Mina]:The short answer is yeah. We start seeing viruses when we’re 2 months old, when we’re a month old. And a lot of these viruses we’ve seen literally tens, if not hundreds of times for some people by the time we’re adults. People tend to think that immunity is binary … Read More
“Some meatfluencers stress that human beings are animals and maintain that, if allowed to eat according to our animal instincts, we will favor a meaty menu. But the biologists David Raubenheimer and Stephen J. Simpson have been investigating animal alimentation for more than thirty years, and their new book, “Eat Like the Animals,” suggests that the meatfluencers have it all wrong. The authors started collaborating at Oxford, studying the eating preferences of locusts (grasshoppers, basically). First, they found that locusts preferred a certain ratio of carbohydrates to protein. When forced to live on foods higher in carbs and lower in … Read More
“Recently, the U.S. Preventive Services Task Force (USPSTF) changed its recommendation for the starting age for mammography screening from 50 to 40 years. Previously, the Task Force deemed screening in 40-to-50-year-old women a personal choice. Because USPSTF recommendations are so influential, mammography screening for women in their 40s will probably become a health care performance measure; if so, it will effectively become a public health imperative with which primary care practitioners must comply. Such a change will affect more than 20 million U.S. women, and it raises some important questions. First, is there new evidence that mortality from breast cancer … Read More
“Analyzing the nature of misdiagnoses also provides significant opportunities for solutions: The errors are many, but they are quite concentrated. According to the study, 15 diseases account for about half the misdiagnoses, and five diseases alone — stroke, sepsis, pneumonia, venous thromboembolism, and lung cancer — caused 300,000 serious harms, or almost 40% of the total, because clinicians failed to identify them in patients. “That’s a lot that you could accomplish if you cut those harms by 50% for just those five diseases — that would be 150,000 prevented serious permanent disabilities or death,” said [lead author of the BMJ … Read More
“Over the years, medical schools have made some progress in diversifying their student bodies, with numbers ticking up. But just like undergraduate admissions, wealth and connections continue to play a determining role in who is accepted. More than half of medical students come from families in the top 20 percent of income, while only 4 percent come from those in the bottom 20 percent, according to data from the Association of American Medical Colleges. There is also a family dynamic. Children of doctors are 24 times more likely to become doctors than their peers, according to the American Medical Association. … Read More
Excerpt – “Crisis,” “collapse,” “catastrophe” — these are common descriptors from recent headlines about the National Health Service (NHS) in the United Kingdom. In 2022, the NHS was supposed to begin its recovery from being perceived as a Covid-and-emergencies-only service during parts of 2020 and 2021. [..] In the background of this acute [COVID] crisis, waiting lists for specialist consultation have been growing and now exceed 7 million patients (in a country of 66 million people), up from 4.4 million before the pandemic. There is substantial consensus about the causes of these crises, though different experts weight the contributory factors … Read More
“Since the early 2000s, hospitals have been developing metrics to define high-quality care. In addition to readmission rates and the incidence of various iatrogenic infections, reducing hospital length of stay has been a popular target. Most people prefer nonhospital days to hospitalized days, and insofar as effective treatments hasten the return to health, it seems plausible to assume that shorter stays correlate with effective stays. As an ancillary benefit, shorter stays may cost less and increase “throughput,” resulting in more revenue for hospitals. Because tallying the length of stay is easier than quantifying high-quality care for heterogeneous “hospital problems,” patients … Read More
“The Medicare Physician Fee Schedule (MPFS) directly determines nearly $200 billion in Medicare spending and indirectly affects an additional $600 billion or more in payments to physicians by other payers. Yet the fee schedule has widely recognized flaws: paying whether the service rendered is medically necessary, is performed efficiently, or meets acceptable quality standards. At its core, clinician fee schedules attempt to pay for clinicians’ time and effort, not whether the care maintains or improves patients’ health. Many hoped that value-based payment models would make MPFS flaws moot. Paradoxically, virtually all the alternative payment models that the Centers for Medicare … Read More
“In 2012, Scott Zeller, who was then the head of psychiatric emergency services at the Alameda Health System, in Oakland, California, was growing frustrated with the status quo. Many observers blamed long wait times for psychiatric patients on a sharp decline in the number of psychiatric beds in public hospitals. Zeller thought they were missing a more fundamental point. “Why is mental illness the only emergency where the treatment plan is, Let’s find them a bed somewhere?” Zeller asked. “If someone comes in with an asthma attack, we don’t say, ‘We’ve got a gurney here in the back for you. … Read More