“over the past half-century, as was made especially clear by the Covid pandemic, patients have increasingly challenged their physicians’ expertise. Merely providing patients with data and advice has become an inadequate way to disseminate information and promote informed consent. [The author goes on to describe medicine’s historical failures with patients, including Tuskegee, childbirth practices in the 1970s, harvesting cancer cells from Henrietta Lacks, physicians paid by tobacco companies to “manufacture doubt,” the slow response to the AIDS epidemic and 2024 medical article retractions from researchers at the Dana-Farber Cancer Institute.] To some degree, the AIDS model — in which patients … Read More
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“Colonoscopy is the dominant approach to colorectal cancer screening in the United States. Among people who are screened, two thirds get a colonoscopy. This fact is easy to miss in Halpern and colleagues’ 2021 data, which included 9.2 million people reporting colonoscopy and 9.8 million reporting fecal immunochemical testing (FIT). That ambiguity is explained by the distinct screening intervals (every 10 years for colonoscopy and annually for FIT), whereas there is no ambiguity about the difference in the resources required each year: $24 billion for colonoscopy versus $0.6 billion for FIT. Colonoscopy is clearly overused in the United States. It … Read More
Excerpt – Consulting medical teams nearly always follow my antibiotic recommendations, no matter how idiosyncratic they may seem, but recommending that they stop checking white-cell counts on stable inpatients seems to strike them as beyond the pale. Much of this trend is driven, I believe, by the quantitative fallacy: the human tendency to attach too much weight to factors that are easy to measure, and not enough weight to more complex, hard-to-quantify variables. This inclination induces doctors and patients alike to obsess over the crisp, objective, but highly nonspecific assessment of leukocytosis, while eschewing the seemingly squishy but highly informative … Read More
“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
“We used Elevance Health’s in-network pricing data and medical claims data. We focused on in-network prices because these are the prices negotiated by the payer, and out-of-network providers represent a small percentage of use for planned procedures. The formatting of the released data files follows the specifications provided by CMS. We limited our analysis to one state, Colorado, and one month, August 2022, to illustrate the concepts. [..] We split the prices into two components, the professional price and the facility price. Notably, these two components may not be the only costs associated with a procedure as there are often other … Read More
“Introduction Although cancer screening has been shown to reduce cancer-related mortality and morbidity, there is increasing recognition that it can also be harmful and burdensome, especially for older adults. The benefits of cancer screening typically lag by 10 or more years for breast, colorectal, and prostate cancer screenings, whereas the harms and burdens of these screenings—which include complications from screening and follow-up tests, overdiagnosis and overtreatment of clinically unimportant cancers, psychological stress from false-positive results, diverted attention away from other health conditions—occur in the short term. Guidelines recommend against routine cancer screening for older adults for whom the harms outweigh the benefits, … Read More
“A new rulemaking by the Biden administration seeks to lessen the harmful effects of abortion bans by protecting certain health data from being used to prosecute both clinicians and patients. But in the current draft, the rulemaking is designed to reinforce the privacy of reproductive health in states where abortion is legal and does little for those seeking abortion in states where it is illegal. Further, some states, like Idaho, are implementing a law that makes it illegal to travel out of state for an abortion, effectively blocking its citizens from the potential benefits of this rulemaking. The draft Notice of Proposed Rulemaking, titled … Read More
“Transparency has always been seen as a hallmark of honesty and integrity. The logic is familiar: democracies aspire to be transparent, but dictatorships are opaque; faithful spouses are guileless, while philanderers lie; reputable businesses operate in the open, but shady operations literally draw the shades. Collectively, we’ve embraced Louis Brandeis’s dictum that sunlight is the best disinfectant. We demand transparency in government, charitable institutions, nutrition labels, and middle-school grading rubrics. The medical record should be no different. [..] In 2008, Ethan Bernstein, an associate professor at Harvard Business School, travelled with a team of students to a vast mobile-phone-manufacturing plant … Read More
“When Roe v. Wade was decided in 1973, a group of 100 U.S. professors of obstetrics and gynecology predicted that teaching hospitals would emerge as leaders in compassionate abortion care, creating outpatient clinics to meet the demand for legalized abortion. But most hospitals did not embrace abortion provision; many of them in fact adopted policies that were more restrictive than was legally required. Freestanding clinics instead emerged as the primary provider of abortion care, and this siloing was further reinforced by stigma, threats of violence, and the exclusion of abortion coverage by major health care payers. In 2020, hospitals accounted … Read More