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Life before Anesthesia


EMO ether inhaler and Oxford inflating bellows

This is how Fanny Burney described the mastectomy she received in 1811, a long time before effective anesthesia was available:

I mounted, therefore, unbidden, the bed stead. When the dreadful steel was plunged into the breast – cutting through veins – arteries ––flesh – nerves – I needed no injunctions not to restrain my cries… O heaven! – I then felt the knife rattling against the breast bone – scraping it!

If I had read that paragraph to my wife, she would respond by saying: “How do you think listening to that paragraph improved my day?” A fair point, no doubt. I guess I can only hope that sometimes remembering how bad things were helps us appreciate how good they are now.

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Posted in Miscellaneous | Tagged

Have I Officially Become an Economist Now?

In a recent Huffington Post article, I was described as a Duke University economist. I’m sure the economic community would like to make very clear that I am not one of its members. The same goes for most communities, as far as I can tell.

Nevertheless, despite that glaring error, much of the content of that Huff Po piece was pretty good. It talks about some myths regarding happiness and aging. I thought I’d share the beginning of that article with you, so you can decide whether you want to peruse it any further.

“In the game of life, is it all downhill as young adulthood turns into maturity? Our culture of youth obsession and celebration of the college years and 20s as the golden years of one’s life has led many of us to believe that our happiness declines as we age. Some (rather depressing) research has found that 80 percent of life’s defining moments occur by the age of 35 — suggesting that there may not be much to look forward to in the second half of life.

But this couldn’t be further from the truth. The concentration of life’s major events in adolescence and early adulthood may not be anything to feel discouraged about — and it certainly doesn’t mean that happiness and life satisfaction decline as we get older. In fact, a growing body of research has proven that we’re wrong to think that happiness is correlated with youth. A wealth of scientific and anecdotal evidence demonstrates precisely that it’s when people have surpassed many of life’s big landmarks that their overall satisfaction and happiness peaks”...Read more at HuffPo

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Look How Much Medicare Spends after Patients Leave the Hospital

As readers of this blog know, Medicare costs loom large in our nation’s future. If we do not find a way to control Medicare spending, it’s hard to imagine any way to remain a solvent nation. As we continue to explore ways of controlling these costs, it is important to remember that a great deal of Medicare spending occurs after people leave the hospital. Consider this picture, reproduced from a February article in the New England Journal of Medicine.


(Note: COPD is emphysema.)

One reason that post-acute care is so expensive, of course, is that Medicare has put so much pressure on hospitals to hold on their expenses. As students in my health policy class get sick of hearing: “if you squeeze the balloon in one location, it just expands in another.” That’s why I expect to see lots more efforts to “bundle” medical payments, so that when a person gets admitted to the hospital with emphysema, the hospital – actually healthcare system that the hospital is part of – gets money to take care of that patient for the next, say, six or eight weeks. That gives the healthcare providers an incentive to provide the best possible care, in the most efficient manner. If it means an extra day in the hospital will reduce a lot of post-hospital spending, so be it.

I wonder if growing up in Minnesota is what has made me such a fan of bundling up!

Posted in Health Policy | Tagged ,

On Parenting Adam Lanza, the Sandy Hook Shooter


Andrew Solomon wrote a wonderful article in the New Yorker recently about Adam Lanza’s father and his search for answers to his son’s awful behavior. The piece included a quote I thought I would share with you today:

All parenting involves choosing between the day (why have another argument at dinner?) and the years (the child must learn to eat vegetables).

As a parent of two teenage boys who do not like vegetables or homework, I can totally relate to this idea.

Posted in Miscellaneous | Tagged

Want More Proof That Correlation Is Overrated?


And if that isn’t good enough?

fig2 _2ping

End of topic!

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Posted in Medical Decision Making, Uncategorized

Has Obamacare Made Restaurants Partisan?

Politics in the US is discouragingly partisan. National politics has become increasingly partisan since at least the late ’60s, when the passage of civil rights legislation influenced many conservative southern Democrats to join the Republican Party. Even state politics has become more partisan, where even famously nice people in Wisconsin have found themselves battling their neighbors across political divisions. Fortunately, most of life does not force us to confront our political differences, meaning we can go out to dinner with our family and friends, sharing space with other diners free from concern that we will be confronted with partisan rhetoric.

Until now.

According to a report on CNN Money, some restaurants in Florida are now making sure their patrons recognize the burdens being placed upon them by the Affordable Care Act. Here’s a copy of a receipt from one of these restaurants…(Read more and view comments at Forbes)

Posted in Behavioral Economics and Public Policy, Political Psychology | Tagged ,


I recently reread a very informative New Yorker article by Ryan Lizza, called the Obama memos. I have assigned the article to my undergraduate health policy class, to help them understand the political climate surrounding the passage of The Affordable Care Act. And that climate was one of severe polarization, which cut against Obama’s naïve desire for a post-partisan presidency. Here is a quote from the article, that highlights this polarization:

According to the political scientists Keith T. Poole and Howard Rosenthal, who have devised a widely used system to measure the ideology of members of Congress, when Obama took office there was no ideological overlap between the two parties. In the House, the most conservative Democrat, Bobby Bright, of Alabama, was farther to the left than the most liberal Republican, Joseph Cao, of Louisiana. The same was true in the Senate, where the most conservative Democrat, Ben Nelson, of Nebraska, was farther to the left than the most liberal Republican, Olympia Snowe, of Maine.

And here is a picture that illustrates this level of polarization:


Not surprising that Obama’s politically moderate health reform plan has now been characterized by Republicans as a socialist government takeover of our healthcare system. The middle is a very difficult place for politicians to work in, these days, a fact that makes political moderates like me nostalgic for, of all things, the 1980s.

Minus the big hair and shoulder pads, of course.

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Posted in Health Policy, Political Psychology | Tagged

Calorie Counts on… Stairs? Interesting Nudge

Just came across an interesting way to try to motivate people to exert themselves: post calories-burned-counts on the stairs.

Would that work for you?  For me, it would probably make me look down while walking up, only to trip, fall backwards, crack my head, all the while asking myself: “What the heck is a kcal anyway?”

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Posted in Behavioral Economics and Public Policy | Tagged ,

A Reminder That Correlation Does Not Equal Causation

I think this picture just about covers it:


Posted in Uncategorized

When Physicians Pay Attentions to Costs, They Promote Public Health!

This week, my good friend Reshma Jagsi and I published an article in the New England Journal of Medicine, in which we explain why physicians are doing their job, as physicians, when they pay attention to healthcare costs. Here is a snippet from that article, and a link to find the full version.

Health care costs are straining budgets throughout the developed world, threatening the fiscal solvency of governments, employers, and individuals. Many countries are trying to restrain health care spending through top-down approaches, such as price regulation and even refusal to reimburse for interventions that are not cost-effective. Still controversial is the role that physicians should play in controlling health care costs. For instance, the Choosing Wisely campaign of the American Board of Internal Medicine Foundation encourages physicians to avoid interventions that “may be unnecessary, and in some instances can cause harm,” but it does not ask physicians to contemplate trading off small clinical benefits for individual patients in order to promote more general societal welfare.

Yet concern for societal interests has long been recognized as part of physicians’ duties. Physicians’ specialized knowledge and skills result from publicly funded graduate medical education and the hands-on learning afforded to them by patients who allow trainees to participate in their care. In turn, physicians gain an obligation, as members of a uniquely privileged profession, to serve not only their individual patients but also society.

Consider the campaign launched by the Centers for Disease Control and Prevention to promote “antibiotic stewardship.” The campaign recognizes that aggressive use of antibiotics in patients who are unlikely to benefit from their use promotes the development of antibiotic resistance, a serious public health problem. Thus, a physician who believes that an individual patient has only a small chance of benefiting from an antibiotic might choose not to prescribe one, out of a desire to forestall resistance in the population at large. Such societal stewardship involves forgoing a small, or even uncertain, benefit for an individual patient in order to promote the health and well-being of the general population.

 Click here to read the full article 

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Posted in Health Policy | Tagged ,