Vol. 111 April 15, 2014 Who’s On First?

In current events, government, health care reform, humor, medical economics, politics on April 15, 2014 at 11:55 AM


Washington – April 10, 2014
“A welcome relief from rising health care cost for U.S. consumers is being less warmly received by the Federal Reserve.”

Mr. Abbott, a Washington economist, is heard explaining it to Dr. Costello, a physician.

A: The cost of health care services rose just 0.8% this year.
C: That’s good news. We all have been working hard to reduce costs,what with meaningful use, and evidence-based medicine, and transparent patient portals. It’s hard work.
A: Its not good news.
C: What?
A: Health care sevice prices are down from its 10 year average of 2.6% increase.
C: That’s really good.
A: No,its not.
C: Why?
A: It’s a sign of persistent deflation.
C: Aren’t we afraid of inflation?
A: Not now.
C: What?
A: Their current goal is 2% inflation.
C: Whose?
A: The Federal Reserve.
C: Who?
A: They measure the economy.
C: How?
A: Using the Personal Consumption Expenditures or PCE.
C: What?
A: LIke the Consumer Price Index, the PCE measures what people spend on things.
C: Why?
A: People spending more money on things means the economy is growing stronger.
C: Who says?
A: Mr. Bush. Remember, he asked us all to go shopping to get out of the recession.
C: Where?
A: In America, of course.
C: What do health care services have to do with the mall?
A: Health care services make up 25% of the prices measured by the PCE.
C: So what.
A: Physician fees went up only 0.2%, down from 1.6% in 2012.
C: THAT’S not good for me!
A: No, its not.
C: What!?
A: Nursing home prices went up only 0.3% rather than the 1.8% rise of two years ago.
C: I know, I know. That sounds good but its not?
A: Right!
C: Why?
A: If health care prices don’t go up, the PCE doesn’t go up, and our economy looks stagnant.
C: Oh, boy! I think I got it. If all the efforts to reduce health care costs succeed, the PCE will not rise, inflation will be less than 2% a year, deflation will persist, and the Federal Reserve will label the economy as stagnant.
A: Now you’ve got it!
C: What about the impact of the Affordable Care Act?
A: Economists agree that the impact of Obamacare is not yet clear.
C: Oh boy!
A: Any questions?
C: Just one.
A: What?
C: Who’s on first? 

Vol. 110 April 1, 2014 PUTINCARE UNVEILED

In April Fools Issue, current events, government, health care reform, humor, politics on April 1, 2014 at 12:05 AM


Putin on horseback  PUTIИCAЯE UNVEILED

Vladimir Putin, President of the Russian Federation, today unveiled his country’s plan for universal medical care, the Accessible Care Act (ACA) or Putincare. The act was passed by a unanimous vote in both the Upper and Lower Houses, “an easy task of collective wisdom once we eliminated the ‘individual mandate’ clause.” Mr. Putin remarked that he had hoped to make the announcement while on the crest of success of the Sochi Olympics, but that the unexpected expression of states’ rights in the Ukraine distracted him. “I understand”, Mr. Putin went on to say, “that Mr. Obama sometimes has his own problems with state’s rights, but our Georgia is not like his Georgia”.

Putincare will establish medical care Exchanges in all states belonging to the Russian Federation. Every citizen (Yes, EVERY citizen. After all, the number of immigrants into Russia is not an issue.) will be able to bring in pigs, or chickens, or even potatoes and exchange them for medical care. Each Exchange will set its own eligibility criteria and rates. For example, in Georgia one pig could be exchanged for a throat culture and ten days of penicillin while in Moscow the same would cost one pig PLUS the names of two suspicious neighbors. The urban-based social networks, like “2Facebook”, will encourage this.

Full implementation of Putincare will depend on increasing the number of doctors and nurses in Russia since many towns have none. Despite the concerns expressed by the BAR Association (Babushka Assistants of Russia) that new doctors and nurses will compete unfairly with their services, Putincare calls for the immediate recruiting of as many Indian and Pakistani providers as possible. “It seems to have worked for Britain and America.” Mr. Putin expressed great confidence in their ability to avoid some of the early problems experienced by Obamacare. “Our computer expert, Mr. Snowden, assures us that we will have no problems. Of course, if he is wrong, he will return to America sooner rather than later.”

Putincare, like Obamacare, will not cost any additional money. The medical care provided through the Exchanges will get sick people better and reduce the work days lost due to death. The plan will increase revenue as a result of more pigs, chickens, and even potatoes… not to mention the increased number of State enemies identified in Moscow alone. As proof of the need for this program State spokesmen confirmed reports that one of the Exchanges had collapsed under the weight of 200 pigs. “We were expecting about 25 an hour the first day and so had a floor that could support 100 an hour, but the sudden traffic just overwhelmed us, and we crashed.”

Implementation of the requirement for small business to participate in the Exchanges has been postponed because of unfamiliarity with the term “small business”, some concerns about “creeping capitalism” which would enrich the Exchanges, and the cessation of operations in Russia by Visa and Master Charge brought on by U.S. sanctions. Most of Putin’s close associates were unavailable for comment, being occupied in trying to recover their own frozen assets.

Mrs. Putin, who rarely makes public appearances, will be launching a Russia-wide children’s education effort to support this plan; SISCAK, “Stay In School, the Chinese Are Coming” (rough translation).

Foreign critics of Putincare dismissed this announcement as an obvious attempt to deflect international attention away from the Ukraine. If you read the plan carefully, and we’re not certain anyone has, you will see that there is no Exchange designated for the Crimea. “Federal Russia will provide.”

Donald Berwick, MD, failed-appointee for Chief of Obamacare in America, commented, “Russia needs to improve its cost/quality ratios a great deal. Putincare is a step in the right direction, but I am not certain that even Mother Russia is ready for a Health Czar.”

Several courageous  Soviet scientists introduced a sense of urgency to the discussion, “Because of the current state of the world we should not delay. The Siberian permafrost is already getting squishy, … and the Chinese are coming.”

Putin officially ended the press conference with, “We are confident that all the States and Provinces in the Russian Federation will embrace and implement this plan, …and also visit Sochi to help us pay for it. If they do not, the army will march.”  Putin’s exit words, whispered aside, were unintentionally recorded, rebroadcast on both The Daily Show and The Colbert Report, and immediately went viral;  “Eat your heart out Barrack!






Vol. 109 March 15, 2014 “Misfearing” – Misperceptions of Health (and Other) Risks

In current events, drugs, evidence-based medicine, Pediatrics on March 15, 2014 at 9:45 PM


“Heart Attack Three Times as Likely With Drug A.”

We are all familiar with headlines like this, sometimes not as dramatic, but still attention-getting. It’s enough “to strike fear into your heart”.  As we read on we see the actual numbers, often buried more than half way through,  “ 1000 patients were given drug A and 3 of them had a heart attack. 1000 similar patients were not given the drug and only 1 of them had a heart attack.” 3 is 300% more than 1, but look how low the risk is: an increase from 0.1% to 0.3% risk invokes a lot less fear. By reporting the relative risk percentages rather than the absolute risk percentages the article nurtures “misfear” ; instinctive fear rather than factual fear.

When women are asked what they think the number one killer of women is, most respond, “breast cancer”.  The correct answer is “heart disease”. Clearly women fear breast cancer more than they fear heart attacks.

Which is a greater danger to a child, a gun in the house or a swimming pool?
Each year in the U.S. one child is killed by a gun for every 1,000,000 gun owners. One child drowns for every 11,000 residential swimming pools. Residential swimming pools are much more dangerous to children, but they won’t get the headlines until perhaps a whole birthday party drowns in one. It is less expensive to take steps at home to safeguard guns than it is to build a fence and install alarms around a swimming pool.This raises the issue of cost-benefit analysis in risk assessment. Does the cost of prevention efforts result in a significant benefit? Do we spend a lot of money to try to reduce small risks and little or nothing to reduce big risks? (2)

Sex Offenders
Our current policy of publicly identifying names and addresses of past sex offenders is based on two specific cases (3): an 11-year-old boy kidnapped by a masked gunman in 1989 and never found and Megan, a seven-year old raped and killed by a neighbor in 1994.  “Megan’s Law”  requiring states to publish personal information about sex offenders was passed by Congress in hopes of helping people to protect their children and prevent such crimes. Unfortunately that has not been the result. Two 2008 studies found no decrease in such crime rates and concluded that public notifications “tell the public nothing about the actual risks of a sex crime.” The resulting “misfear” may lead to all sorts of school bus stop, day care drop-off, shopping mall, etc. regulations which may do nothing to reduce risks. In addition such notification may be harmful by making it harder for the “ex-con” to reintegrate into society, find a job, and avoid harassment of fearful neighbors.  In my town such a discharged sex offender killed an adult neighbor with a baseball bat during an afternoon argument on the neighborhood street. As the story unfolded, the dead victim, who had no young children, was described as the only neighbor that had not accepted the presence of the discharged and publicly identified offender, and who was reported to have repeatedly disparage and verbally harass him.

“One in 7 Young People Solicited For Sex Online” is enough to start a moral panic about the internet. The actual report that on which this headline was stated that nearly all of the solicitations were from teens’ peers and other young adults, and that most teens did not find such encounters as upsetting. (4) “Misfear” has led to numerous attempts to regulate the internet “to control sexual predators” rather than fund programs to help vulnerable youth. Statistically such sexual victimization is more likely to occur through school or church participation than through the internet.  One expert decries the blooming of this “misfear” into a general distrust of adult strangers which can blunt “the teenager’s exploration and learning of the world.”

Examples of past “misfears” include - (5)
Elevator Sickness (1892): Scientific American reported that the new 600 feet per minute elevators (that made skyscrapers possible)  could cause “dizziness, irregular sleep, a constant desire to void, and motion sickness” through the herky-jerky motion of internal organs. The elevator was also feared as a spreader of contagious disease through shared conveyances, the originator of the concept of claustrophobia, and  a source of psychological stress about new kinds of “stranger etiquette”. (6)

Bicycle Face (1890): “Nearly all bicyclists have an expression either anxious, irritable, or at best stony… due to the nervous strain of balancing on two wheels.” Now “joggers face” is something I can believe in. I have never seen a jogger with a smile on their face.

Television Neck and Legs (1950): ‘ Viewing your favorite shows too intently could permanently limit the range of motion of your head.”  The AMA warned teens not to sit too long watching TV lest they develop “lack of flexibility” below the waist. That “misfear” of “lack of flexibility” has been translated by modern statistical research into the real fear of childhood obesity.

Examples of present “misfears” include:
Drinking bottled water: More than half of the parents studied chose bottled water for their children believing it was safer, cleaner, and more convenient than tap water. Several other studies have shown that except for increased convenience, those reasons are not true. Besides noting that the average cost of $23 a month for the bottled water, public health experts decry its use because of its lack of fluoride to improve pediatric oral health. (7)

Lice: The launching of the “Lice Protocol” by schools and day care centers currently rivals the launching of the “Concussion Protocol” and the“Bullying Protocol” in terms of drama and “misfear”-mongering. Lice do not cause any disease, hardly ever cause any symptoms except some mild itching, are spread only by direct contact, but are the subject of wide-spread fears and treatments. Such “misfear”, perhaps bolstered by the yuck factor, has spurred development of $200 per visit home delousing services (NitWits, Lice Aunties, Desperate Lousewives) (8)  The Academy of Pediatrics recommendations state,  “Head lice are the cause of much embarrassment and misunderstanding, many unnecessary days lost from school and work, and millions of dollars spent on remedies. Because of the lack of evidence of efficacy, classroom or school-wide screening should be strongly discouraged. No healthy child should be excluded from or allowed to miss school time because of head lice. “No nit” policies for return to school should be discouraged.” 

Wind Turbine Syndrome: Much too long and complicated a subject for this brief blog. Maybe in the near future, if it turns out to be the result of “infrasound” rather than going the way of elevator sickness.

1. “Misfearing”,NEnglJMed 370;7 Feb. 13, 2014, p.595, Lisa Rosenbaum, MD
2.  “Avoiding the Cost of Needless Fear,” BosGlobe Ma.r 6 2014, pg. K6, Cass Sunstein, Prof. Harvard law School)
3.  “Follow Evidence, Not Gut Feeling, on Sex Offenders”, BosGlobe August 28, 2011, Gareth Cook, p. K9
4. “Parents, Forget the Online Bogeyman”,Bos Globe Mar 9. 2014, pg.K10, David Finkelhor at the Crimes Against Children Research Center.
“Its Complicated: The Social Lives of Networked Teens.”, Danah Boyd, Microsoft Research, in press
5. Bos Globe Feb. 19, 2012, p.K12
6. Bos Globe March 2, 201, p.K1, Leon Neyfakh, Daniel Levinson Wilk, Assoc Prof of History at Fashion Institute of Technology, NY.
7. ArchPediatrAdolesc Med 2011 Jun 6
8. “Cleaning Up With Lice Treatments”,Bos Globe May 27, 2011, p. B5, Jenifer McKim

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