Tag Archives: health care

April 2017 in Review

Most frightening stories:

Most hopeful stories:

Most interesting stories, that were not particularly frightening or hopeful, or perhaps were a mixture of both:

  • I first heard of David Fleming, who wrote a “dictionary” that provides “deft and original analysis of how our present market-based economy is destroying the very foundations―ecological, economic, and cultural― on which it depends, and his core focus: a compelling, grounded vision for a cohesive society that might weather the consequences.”
  • Judges are relying on algorithms to inform probation, parole, and sentencing decisions.
  • I finished reading Rainbow’s End, a fantastic Vernor Vinge novel about augmented reality in the near future, among other things.

An American Sickness

The New York Times has a review of a new book called An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. Here’s an excerpt from the review:

Rosenthal thinks the health care market is different, and she sums up these differences as the “economic rules of the dysfunctional medical market.” There are 10 — some obvious (No. 9: “There’s money to be made in billing for anything and everything”); some humorous (No. 2: “A lifetime of treatment is preferable to a cure”) — but No. 10 is the big one: “Prices will rise to whatever the market will bear.” To Rosenthal, that’s the answer to Scalia’s question. The health care market doesn’t work like other markets because “what the market will bear” is vastly greater than what a well-functioning market should bear. As Rosenthal describes American health care, it’s not really a market; it’s more like a protection racket — tolerated only because so many different institutions are chipping in to cover the extortionary bill and because, ultimately, it’s our lives that are on the line…

The difference between the United States and other countries isn’t the role of insurance; it’s the role of government. More specifically, it’s the way in which those who benefit from America’s dysfunctional market have mobilized to use government to protect their earnings and profits. In every country where people have access to sophisticated medical care, they must rely heavily on the clinical expertise of providers and the financial protections of insurance, which, in turn, creates the opportunity for runaway costs. But in every other rich country, the government not only provides coverage to all citizens; it also provides strong counterpressure to those who seek to use their inherent market power to raise prices or deliver lucrative but unnecessary services — typically in the form of hard limits on how much health care providers can charge.

In the United States, such counterpressure has been headed off again and again. The industry and its elected allies have happily supported giveaways to the medical sector. But anything more, they insist, will kill the market. Although this claim is in conflict with the evidence, it is consistent with the goal of maximum rewards to (and donations from) the industry. As a result, Medicare beneficiaries have prescription drug coverage (passed by Republicans in 2003), but Medicare administrators have no ability to do what every other rich country does: negotiate lower drug prices. In January, President Trump said drug companies were “getting away with murder” because they had “a lot of lobbyists and a lot of power,” insisting he would get Medicare to bargain. Should we really be surprised that the dealmaker in chief dropped the subject after meeting with pharma executives earlier this year?

At the individual level, there are really only two things I can think of to do. One is to attempt to shop around for health care. If you call your doctors office or hospital and ask for the price they charge for a particular service you are considering buying, which is how every other market works, they are likely to laugh at you. Your insurance company might actually help though. I have tried this with Blue Cross Blue Shield with limited success, but it definitely takes time and effort. The second option is to go abroad for checkups, lab work, and elective procedures. It’s not that hard to combine a vacation with a doctor or dentist visit. Insurance companies will generally cover it, because it will almost always save them money, but you definitely have to talk to them in advance. Foreign hospitals (I have experience in Singapore and Thailand) will sometimes bill U.S. insurance companies provided you have a letter form the insurance company up front. Otherwise you might have to front the cash and do the paperwork for reimbursement when you get back.

Like I said, all this takes time and effort, but there are significant savings to be had. So why aren’t third parties stepping into the vacuum to make comparison shopping and medical tourism easier for the masses?

breaking the 90 barrier

 

The Lancet has an open-access article on projected life expectancies in 35 industrialized countries by 2030. A few interesting findings are that South Korea seems to have some of the longest life expectancies and some of the largest gains in life expectancy among both sexes. South Korean women are projected to be the first to break the barrier of an average life expectancy of 90, with a 50% probability of this happening by 2030. The USA is consistently below the middle of the pack. The good news is that life expectancy is projected to increase in all countries studied, and the gap between men and women is projected to narrow. The graphics in this article are really interesting – I have picked just one below.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32381-9/fulltext

Figure 3 from Future life expectancy in 35 industrialised countries: projections with a Bayesian model ensemble

self-healing teeth

Teeth – I have always thought they are one of the weakest links in our evolution, and an example of how nature does not always come up with an optimal design. They just don’t make any sense. Why make them out of substances that dissolve in acid when most of our food is made of acid? They just don’t last as long as most of our other body parts, and they cause us tremendous pain and suffering. Maybe in the future we will just have them all pulled out at some point and replaced with titanium or something else durable. Something I didn’t know, though, is that teeth actually have the ability to heal themselves at a slow rate, and this ability could maybe be accelerated using drugs.

do the rich deserve more health care?

This New York Times opinion article is an economist making the somewhat offensive argument that maybe poor people should not be offered the same access to newer more expensive health care technology as rich people. I say offensive because that is the gut reaction. But part of the article’s point is that newer, higher-tech and more expensive don’t automatically mean a big benefit in terms of outcome and effectiveness. If they do improve outcomes, it is often just by a little bit compared to the lower-tech alternative, and at a much higher price. So it is an argument that a small increase in health is not worth a high price, or at least people should be helped to understand that tradeoff and then decide for themselves. It’s the economist’s basic argument that we live in a universe with finite resources available and we have to decide how to allocate them, and a large number of people making small decisions in a relatively free market will do that efficiently, if not necessarily fairly. Fairness is not really an economic argument, after all.

Consider, for example, treating prostate cancer with proton-beam therapy. It’s more expensive than alternatives like intensity-modulated radiation therapy, but isn’t proven to be any better. If given the choice, many people — especially those with lower incomes — might rather buy health insurance plans that exclude high-cost, low-value treatments.

The trouble is that insurers rarely sell those sorts of plans. Even insurers that try to exclude a particularly expensive and unproven technology from coverage are often rebuffed by legislatures and the courts.

This one-size-fits-all approach to insurance coverage disproportionately hurts low-income people, many of whom might reasonably prefer to devote their scarce dollars to housing or their children’s education. To some extent, subsidies and other monetary adjustments can mitigate this problem. Medicare and Medicaid, for example, are financed in large part out of federal income taxes. And within the Affordable Care Act marketplaces, lower-income people receive subsidies that cover some of their costs.

One way to handle this, which is not suggested in this article, is for the government to provide a minimum level of cost-effective treatment to all citizens, plus catastrophic coverage for the really big stuff like heart attacks and car accidents. The private health insurance market could still exist to cover everything in between, which you could argue is the stuff people want but don’t necessarily need. Which is the proper domain of economics. Distinguishing between high value treatments that prolong and improve the quality of life, and shiny new technologies that we might want but don’t necessarily all need, may become more and more important as technology continues to accelerate.

vaccine for the common cold

According to Inhabitat, there may soon be an effective vaccine for the common cold.

Could the common cold soon be a thing of the past? Scientists have created a breakthrough nasal spray that could block the virus as it tries to enter through the nose, where more than 90% of pathogens get in. The vaccine is called SynGEM, and it treats Respiratory Syncytial Virus (RSV), one of three viruses that cause 80% of common colds.

breakthroughs in antibiotic resistance

There are potential breakthroughs against antibiotic-resistant bacteria, which I think is good as I’ve been coughing up some kind of alien green goo for about a week now.

An anti-infective synthetic peptide with dual antimicrobial and immunomodulatory activities

Antibiotic-resistant infections are predicted to kill 10 million people per year by 2050, costing the global economy $100 trillion. Therefore, there is an urgent need to develop alternative technologies. We have engineered a synthetic peptide called clavanin-MO, derived from a marine tunicate antimicrobial peptide, which exhibits potent antimicrobial and immunomodulatory properties both in vitro and in vivo. The peptide effectively killed a panel of representative bacterial strains, including multidrug-resistant hospital isolates. Antimicrobial activity of the peptide was demonstrated in animal models, reducing bacterial counts by six orders of magnitude, and contributing to infection clearance. In addition, clavanin-MO was capable of modulating innate immunity by stimulating leukocyte recruitment to the site of infection, and production of immune mediators GM-CSF, IFN-γ and MCP-1, while suppressing an excessive and potentially harmful inflammatory response by increasing synthesis of anti-inflammatory cytokines such as IL-10 and repressing the levels of pro-inflammatory cytokines IL-12 and TNF-α. Finally, treatment with the peptide protected mice against otherwise lethal infections caused by both Gram-negative and -positive drug-resistant strains. The peptide presented here directly kills bacteria and further helps resolve infections through its immune modulatory properties. Peptide anti-infective therapeutics with combined antimicrobial and immunomodulatory properties represent a new approach to treat antibiotic-resistant infections.

October 2016 in Review

3 most frightening stories

  • The U.S. electric grid is being systematically probed by hackers working for foreign governments.
  • According to James Hansen, the world needs “negative” greenhouse gas emissions right away, meaning an end to fossil fuel burning and improvements to agriculture, forestry, and soil conservation practices to absorb carbon. Part of the current problem is unexpected and unexplained increases in methane concentrations in the atmosphere.
  • The epidemics that devastated native Americans after European arrival were truly some of the most horrific events in history, and a cautionary tale for the future.

3 most hopeful stories

  • New technology can read your heartbeat by bouncing a wireless signal off you. Mark Zuckerberg has decided to end disease.
  • While he still has people’s attention, Obama has been talking about Mars and zoning. Elon Musk wants to be the one to take you and your stuff to Mars.
  • Maine is taking a look at ranked choice voting. Ironically, the referendum will require approval by a simple majority of voters. Which makes you wonder if there are multiple voting options that could be considered and, I don’t know, perhaps ranked somehow? What is the fairest system of voting on what is the fairest system of voting?

3 most interesting stories

wireless ECG

This paper from MIT describes a technology that can read emotions accurately by detecting heartbeats simply by bouncing a wireless signal off a person. It is supposedly as accurate as a an electrocardiogram. Reading emotions this way is pretty amazing, but to me just the idea of reading a heartbeat accurately this way sounds like a pretty big deal in a medical setting. It also could have obvious implications in psychology, and quite possibly disturbing uses in security, intelligence, military and business settings. Imagine something like Google Glass giving you information on the health and emotions of a person you are talking to.

Emotion Recognition using Wireless Signals

This paper demonstrates a new technology that can infer
a person’s emotions from RF signals reflected off his body.
EQ-Radio transmits an RF signal and analyzes its reflections
off a person’s body to recognize his emotional state (happy,
sad, etc.). The key enabler underlying EQ-Radio is a new
algorithm for extracting the individual heartbeats from the
wireless signal at an accuracy comparable to on-body ECG
monitors. The resulting beats are then used to compute
emotion-dependent features which feed a machine-learning
emotion classifier. We describe the design and implementation
of EQ-Radio, and demonstrate through a user study
that its emotion recognition accuracy is on par with state-of-the-art
emotion recognition systems that require a person
to be hooked to an ECG monitor.

June 2016 in Review

3 most frightening stories

  • Coral reefs are in pretty sad shape, perhaps the first natural ecosystem type to be devastated beyond repair by climate change.
  • Echoes of the Cold War are rearing their ugly heads in Western Europe.
  • Trump may very well have organized crime links. And Moody’s says that if he gets elected and manages to do the things he says, it could crash the economy.

3 most hopeful stories

  • China has a new(ish) sustainability plan called “ecological civilization” that weaves together urban and regional planning, environmental quality, sustainable agriculture, habitat and biodiversity concepts. This is good because a rapidly developing country the size of China has the ability to sink the rest of civilization if they let their ecological footprint explode, regardless of what the rest of us do. Maybe they can set a good example for the rest of the developing world to follow.
  • Genetic technology is appearing to provide some hope of real breakthroughs in cancer treatment.
  • There is still some hope for a technology-driven pick-up in productivity growth.

3 most interesting stories