Alan Pean and the use of excessive force

When Alan Pean, a patient St. Joseph’s Medical Center, was assaulted and nearly killed by off-duty police officers, it highlighted the need for better police training to de-escalate tense situations without the use of deadly force. More broadly, it highlighted the need for broad reforms to reduce the use of excessive force. Campaign Zero has a list of specific policies that can accomplish this goal.

DeRay Mckesson, a ‪#‎BlackLivesMatter‬ activist and Baltimore mayoral candidate, brought these policy proposals to President Obama this week during a inter-generational meeting of civil rights leaders. Obama promised to look into implementation of these policies, a promise I hope he keeps and one that I hope both the Sanders and Clinton campaigns support.

If we are to have a culture that celebrates the sanctity of life and promotes justice, reducing the rate and racial disparity of excessive force is essential.

Alan Pean sought refuge

Alan Pean, a college student with bipolar disorder, recognized in the midst of a manic episode with terrifying delusions that he needed help. Driving to the first emergency room he could find, he sought refuge in our medical system.

As he lost track of reality and a frightening paranoia set in, he became agitated. At another hospital, personnel trained in de-escalation might have helped re-orient him to his surroundings and calm the situation. A doctor may have given him Haldol to calm his storming mind and help him sleep until the morning when a trained psychiatrist could have tended more thoroughly to his suffering.

Unfortunately, he ended up in the wrong hospital that day. He ended up at a hospital patrolled by armed off-duty police officers with no training in de-escalation and insufficient experience helping patients having psychiatric crises. Rather than help Alan, they shot him the chest, rupturing his lung. The bullet passed within millimeters of his aorta, millimeters of his life.

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Subsidizing U.S. healthcare

In this month’s issue of the American Journal of Public Health, Drs. Steffie Woolhandler and David Himmelstein of Harvard Medical School describe the extent to which our healthcare costs are already largely subsidized by the government.

In fact, between the tax subsidies for employer-sponsored insurance, Medicare, Medicaid, and insurance for public employees, the government already pays for 65% of all U.S. health expenditures, amounting to $6,560 per person in 2015. For less than this countries like Canada are able to offer universal coverage without the extremely expensive premiums and deductibles we are saddled with in the United States.

Woolhandler and Himmelstein argue that the excess we pay is essentially a handout to healthcare industries. When so many Americans are struggling with stagnant wages, is it wise for us to be doling out cash to these companies?

Read their op-ed here: “Single-payer health plan wouldn’t cost U.S. more”

An insurer’s perspective on healthcare costs

Jonathan Blum of CareFirst BlueCross BlueShield gave a great talk on delivery system transformation at the Leonard Davis Institute today. As someone that has worked for the Center for Medicare and Medicaid Services (CMS) on cost-control initiatives and now does similar work for a commercial insurer, he had a unique perspective on optimal strategies for curbing the rise in healthcare spending.

Unsurprisingly, he pointed out that brand name medications are a major driver of rising costs for health insurers (and thus a major driver of rising premiums). For both personal and legal reasons, insurers have a hard time saying no when physicians and patients push for expensive treatments.

Drug companies know this and so they have a extremely strong negotiating position when choosing a price for their therapy. They rightly predict that individual consumers, pressured by glossy advertisements, will demand their expensive medications; insurers will be unable to say no for an extended period of time; and when these costs push up premiums for everyone, this consequence will be so dissociated from its cause that it will lose emotional salience to the general public.

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Monitoring outcome-switching in medical journals

Outcome-switching (changing the what outcome you measure after an experiment has started) can invalidate statistical methods leading to false positives and problems with trial replication. Yet, most scientific journals have not reliably reported when this has been happened.

Compare-Trials.org tracks outcome-switching with public registries and then encourages journals to issue corrections, yet some major journals such asAnnals of Internal Medicine have resisted this form of transparency. Scientifically valid results require scientifically valid methods, and it is concerning when major medical journals are not holding themselves to modern standards of scientific rigor.

“Make Journals Report Clinical Trials Properly”

Early results from Mexico’s sugar tax

Mexico has one of the highest rates of soda consumption, overweight, and diabetes in the world. The average Mexican adult drinks 163 liters of soda. 72% of adult Mexicans are overweight, and 15% have diabetes.

In the fall of 2013, the Mexican federal government passed a 10% tax on sugar-sweetened drinks. The following year, purchases of these beverages decreased an average of 6% relative to the counter-factual (controlled for seasonal and pre-existing trends), indicating that this tax was an effective deterrent. Evaluating the public health benefits of this tax will require more time, but this is a promising early result.

While hard evidence for dietary interventions is difficult to gather, much of what we know already argues for a compelling public interest in curbing the consumption of refined sugar similar to the public interest in decreasing smoking or excessive alcohol consumption.

A tax on refined sugar with proceeds going to consumer-level fresh produce subsidies would be a great way for us to invest in a healthier future for ourselves.

“Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study”

The cost of innovation in healthcare

Healthcare spending has been growing at an unsustainable rate.

In 2014, we spent $9,523 per person on healthcare which is up from $4,878 per person in 2000 and $2,854 per person in 1990.1 This growth has dramatically outpaced inflation and now accounts for 17.5% of GDP.2

This translates to rising insurance premiums, deductibles, and medical debt which in turn increase financial pressure on families that are already struggling to get by.3 A recent poll by the New York Times and the Kaiser Family Foundation found that one in five people with health insurance has had problems paying their medical bills requiring them to use up their savings, sell assets, and borrow money at high interest rates.4 For those without insurance, half had similar struggles.

A major driver of these increasing costs is technological innovation which accounts for between 30% and 50% of healthcare cost growth.5 As Nicholas Bagley, Amitabh Chandra, and Austin Frakt explain in a discussion paper written for the Brookings Institute, there are few countervailing forces against endlessly rising prices in medical treatments.6

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