Should we blame technology for increased healthcare spending?

Healthcare economists mistake cause and effect

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Should we blame technology for the growth in healthcare spending?  Austin Frakt, a healthcare economist who writes for the New York Times, thinks so.  Citing several studies conducted over the last several years, he claims that technology could account for up to two-thirds of per capita healthcare spending growth.

In this piece, Frakt contrasts the contribution of technology to that of the ageing of the population.  Frakt notes that age per se is a poor marker of costs associated with healthcare utilization.  What’s important is the amount of money spent near death.  If you’re 80 years old and healthy, your usage of healthcare services won’t be much more than that of a 40-year-old person.

So far, so good.  But should we accept the proposition that technology is the culprit for healthcare spending growth?

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The body language of assisted suicide

What the verbal request fails to reveal

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Laws that allow assisted suicide restrict the provision of “aid-in-dying” drugs to patients whose mental status is not impaired and who are capable of sound judgment.

Medscape recently featured a video interview of Timothy Quill, the palliative care specialist and long-term assisted suicide activist.  He is interviewed by the ethicist Arthur Caplan, and the two discuss the psychological evaluation of terminally ill patients who request physician-assisted suicide (PAS).

Several points made by Quill caught my attention.

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Evidence that women are better cooks than men

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I must admit that my initial reaction to the now famous study by Ashish Jha and colleagues—showing that female internists achieve slightly better 30-day inpatient mortality rates than male internists—was one of annoyance.  “Here we go again,” I thought.  “Data mining at the service of political correctness.”  And I was pleased to read David Shaywitz reply to the study with a piece in Forbes aptly titled “When Science Confirms Your Cherished Beliefs—Worry.”

That said, I must give credit to the study authors for generating a lot of interesting discussion and for stimulating Saurabh Jha to write his magnificent commentary “Homme Fatale.”

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Should assisted suicide be legal in a free society?

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Abigail Hall Blanco, a research fellow at the Independent Institute, recently wrote a piece entitled “Assisted suicide is a personal choice” in which she defends the position that assisted suicide should be legal in a free society.

Before discussing this piece, it is important to clarify what Blanco probably means when she asserts that assisted suicide is a “personal choice.”  After all, the statement may seem like a triviality: all humans are persons, and therefore all human choices are personal choices.

I suspect that what Blanco means to say is that assisted suicide should be legal because it is a free choice that only affects the person making it.  In that sense, the subject and object of the choice are both the same person: The choice begins with the person and the effect ends in the same person.

Having made that clarification, let’s examine the three arguments Blanco makes to support her position.  These arguments are counterpoints to claims allegedly made by opponents of assisted suicide.

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How I learned to stop worrying and love practicing without EBM

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If you’ve enjoyed my previous take-downs of evidence-based medicine but can’t let go of your attachment to the randomized controlled trial, this post is for you.

My aim is to show you practical ways you can safely and effectively exercise clinical judgment without recourse to “evidence-based” knowledge, provided you follow simple but fundamental principles of clinical care: circumspection, parsimony, and due respect to patient autonomy.

What’s more, I will make my case against RCTs using examples that EBM apologists have precisely identified as paradigmatic of this “single greatest medical advance.”

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On the deactivation of implantable devices

Tough ethical questions

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There is an interesting thread on Twitter generated by a BBC article relating the case of a British patient who was granted the right to have her pacemaker deactivated.  Dr. Wes Fisher was interviewed in the article.

The question posed is whether this constitutes assisted suicide or not.  Dr. John Mandrola pointed to the position document of the Heart Rhythm Society regarding such cases and seems firm that pacemaker deactivation is not euthanasia.

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Three cheers for the statin war

The days of healthcare utilitarianism are numbered!

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If anyone has any lingering doubts that the promises of evidence-based medicine are quickly evaporating, the recent blog post by Larry Husten on the statin war should quickly dispel them.  Husten gives an excellent account of the latest battle opposing the pro- and the anti- camps.

What happened?

The pro-statinists published a 30-page diatribe in The Lancet.  Statins save lives, they assert.  The evidence is incontrovertible.  Yes, they can have side effects such as muscle pain, no one disputes that.  But drawing attention to those side-effects—as the anti-statinists do—endangers patients who now find a reason to refuse to take the life-saving drugs.  There’s evidence of that happening.

The anti-statinists voiced their position in the BMJ.  Statins cause muscle pain and fatigue, they assert.  The evidence is incontrovertible.  Yes, they can save lives, no one disputes that.  But trumpeting the benefits or down-playing the harm—as the statinists do—prevents patients from partaking in the glorious activity of “shared-decision making.”  There’s evidence of that happening.

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The brave new world of contemporary bioethics

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A few months ago, I tweeted that today’s ethicists sometimes serve the function that sophists used to fulfill in Ancient Greece: to provide moral cover for the powerful.  A “consensus statement” issued last week by a committee of philosophers and bioethicists  brings some pertinence to my comment.

These international scholars–all from prestigious Western institutions–had met in June in Geneva, Switzerland to take up the question of conscientious objection in healthcare.  Here are the first five points of their ten-point statement, published on the Practical Ethics blog of the University of Oxford philosophy department:

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Beauty, chemistry, and natural philosophy

Summer reflections

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About a year ago, Theral Timpson interviewed Stanford chemist Carolyn Bertozzi on his Mendelspod podcast.  I only heard the show recently and enjoyed it.  The title caught my attention: “Is the future of biology a return to chemistry?”

Bertozzi made some interesting comments about her field, which she regards as “the central science,” and Timpson probed her about her expectations for the place of chemistry in what is otherwise expected to be “the century of biology.”

The discussion was of interest to me for two reasons.

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The mother of all medical errors

Iatrogenesis in perspective

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A study published a couple of months ago in the BMJ  made headlines for claiming that medical errors are the third leading cause of death.  As expected, the reactions were swift and polarized.

For some, the study confirmed that the self-serving healthcare system is utterly careless about the welfare of patients.  For others, the claim was complete hogwash, based on faulty methodology designed to justify further regulatory oversight.

The two positions are not necessarily mutually exclusive.

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