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Does Bergen, Norway, hold the key to the mystery of hypertension?

Michel AccadMay 15, 2017May 18, 2017Articles, Medical science5 Comments

At the beginning of my new book, Socrates engages Geoffrey Rose to discuss one of the most fascinating conceptual questions regarding hypertension.

The question is the following: Compared to normal subjects, do hypertensive patients constitute a distinct population of patients? In other words, if we go out and measure the resting blood pressure of a large swath of the population and plot the numbers as a distribution curve, do we get two separate bell-shaped curves or just one?

The answer to that question was the subject of an intense debate that began in the mid 1950s and lasted a couple of decades until it died down in the 1970s without any settled conclusion. Yet, an answer to that question is of critical importance not just for our understanding of hypertension, but for medical science in general and, by implication, for the direction of our healthcare system.Continue reading “Does Bergen, Norway, hold the key to the mystery of hypertension?”

A health insurance CEO daydreams

Michel AccadApril 4, 2017May 3, 2017Articles, Healthcare economics, Healthcare policy3 Comments

Jim was at his desk, looking weary.

The last few weeks had been brutal. Despite working twelve-hour days, he felt that he had little to show for. His annual board meeting was to take place the next day, and he expected it to be tense.

With a replacement bill for the ACA about to be voted on, and with Trump in the White House, the situation seemed particularly precarious. The board members had asked him to present a contingency plan, in case things in DC didn’t go well.Continue reading “A health insurance CEO daydreams”

Should we blame technology for increased healthcare spending?

Michel AccadJanuary 31, 2017February 6, 2017Articles, Healthcare economics9 Comments

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?Continue reading “Should we blame technology for increased healthcare spending?”

The body language of assisted suicide

Michel AccadJanuary 2, 2017January 6, 2017Articles, Ethics, Philosophyphysician-assisted suicide3 Comments

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.Continue reading “The body language of assisted suicide”

Evidence that women are better cooks than men

Michel AccadDecember 22, 2016Articles, Medical science3 Comments

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.”Continue reading “Evidence that women are better cooks than men”

Overdiagnosis: The disease that cannot be diagnosed

Michel AccadJuly 9, 2015October 17, 2021Articles, Healthcare policy, Medical scienceoverdiagnosisLeave a comment

Some say mammograms don’t save lives, and we order too many of them. That may be true, but which ones should we eliminate? The answer is not so easy after all.

Today’s post will deal with overdiagnosis, a concept preoccupying health care analysts, academics, and policy makers, and one whose importance is confirmed by the distinction of having its own dedicated Twitter hashtag.

And if you follow the #overdiagnosis hashtag these days, you will surely encounter the following chart, excerpted from a recent JAMA Internal Medicine paper:Continue reading “Overdiagnosis: The disease that cannot be diagnosed”

The apostles of “less is more”

Michel AccadApril 14, 2015December 19, 2017Articles, Healthcare policy5 Comments

Gnosticism in medicine

Gnosticism describes a religious movement flourishing at the beginning of the current era, as Roman paganism was foundering but before Christianity became firmly established.

The main belief of the Gnostic sects was a doctrine of “Salvation by Knowledge (gnosis),” the idea that a privileged class of human beings can, by special insight, obtain possession of the mysteries of the Universe.

Gnostics held a deprecating view of the material world, and favored instead the spiritual realm. Gnostic elites would profess a severely ascetic lifestyle as the path to enlightenment, although some have been accused of hypocrisy for shunning the austere discipline they would demand of their followers.

American medicine in the 21st century bears resemblance to the Gnostic movements of old.Continue reading “The apostles of “less is more””