Posts Tagged ‘healthcare’

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Unfounded Truths

Monday, June 22nd, 2009

Reading this short article about the value of health data to combat unfounded best practices reminded me of another story from How Doctors Think:

One of the most common congenital abnormalities of the heart is a hole between the two upper chambers, between the right atrium and the left atrium. Since the pressure in the left side of the heart is higher than in the right, blood will flow from the left atrium through the hole into the right atrium. This aberrant blood flow is called a shunt and can overload the right side of the heart, leading to heart failure and other complications. Lock told me that doctors send children for surgery to close these holes if there is a two-to-one shunt, meaning that twice as much blood flows through the right side of the heart than the left.

“Do you know where that two-to-one number came from?” [Dr. James] Lock [, chief of cardiology at Boston's Children's Hospital,] asked. I imagined ti was from careful clinical studies of children with the hold. “You would think so. But you’d be wrong. At a medical meeting in the 1960s, a pediatrician presented the question ‘When should the hold be closed?’ to a group of cardiologists. There was a heated debate about how much shunting required a surgical fix. So the meeting organizers, out of desperation, took a vote. Some voted for a lower number, some for a higher number. The median ended up being two-to-one. This was published in the American Journal of Cardiology. So now all textbooks have as the truth that you should close a hole when the shunt is two-to-one.

In reality, Children with a two-to-one shunt can live a healthy life without ever requiring treatment. Heart surgery, as one can imagine, is always a dangerous proposition that carries risks for the patients.

Posted by Noah in The Internet
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Primary Care vs Specialists

Friday, June 19th, 2009

Another entry inspired by How Doctors Think for your (in case you missed the last it was about confirmation bias). This time it’s about the differences between primary care physicians and specialists and the way they’re viewed by society.

I just loved this long quote from Dr. Eric Cassell’s book Doctoring: The Nature of Primary Care Medicine:

One should not confuse highly technical, even complicated, medical knowledge — special practical knowledge about an unusual disease, treatment (complex chemotherapy, for example), condition or technology — with the complex, many-sized worldy-wise knowledge we expect of the best physicians.

The narrowest subspecialist, the reasoning goes, should also be able to provide this range of medical services. This naive idea arises, as do so many other wrong beliefs about primary care, because of the concept that doctors take care of diseases. Diseases, the idea goes on, form a hierarchy from simple to difficult. Specialists take care of difficult diseases, so, of course, they will naturally do a good job on simple diseases. Wrong. Doctors take care of people, some of whom have diseases and all of whom have some problem. People used to doing complicated things usually do complicated things in simple situations–for example, ordering tests or x-rays when waiting a few days might suffice–thus overtreating people with simple illnesses and overlooking the clues about other problems that might have brought the patient to the doctor.

Never really thought of it that way but it makes a whole lot of sense.

Posted by Noah in The World
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Helping Doctors Think

Thursday, June 18th, 2009

Over the weekend I finally finished the book How Doctors Think (which will be on our inaugural GE reading list since it was recommended by someone in healthcare). The book is excellent and I’d highly recommend it if you’re into this sort of stuff, it’s basically a study of the cognitive biases of doctors.

Anyhow, I’ve got about half of it underlined and will probably write a few posts from those over the next few weeks, the first of which is this one.

One of the themes of the book is that a patient should help their doctor snap out of confirmation bias (“confirming what you expect to find by selectively accepting or ignoring information”). The book suggests two simple questions to ask your doctor if you suspect this is what’s going on:

  1. What’s the worst thing this could be? “By asking that question, a patient, friend, or family member can slow down the doctor’s pace and help him think more broadly.”
  2. What body parts are near where I am having my symptom? This helps expand a conversation that might be stalled by pain in or around a chronic condition for example. By thinking about the nearby organs a doctor might be pushed to ask some new questions.

In telling Benjamin about this we got to thinking about how we could turn these questions/answers into little applications, maybe even for the phone, so you can take them with you and be armed with questions to ask your doctor.

Posted by Noah in The World
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QALY: Quality Adjusted Life Score

Friday, June 12th, 2009

So a big part of our conversation with David Lee (one of GE’s health economists) last week was talk about QALYs:

QALY: Quality adjusted life year, a year of life adjusted for its quality or its value. A year in perfect health is considered equal to 1.0 QALY. The value of a year in ill health would be discounted. For example, a year bedridden might have a value equal to 0.5 QALY.

Much of David’s work is in this realm, as he explained:

We try and evaluate benefits and costs. The way we measure that is a QALY, quality adjusted life year, we try to figure out what the QALY for certain technologies are. Is the gain in QALYs to the gain in costs worth it. The UK has something like £30,000 per QALY. If the technology can deliver at less than that they’ll pay for it, if it’s more than that they won’t. … What it’s telling technology developers is that if you’ve got a high cost with low medical benefit product your chances of getting into market are lower. If you’re a cancer patient that stands to benefit from an additional three months of life that will cost the NHS $70k is it worth it or not?

This is especially interesting to me because it’s puts a value on human life. In some cases it’s going to be decided that the treatment isn’t worth the cost and while that’s a tough decision to make, it’s an understandable one (at least from an outsider rational standpoint … imagine it’s a different story if you’re the one who wants the treatment). Basically there has to be some way to measure this stuff otherwise it would all spiral out of control. Anyway, lots to think about.

I’ll continue digging into our chat with David over the coming days, going to try to break it down into bite-sized chunks.

Posted by Noah in GE Conversations
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Why Don’t More Men Go to the Doctor?

Wednesday, June 10th, 2009

Hrm …. A very interesting question from The Guardian. As they point out, men are generally less healthy than women, yet they see their doctors less often.

A few hypotheses are included (”They see it as a question of maintenance, whereas men see it as a question of repair. Men treat their bodies a bit like a car: once it’s burnt out they’ll fix it, but until then they power on.”) but it’s a great question. Any thoughts?

Posted by Noah in The Internet
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The Effect of Knowing Your Irrationality

Saturday, May 30th, 2009

The other day we had an hour call with David Lee, one of GE’s health economists (who we mentioned the other day). Anyway, I have about six pages of notes I need to parse and start posting, but this morning I was thinking about something very specific he said: People tend to overestimate small risks. A perfect example is cancer, while any individual’s chance of having it is relatively small we don’t tend to think about it that way. This overestimation can keep us from doing things like getting cancer screenings because we’re afraid of what we might learn.

So … In bed this morning I was wondering whether anyone had studied the effect of knowing this human trait on decision making. Like what happens if you remind people right before you ask them whether they’d like to be screened that all humans tend to overestimate the chances of something that is actually quite rare? Will have to ask David this next time we speak (and if it hasn’t been done maybe we can get someone to do the study). In some ways this feels like exactly the kind of intersection between marketing, health and economics that we can really be helpful in (as marketers).

Just a thought.

Posted by Noah in Random Thoughts/Ideas
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Misaligned Incentives

Thursday, May 28th, 2009

There is a really good article in The New Yorker about healthcare costs and their inverse relationship with the level of care patients recieve. Just a quick quote to get you excited about reading it:

There is no insurance system that will make the two aims match perfectly. But having a system that does so much to misalign them has proved disastrous. As economists have often pointed out, we pay doctors for quantity, not quality. As they point out less often, we also pay them as individuals, rather than as members of a team working together for their patients. Both practices have made for serious problems.

Posted by Noah in The Internet
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The Working Sick

Wednesday, May 20th, 2009

Just ran across an interesting chart that shows the number of guaranteed sick and leave days in different countries (sick days are like you have a cold, leave days are like you have cancer).

Sick Days by Country

This relates to my post about the role of companies in the health of their employees (and the country as a whole). The sick leave entry suggests that the government mandate some number of days. I’ll avoid that question for politics sake, but I do generally think that this speaks to the misaligned incentives in health in this country. As a sick person I’m encouraged to go to work because otherwise I won’t be paid. When I go I am spreading that sickness to all the other folks in the office, ultimately creating a larger loss in productivity than if I had just stayed home for the day (not to mention I’m less likely to get better than having rested).

Yup, misaligned incentives seems to be where it’s at. Excited to speak to David Lee, one of GE’s health economist about some of this stuff.

Posted by Noah in The Internet
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The Role of Companies in Health

Tuesday, May 12th, 2009

One of the things that struck me at Thursday’s health briefing was the trend of companies taking an active role in the health of their employees. As we’ve been thinking about preventative health (which we’ve been tending to think of under the heading life optimization), it’s pretty clear that people aren’t so good at taking care of themselves. For better or worse, they tend to value today over tomorrow. The same isn’t true for businesses, however, where a sick employee can carry a hefty price tag. With that in mind, some businesses are beginning to invest in the wellness of their employees in all sorts of different ways.

One of those companies is General Mills, who were actually represented at the event. On one of the panels they mentioned an article about them in the New England Journal of Medicine which I quickly pulled up and purchased. It was super interesting and actually started to put some meat on the bones of some of the preventative health ideas we’ve been throwing around.

Essentially these companies are putting rewards (and sometimes penalties) for not keeping healthy. While I’m sure that sounds a bit big brotherish for some, I have to say it doesn’t bother me a whole lot (after all, employment is an agreement between both parties). What’s more, it reflects some of the stuff going on in government with cities all over the world banning smoking (and even trans fats in New York City).

Anyway, one of the core features of the General Mills program s a thing called the “health number”:

Employees at General Mills assess their risk factors and compute their “Health Number” by answering seven behavior-related questions — concerning exercise, diet, alcohol intake, tobacco use, stress management and mood, seat-belt use, and cancer screening — plus three questions concerning body-mass index, blood pressure, and blood lipid levels. Employees with a Health Number indicating intermediate risk are advised to consider lifestyle changes, and those with high risk are urged to initiate such changes, either on their own or with the company’s help.

This was especially interesting as we’ve been thinking a lot about how you begin to make health a little bit more like a game. Actually one of the conversations we had at the briefing was about just this, where we were told about some company (whose name I can’t remember) that does something similar and then creates an anonymous leaderboard for you to see how you stack up against the competition. Not sure how effective this stuff is, but would love to find out more.

Anyway, lots of good stuff to think about.

Posted by Noah in Washington DC Healthcare News
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Great Bones!

Thursday, May 7th, 2009

So we are in DC for a big GE healthcare event, and got to see the Achilles Express, which analyzes your bone strength and provides information that doctors use to help check for osteoporosis (among other things? ). Its pretty cool, its almost an industrial appliance in the sense that it can be used at a Health Fair to quickly analyze hundreds or thousands of people, and then they come in for follow-up care if something is spotted.

Pretty cool, and I hadn’t heard of a Health Fair, which is basically where a bunch of people can come get some health tests, seems like half public service, half marketing outreach for hospitals.  This is interesting territory to explore.

One question/thought I had is that most people are sometimes nervous to use devices like this because you either get baseline feedback (no problem) or negative feedback (this is how bad your bones are)  but there’s no positive feedback.  Like if you have really superb bone strength, you will get a higher number, but I don’t think this thing lights up like a pinball machine and makes you feel awesome about your great bones.  Might be interesting to think about how to balance the good/bad feedback so you can have a really positive experience and thus motivate folks to get themselves checked out even earlier?  Maybe something with the device, and maybe just the communications around what your motivation is in the first place to stick your foot in one of these.

Posted by benjamin in Washington DC Healthcare News
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