Tag Archives: healthcare

Fighting Anecdotal Fire With Anecdotal Fire

This article in Slate, written by a woman whose mother did not have her vaccinated and thus suffered through mumps, measles, rubella, etc., is an excellent piece of thinking about the current hubbub related to vaccinations. I like this part in particular:

I find myself wondering about the claim that complications from childhood illnesses are extremely rare but that “vaccine injuries” are rampant. If this is the case, I struggle to understand why I know far more people who have experienced complications from preventable childhood illnesses than I have ever met with complications from vaccines. I have friends who became deaf from measles. I have a partially sighted friend who contracted rubella in the womb. My ex got pneumonia from chickenpox. A friend’s brother died from meningitis. 

Anecdotal evidence is nothing to base decisions on. But when facts and evidence-based science aren’t good enough to sway someone’s opinion about vaccinations, then this is where I come from. After all, anecdotes are the anti-vaccine supporters’ way: “This is my personal experience.” Well, my personal experience prompts me to vaccinate my children and myself. I got the flu vaccine recently, and I got the whooping cough booster to protect my son in the womb. My natural immunity—from having whooping cough at age 5—would not have protected him once he was born.

(Bold emphasis mine)

There are a lot of things that frustrate me about the vaccination debate, not the least of which is that someone else’s decision to ignore science and logic might adversely affect other peoples’ health, but what really gets my goat is the trend the author points out of people refuting evidence with anecdote.

Recently I saw a post on Facebook in which someone shared an information piece of dubious origin that said something like: “Number of deaths from measles last year: 0. Number of deaths from measles vaccines: 106” There are so many things wrong with this, but here are the most obvious:

  • First of all, if you’re going to share this kind of data then please share the source so it can be verified as legitimate.
  • Second, if it is legitimate then please share whether or not that’s in the US or the world. Why? Because if it’s the world then I can flat out tell you it’s BS. From the World Health Org.:
    WHO warned today that progress towards the elimination of measles has stalled. The number of deaths from measles increased from an estimated 122 000 in 2012 to 145 700 in 2013, according to new data published in the WHO Weekly Epidemiological Report and the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report. The estimated number of measles deaths in 2013 represents a 75% decline in mortality since 2000, significantly below the target of a 95% reduction in deaths between 2000 and 2015.
  • Third, if it IS true and it is just the US then use percentages rather than raw numbers. One reason so few people would have died from measles is because so many people were vaccinated! What percentage of people who got the vaccine died? Vanishingly small. And while the percentage of people who die after contracting measles would also be vanishingly small, that doesn’t mean the disease doesn’t wreak havoc by making people very sick.

So here’s the point, and I’m going to type it really slowly so the anti-vaxxers can keep up: You are entitled to your opinion. You are also entitled to ignore science and generally do stupid things. Your entitlement ends where others’ well being begins, thus if you decide to not vaccinate your children then your family should NOT be allowed to partake in any public activities or enjoy any other societal benefits that would put you in direct contact with the vaccinated population. No schools, no restaurants, no stores, no swimming pools, no movie theaters, no malls, no amusement parks, no public parks and no places of business (okay, maybe Walmart). Nada. Nothing. Don’t want to participate in 21st century public health programs? Fine, then don’t participate in 21st century public gatherings.

Billions Left on the Table

North Carolina is one of the states that didn’t expand its Medicaid program after the passage Obamacare. According to this little item from the Wonkblog there are a BUNCH of states that are reconsidering their decisions to opt out:

Money talks: Medicaid expansion makes headway in Republican states. “Two things have led to a change of heart for some Republican politicians. Most of the 27 states that are already expanding the program have begun to reap billions in federal subsidies for insurers, hospitals and healthcare providers, putting politicians elsewhere under intense pressure to follow suit. As demonstrated by Pennsylvania’s deal with Washington, the Obama administration has also proved willing to accept tweaks that give the private sector a greater role in providing healthcare and place new responsibilities on beneficiaries. All of that has got as many as nine states talking to the administration about potential expansion terms.” David Morgan in Reuters.

According to the Reuters article referenced above, North Carolina is one of the states looking at what it can do:

Some states with Republican governors, such as Indiana, are negotiating with Washington for agreements that could pass political muster with conservatives back home. Others such as North Carolina, South Dakota and Wyoming are exploring options.

One of the reasons that North Carolina’s leaders said they didn’t want to opt for expansion is that they feared the Feds wouldn’t pick up the vast majority of the cost as they’d promised (I’m paraphrasing). Now that they’re seeing what kind of money they’re leaving on the table they seem to be second guessing their decision, but they’re likely going to slow-play their hand because things might change in November.

According to the Reuters article if the Democrats lose control of the Senate then the wave of Republican states reconsidering their Medicaid expansions might ebb. Here’s the irony for North Carolina Republicans, many of whom might benefit from Medicaid expansion: on this particular issue they might be better off if Dem. Senator Kay Hagan wins reelection. And if you think the only Republicans who might benefit are those who are eligible for Medicaid then you’re forgetting all the Republicans who work in the health care industry. Just look at the projections for Pennsylvania:

A study by the RAND Corp predicted a $3 billion economic boost and the creation of 35,000 jobs – big advantages for a state that has struggled for decades to make up for jobs lost from the decline of the coal and steel industries.

Unfortunately for the Democrats this kind of issue is far too complex to make an effective campaign tactic. After all, this is a country full of people who said things like “Keep the government’s hands off my Medicare” when Obamacare was being debated. You can’t possibly expect them to back a candidate out of enlightened self interest when they don’t even know what their self interest is.

North Carolina’s $51 Billion Gamble

Brad DeLong has some thoughts about Obamacare and here in NC this one bites:

The willingness of state-level Republican politicians to hurt their own people–those eligible for the Medicaid expansion, those who would benefit from a little insurance counseling to figure out how to take advantage of subsidies, those hospitals who need the Medicaid expansion to balance their finances, those doctors who would ultimately receive the subsidy dollars–is, as John Gruber says, “awesome in its evilness”. The federal government has raised the money, and all the state has to do in order to get it spent is to say “yes”. Especially in contrast with the extraordinary efforts state-level politicians routinely go through in order to attract other spending into their state, whether a BMW plant or a Social Security processing center, this demonstrates an extraordinary contempt for a large tranche of their own citizens. And when I reflect that a good third of that tranche reliably pull the lever for the Republican Party year after year…

To that point, here’s some encouraging news about North Carolina’s non-participation in Medicaid expansion:

North Carolina’s decision not to expand Medicaid coverage as part of Obamacare will cost the state nearly $51 billion in federal funding and reimbursements by 2022, according to research funded by theRobert Wood Johnson Foundation

It notes that North Carolina stands to lose $39.6 billion in federal funding between 2013 and 2022…

“States are literally leaving billions of dollars on the table that would support their hospitals and stimulate the rest of their economies,” says Kathy Hempstead of the Robert Wood Johnson Foundation.

The report notes that for every $1 a state invests in Medicaid, it will receive $13.41 in federal funds.

And here’s the real kicker:

The decision not to expand Medicaid coverage will leave 6.7 million U.S. residents uninsured in 2016. That includes 414,000 people in North Carolina.

Of course Obamacare isn’t perfect and Medicaid isn’t the end-all, be-all of health care insurance — DeLong himself says in his thoughts about Obamacare that “Where the Medicaid expansion has been allowed to take effect, it has taken effect. People are going to the doctor more, people are finding doctors to go to, and the only minus is one that we already knew: that Medicaid is not a terribly good way to spend our money in treating people with chronic conditions” — but it is still a better option than nothing and an improvement over the Emergency Room as primary care provider system that we’ve had.

What’s truly frightening to consider is where we’ll go from here. Without the funds our doctors and hospitals will be missing out on literally billions of dollars of reimbursement, almost 1/2 million citizens will be uninsured and will continue to use the emergency room as their primary caregiver, the hospitals will have to eat the cost and downward we spiral.

Health Care Offers Huge Investment Opportunity

Venture investor Fred Wilson sees the digitization of the health care sector as one of the great investment opportunities we’re likely to see:

Mary Meeker’s slide deck addressed this is bit. Here are a few of the big points from it:

  • Healthcare is now $2.8 trillion in the US, which represents 17% of GDP
  • Healthcare is being consumerized
  • Healthcare is being digitized
  • Digital Health Venture Investment was $1.9bn in 2013 (out of a total of $24bn)

We are looking for networks of users, patients, doctors, and other stakeholders in our health care who can transform the way health care is delivered. We only have one game plan at USV and look to play it in every market opportunity we see.

I am pretty certain the intersection of the Internet and mobile, the digitization of the health care system, and a desire for people to take more control over their health is going to be one of the biggest investment opportunities we will see in my lifetime. And its game on.

As we’ve seen here in Winston-Salem the process of digitization won’t always be pretty. We’ve seen a lot of news regarding the problems our large health care networks, particularly Wake Forest Baptist, are experiencing as they try to (finally) catch up with almost every other industry in the use of information technology. While these are very large problems, and people have lost their jobs as a result, they almost certainly have more to do with terrible implementation strategy from executives than with the technology itself. In the long run those providers should realize huge gains in efficiency, and the data they’re accumulating will provide untold numbers of opportunities for entrepreneurial companies to create products and services that benefit providers and consumers alike.

It’s about damn time and it’s great to see that some smart money people are ready to put their money behind some of these initiatives.

A Parent’s Nightmare

Last month I wrote a post titled The Miracles and Limitations of Modern Healthcare that was prompted by my family's experience at Brenner Children's Hospital where our son had a procedure called a cardiac ablation to take care of a heart condition he'd been dealing with for a couple of years. I wrote the post the day after my wife and I had our son safely home following a successful procedure. As you can imagine we were thrilled with the outcome, but that thrill was tempered by some of our experiences in the waiting room. Here's part of what I wrote:

Unfortunately modern medicine also has its limitations. While we were in the waiting room during our son's surgery a doctor came out and met with a mother and grandmother waiting near us. It was very early in the morning and most of the folks in the waiting area were asleep, thus it was pretty quiet. We tried our best not to eavesdrop, but it was impossible not to hear pieces of what the doctor was telling the mother – that her child did indeed have some rare, malignant cancer. It was also impossible not to hear the mother's crying and her mother trying to console her. And quite frankly it was impossible not to break down ourselves once they left – I haven't cried in public since I was a child, and I'm not ashamed to say that I just couldn't hold it together. I can't imagine going through what that family is going through right now.

Right now our country is dealing with a lot of change in our health care system thanks in large part to theAffordable Care Act, aka Obamacare. There's (rightfully) a lot of discussion about how our health care system and the related health insurance industry work. The debate often focuses on cost and on whether or not we're moving towards a system of "socialized" medicine similar to Canada's or the UK's, and if we are, whether that will lead to a stall in medical advances that have led to every day "miracles" like what our family experienced.

Those are all worthy discussion points, but after yesterday all I could think was this: when it's your child in the operating room you really don't care how expensive the procedure is, you just want him to have whatever it takes to make him well. I would gladly live in a cardboard box in order not to have to hear what that poor mother next to us heard. Whatever we do I hope we continue to work towards making sure that fewer and fewer parents have to hear that their child doesn't have a miracle available to them at any price.

Today we learned that a 15 year old student at our son's high school, a boy named Ryan Wood, died today of cancer. His classmates had started a #prayforryan campaign on Twitter, which brought his and his family's ordeal to the attention of the media, celebrities like West Forsyth alumnus Chris Paul, and the community at large. When he passed away today a lot of us in the community heard about it, and that's what is prompting this post.

Ryan was treated at the same hospital – Brenner Children's Hospital – as our son, which means he had access to some of the best treatment available anywhere. When I heard his story I couldn't help but think back to the experience in the waiting room, and I couldn't help but wonder about how Ryan's family can possibly deal with this loss. And I can't help but hope and pray that the capabilities, the miracles,  of modern medicine keep expanding at an ever faster rate so that fewer and fewer families have to discover the absolute devastation that they are feeling with the loss of their son today. 

If you are a religious person please keep the Wood family and all families dealing with tragic loss in your prayers. If you aren't religious please send kind thoughts and reflections their way. 

Make Sure to Tell Your Ambulance Driver to Head to the High Rent Hospital

From the Freakonomics blog:

Both strategies show that higher-cost hospitals have significantly lower one-year mortality rates compared to lower-cost hospitals. We find that common indicators of hospital quality, such as indicators for “appropriate care” for heart attacks, are generally not associated with better patient outcomes. On the other hand, we find that measures of “leading edge” hospitals, such as teaching hospitals and hospitals that quickly adopt the latest technologies, are associated with better outcomes, but have little impact on the estimated mortality-hospital cost relationship. We also find that hospital procedure intensity is a key determinant of the mortality-cost relationship, suggesting that treatment intensity, and not differences in quality reflected in prices, drives much of our findings. The evidence also suggests that there are diminishing returns to hospital spending and treatment intensity.

Basically what they're saying is that if you go to the budget hospital you're likely screwed.