Around the Mediverse: August 18, 2010

What with this whole commencement of medical school, it’s been a while since the last edition.  So I bring you slightly more than usual

Fun tidbits, health-related and otherwise, from around the ‘tubes:

• Worthwhile Canadian Initiative reminds us that counterintuitive though it may be, there is an optimal amount of forgetting.  Dr. Bob Centor suggests that proposed performance payment for physicians forgets the role of patient preferences in steering therapy.  Sticking with patient preferences, two posts at KevinMD argue that the long-term viability and feasibility of the PCMH care model should be determined by patient desires.  That is, if the PCMH model is workable to begin with… an arguable proposition.  Of course, if recent trends with retail clinics are any indicator… well, it could indicate many things.  You be the judge.

• Beware economists bearing dynamic stochastic general equilibrium macroeconometric models!  Beware surrogate endpoints in clinical research!  Beware constitutional challenges to the PPACA!  Beware Robin Hood… libertarian rebel?  Beware overly alarmist bullet points!

• End-of-life spending has gotten some attention.  The DMCB and Health Affairs alike aren’t convinced that reducing this spending will be easy, or that the savings are in fact possible to realize, at least as conventionally measure.  Relatedly, a guest poster at KevinMD points out that in medicine, sometimes “more is more.”  Not all potential cost-savings are “free lunches.”

• The Happy Hospitalist argues that data on physician reporting on impaired colleagues shows that the profession’s ethical standards are quite high.  Dr. Wes points out the ethical shortcomings of conducting large-scale policy experiments without any concept of research subject welfare as found in clinical research.  Arguably least ethical of this bullet point is Congressional exemption of the SEC from most FOIA requests.

• Pretty pictures!  Congressional Republicans give us charts explaining new government agencies created by the PPACA and the criteria for obtaining small business health insurance tax relief under the act.  The Denver Post posts some extraordinary colour photos from the Depression era.  Of course, sometimes making use of pretty pictures (and text) will cause one to run afoul of the federal government, as with the ADA actions taken against universities piloting Kindle usage among their students.

• Let’s talk unintended consequences of government actions.  Start by guessing which Senator takes exception to certain provisions of the PPACA?  Hint:  his name rhymes with “Hairy Reed.”  Elsewhere, the recession has forced two entrepreneurs to decamp to Canada because of the arcana of the E-2 visa.  What happened to new bond issues after the passage of the Dodd-Frank financial reform bill?  Would “disaster” be hyperbolic?  Becker and Posner ponder the effects of the administration’s pro-union attitude on business uncertainty and the recovery.  Megan McArdle discusses the optimal level of regulatory enforcement, whereas another blogger discusses the “tyranny of big ideas” in the context of regulatory change and improving human welfare.

• On lighter notes, we have a farmer who reminds the world that old-school farming isn’t all it’s cracked up to be, and a brief history of Tibetan Buddhism that is markedly different from the sort of thing you’d probably expect.

• Rounding out this week’s edition…  Medical schools, broadly speaking, do three things.  They educate physicians, produce research, and care for patients.  As someone just starting medical school, it’s nice to read things like this post from Dr. Centor arguing that the primary mission of medical schools should in fact be medical education.
  

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