Adult “Selective Eating Disorder” to be included in DSM-V?

Via John Goodman comes a story at LA Weekly reporting that the next released edition of the Diagnostic and Statistical Manual of Mental Disorders might include picky eating, or “Selective Eating Disorder.”  One of the lead researchers into the “causes and severity of the disorder” explains it thusly:

She went on to explain that these finicky eaters often reject food not because of taste, but rather because they find the look or smell unappealing or have negative physical or emotional childhood associations with food.

I know I’m only one-eighth of the way to being a medical professional and so might be missing out on something here, but it seems to me that what she’s saying is that sometimes people base their eating decisions on subjective personal preferences about the food in question.

Heaven forfend!

The implication seems to be that if you don’t like a given food for reasons other than taste, you may have a mental illness.  I wonder if that covers my avoidance of foods like deep-fried Twinkies for the sake of my health.

Defensive Medicine 101… it starts now

Over the past few years I’ve seen many exhortations (such as this one) to be aware of the “hidden/shadow/unofficial/cultural curriculum” of medical school. The “hidden curriculum” is that part of training that imbues us freshly-minted medical students with the often-unspoken values, norms, stereotypes (surgeon jokes, anyone?), and attitudes common to the profession.  Most often, this “hidden curriculum” is said to be imparted unintentionally by professors and clinical role models.

Sometimes, however, there’s nothing hidden or unintentional about it.

Our recently-started anatomy class actually begins with a couple of weeks of embryology.  Here’s one of the questions from the textbook, and its answer.  To be fair, the question itself wasn’t assigned, but rather the chapter in which it was located.

Question:  “A 22-year-old woman who complained of a severe “chest cold” was sent for a radiograph of her thorax.  Is it advisable to examine a healthy female’s chest radiographically during the last week of her menstrual cycle?  Are birth defects likely to develop in her conceptus if she happens to be pregnant?”

Answer:  “Yes, a chest radiograph could be taken because the patient’s uterus and ovaries are not directly in the x-ray beam.  The only radiation that the ovaries receive would be a negligible, scattered amount.  Furthermore, this small amount of radiation would be highly unlikely to damage the products of conception if the patient happened to be pregnant.  Most physicians, however, would defer the radiographic examination of the thorax if at all possible, because if the woman had an abnormal child, she might sue the physician, claiming that the x-rays produced the abnormality.  A jury may not accept the scientific evidence of the nonteratogenicity [doesn’t cause birth defects –NWS] of low-dose radiation.” [emphasis added]

There you have it.  Our first explicit lesson in defensive medicine before we even get near the cadavers in anatomy class.  Some things you just can’t make up.

***

I hear the answer to that question in the next edition will include a helpful reminder to make sure to run the radiograph order by the patient’s insurer’s radiology management service first.

The “if only” EMR

The Happy Hospitalist has a great proposal to improve the utility of EMRs.  Right now, these systems are often plagued with what one blogger calls “Copy n Paste Gone Amok Syndrome.” Reams of redundant information is copied into the EMR, and physicians who want to extract the clinically useful information from a note have to expend a lot of effort to wade through the pro forma notations that are primarily there to satisfy E&M billing requirements.  If you want to get paid for that high-level patient encounter, you had best document each point of the x-point review of systems, and so on.  When every physician does this for a patient being bounced around to multiple specialists (or with frequent medical contact, generally), the length adds up.

Add to this the frequent proposals that some patient behaviour or another be tracked in the EMR by every treating physician, regardless of why the patient is there in the first place.  Some of this is probably a result of the trend towards overmedicalization of everyday life that we see in North America.  Some of this is probably a result of medical interest group politicking that seeks to enhance the profile/prestige/importance of their constituency.  Some of this is probably a result of the “what harm can come from another checkbox in the record?” mentality, coupled with the fact that this data can actually be useful to policymakers, researchers, and sometimes even patients(!).  Off the top of my head, I can think of proposals for medical monitoring (or notice-taking, or box-checking) of social markers as disparate as smoking status, BMI, domestic violence, seatbelt use, and texting-while-driving.

Happy’s open-source H&P would go a long way to restoring sanity.  Unfortunately, as he points out, the payment system isn’t too conducive to that sanity.  When every physician has to check all of those boxes in order to get paid… they’ll get checked, and then copied-and-pasted.

In some ways, his proposal reminds me of the way that record-keeping functioned when I worked for my campus IT department.  The required drop-down lists for all the data the “higher-ups” wanted to collect was kept in a separate part of each case record, never impinging on the employee-written narrative reports that contained only the vital information.  They got their data, we got to see what we needed about the case’s progress and past work history, without the former getting in the way of the latter.  Data collection didn’t excessively impede workflow.  Win-win.

Lots of people have rightly pointed out that EMR vendors would do well to design their products based on how medical practices actually operate, instead of assuming that medical practice should be shoehorned into the constraints of the electronic record.  For some good ideas, they need not look beyond their own industry’s analogues.

Whose costs? Our costs.

One of the problems that comes up frequently in health economics/policy, and discussions of other economic issues, is the definition and especially the measurement of cost.  Is a given cost a real economic cost, or just an accounting cost to one particular entity?  Whose cost is it?  What kind of cost?  Depending on the question that’s being asked, these sorts of questions need to be answered in order for an analysis to be valid and accurate.

The issue of cost in health care is obviously a huge one, but a recent post by The Happy Hospitalist provides a timely reminder about the fact that certain costs are liable to be systematically under-counted by policy analyses. I’m talking about “convenience” costs.

“Convenience,” broadly defined, implies a lack of necessity… you can get rid of it, because it doesn’t really affect the important stuff.  That’s as true in health care as it is everywhere else.  However, just because something is “only a convenience” doesn’t mean that it doesn’t improve people’s lives in a real way; conversely, reduced convenience does make its erstwhile beneficiaries worse off.

When Canada Post decides to stop house-by-house mail delivery in favour of neighbourhood postbox stations, it might reduce its cost of delivery, but does so by increasing the cost to the neighbourhood of receiving its mail.  It doesn’t cost more money to pick up one’s mail from a neighbourhood mail station; the additional cost is in terms of time (and potentially a psychological “hassle factor”).  Whether this switch is desirable overall depends on the relative magnitude of the two costs in question.  The same goes for health care.

Time is sometimes the forgotten factor in health reform discussions.  Perhaps not coincidentally, it’s patients (and physicians) who probably bear the brunt of the time costs the system imposes.  Patients spend time waiting… waiting in the waiting room at the doctor’s office, waiting for the next available appointment, or as in Happy’s case, waiting for a VA hospital bed to open up, waiting for a VA doctor to be available, and waiting for an opportunity to travel 75 miles to the nearest VA pharmacy.

Sometimes the “inconvenience” costs more than just time.  The wages forgone while waiting to see the doctor, the childcare to pay for on the day of the appointment, the cost of fuel or fare to the distant healthcare facility… these are real costs of “inconvenience,” too.

In most analyses, it seems, these costs aren’t factored in.  On one level, that’s understandable because this sort of thing is probably insanely difficult to measure and value accurately.  That doesn’t mean that it can be safely forgotten.

When a study shows that making certain changes cut cost to the “system” without affecting whatever quality metric was being examined, that doesn’t mean that the change is truly costless.  As Happy’s example shows, a healthcare system (an HMO, an insurer, the VA) can cut its own costs without affecting quality by increasing the “inconvenience cost” to its patients.  Even though there’s no “real” effect on the clinical quality of care, I challenge anyone to read the linked story and say that the cost to the patient is non-trivial.

These decisions about convenience can only increase in relevance as we move forward.  To pick one example, with the decline of the solo general practitioner and the rise of the ACO/PCMH/hospital-owned group practice, it’s worth asking what minimum community size is required to sustain the presence of a medical professional, and which of our rural communities won’t make the cut.  Another might be the desired number of home care physicians, given the existing limitations of the primary care physician workforce.

Sometimes, the cost to the patient of added inconvenience will be outweighed by the decreased cost to the system of providing more inconvenient care of the same or similar clinical quality.  There will be many occasions, I suspect, where the magnitudes of these two costs will be much closer than is presently acknowledged.

So what to make of Happy’s assertion about the VA?  Maybe they keep their costs artificially low by forcing the patient and his community physicians to spend more of their time and money doing what the VA won’t do.  Maybe the savings the VA gets from reducing their physician and pharmacy availability outweigh whatever additional cost is imposed on the patient and on Happy’s hospital.  Regardless of what the right answers are to these questions, it would be nice to see an attempt to answer them that doesn’t pretend that the patient’s time isn’t worth anything.  Health care already is, and will continue to be, rationed by one system or another.  For people to have faith in that system, they need to see that when the numbers are being run, their preferences aren’t being ignored.

Around the Mediverse: July 17, 2010

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

• How do the media deal with new research?  How should the media, or anyone else for that matter, interpret new research?  Unfortunately, the New York times only devotes a couple of paragraphs to this first question, but even that is enough to illuminate the complex web of incentives facing those in the science communications industry, and what it means for the science coverage that you see.  A blogger at Foreign Policy provides some useful advice in response to the second question.

• The Placebo Journal Blog takes on a proposal to save family practice… by extending the residency to 4 years from 3 (in contrast, FP residency in Canada is 2 years).  The comments are harsher than the post itself.  A family practitioner blogging at Better Health gives an example of how opting out of Medicare can be win-win for the doctor and the patient.  This strikes me as a better option than an extended residency.  Even if primary care can be saved, it probably won’t happen soon enough to stave off what could be a massive increase in Emergency Department utilization by newly insured patients as a result of the PPACA.

• File these under “overutilization” for sure:  Dinosaur accuses the American College of Obstetrics and Gynecology of “usurping” primary care’s scope of practice with new guidelines recommending OB/GYN visits for younger teenagers; MD Whistleblower blows the whistle on various “pre-emptive” CT scans that are being advertised to patients despite the fact that they don’t do much good for anyone.

• Science-Based Medicine writes a rebuttal to a Slate piece linked to in the last edition of AtM:  Why Big Pharma should not buy your doctor lunch.  SBM also featured some well-written commentary about new CMS head Don Berwick, touching on his lax attitude towards pseudoscience, and the Central Berwick Paradox of supporting unlimited patient choice and top-down government rationing.  Or something like that.

• Via EconThoughts and Megan McArdle, we find a story in the WSJ describing how some unions hire non-union labour to staff their picket lines.  Delicious.  Less delicious is the story told by House Appropriations Committee Chairman David Obey (D-Wis) of how the White House suggested paying for spending on teachers by cutting food stamp benefits.  Does anybody remember who the largest donors to federal Democrats are?  I’m having trouble, but I don’t think it’s food stamp recipients.

• TJIC and Coyote Blog talk about “big picture jobs,” adding real value through real work, and what Scott Greenfield would call the “Slackoisie” that is much of my generation (I hope not to fall in with that crowd).  We have critiques of  recent NY Times letter-writer Arielle Eirienne, Washington Post interviewee “little-miss-altruist Beth Hanley,” and “big-picture jobs” and the people who think they should have one.  They use lots of harsh words (well, TJIC does), but honestly… they’re right, painful as it may be for some of my contemporaries (heck, a number of my former classmates) to acknowledge.

• Let’s talk safety.  It’s important, right?  Important enough to flex some muscle and shut down a business just for the hell of it?  Coyote finds that some agencies would say “yes” to that.  Toyota and the NHTSA, in a move that didn’t surprise those who cared to think about the issue, announced that virtually all of the so-called “sudden acceleration” issues are attributable to driver error “pedal misapplication.” Whoops.  Coyote asks “how safe is safe enough” in the context of dioxin, pointing out that new EPA efforts at regulation are probably superfluous, as is their existing safety standard.  Lastly, can we afford to hire government employees to supervise children’s dietary intake?  What’s scary is that there are people out there who take the question seriously.

• Doctors aren’t the only ones who deal with emergencies.  There is such a thing as a legal emergency as well.  Why not regulate emergency legal services in the same we that we do emergency medical care?  Of course, like physicians, sometimes lawyers can be breathtakingly, hilariously incompetent.

• Economic mismanagement was a common theme this past week.  From EconThoughts we have Obama’s Dirty Dozen; InsureBlog explains how his state is implementing the PPACA’s high-risk pool provision (not very well, it seems).  Coyote explains why a government program’s popularity is a terrible metric by which to judge it, just as high corporate profits can sometimes spell bad news for the larger economy.

• Ending on a lighter note, we have an interpretation of Toy Story 3 as a libertarian-inspired parable, and an animation of an orthopedist consulting with an anesthesiologist.  “There is a fracture.  I need to fix it.”  Hilarious.
  

The Audacity of Ignorance

I’ve been reading through the Cato Institute’s new white paper on the new health reform bill. The PPACA does a lot of different things, so it was helpful for me to see detailed exposition and analysis of most of the whole thing in one document.  There’s a lot in there to digest, particularly regarding the potential long-term impact of the CLASS Act (long-term disability insurance) program, but the passage that really caught my attention was this [in the section dealing with consumer-directed health plans, PDF page 20]:

President Obama has always been hostile to consumer-directed health care.  In his book, The Audacity of Hope, for example, he  dismisses health savings accounts as being based on the idea that people have “an irrational desire to purchase more than they need.”

Let’s leave aside the question of whether people make decisions perfectly rationally, even when dealing with health, life, and death.  Let’s even set aside the question of whether HSAs are a positive market development (my take is that they are, but that’s neither here nor there for this post).  Is it really so inconceivable that people might want to purchase more medical goods and services than they “need?”

Apparently we now live in a world in which moral hazard doesn’t exist, demand curves don’t slope downwards, patients never demand antibiotics for their colds, super-gee-whiz-ultra-shiny-full-body-CT-scans aren’t regarded as “newer and shinier” by consumers, and the RAND Health Insurance Experiment never occurred, among numerous other things that seem to have changed.

Somehow I don’t think that I’m the one who missed the memo.

Around the Mediverse: May 7, 2010

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

• This past week saw lots of discussion of primary care, its role, and its future.  Dinosaur talks about the different skills needed for diagnosis vs. treatment, and ill-care vs. well-care in the context of NPs and PAs filling the primary care void that medical students are shying away from.  A guest post at KevinMD talks about how concierge care can be a boon for internists and their patients alike.  Dr. Rob discusses the long-term relationships that primary care physicians can forge with their patients, and how that affects both the physician and patient.  The Placebo Journal Blog explains why it doesn’t buy into the idea of e-mail communication between physician and patient… at least not in this legal environment. Dr. Bob Centor posted 4 pieces touching on the theme of primary care revitalization in the context of internal medicine.  He argues that policy wonks misunderstand the causes of practice variation, and even the nature of primary care itself.  He explains how being “out of flow” can be damaging to physician morale, and implicitly to physician supply.  Finally, he proposes a change in the nature of internal medicine practice to one more closely resembling that found here in Canada:  that of a consultant.

• I like the idea of “concierge” medicine, even though there are many vocal opponents of the concept.  I reject their argument that it is necessarily something that will limit itself to the richest and best-off in society.  I present to you PartnerMD and Qliance.  Much more has been written on Qliance here, here, and here.

• I used to be a fan of “more regulation” until I realized that the costs of compliance are very real, especially for small businesses (say, small independent medical practices).  Coyote points out that the new healthcare bill imposes a whopper of a new tax filing requirement on all businesses… one whose passage is a scary commentary on the state of the legislative process.  Relatedly, the Volokh Conspiracy tells us that provisions in the new financial reform bill could screw up medical practices that allow their patients to pay on installment.  All of a sudden, Dr. Rich’s conspiratorial rhetoric becomes the tiniest bit more believable.  Payment plans are a great way to make out-of-pocket payments accessible.  Get rid of those…

• The Volokh Conspiracy had a series of eloquent posts on Harvard Law School’s Emailgate, all to be found here.

• Also in the Harvard Square area, two of my favourite economists take on the question of “price gouging” in the context of the recent water main break in Boston.  Relatedly, two bloggers at Volokh Conspiracy address recent research that suggests that people who lean left are more likely to be uninformed about economics.

• Economists like to say that their field is a science.  There’s some legitimate disagreement on that point.  There really shouldn’t be any such debate about the nature of such things as homeopathy and the anti-vaccine movement.  It’s unfortunate that there still is.  Megan McArdle discusses homeopathic WMDs in the first link, and Science-Based Medicine answers all of your anti-vaccine loaded questions in the second.

• There’s been a lot of anger directed at Wall Street recently.  Someone there decided to direct a little bit back to the rest of us.  Enjoy!

• Maggie Mahar at Health Beat Blog argues that our society is suffering from “cancerphobia” and an accompanying “epidemic of diagnosis.”  If I weren’t already persuaded of these points, this would have convinced me.

• There’s always a lot of talk about Medicare and Medicaid, but this past week brought us talk from CMS.  Health Affairs conducted a roundtable discussion with past heads of CMS.  The transcript is fascinating; the conversation touches on political and funding dynamics within the agency and department, the mechanics of anti-fraud activities, the implementation of reform, how physicians were ignored, and how Don Berwick will fit within the agency.  From the CMS of the present, we get the Chief Actuary’s report on the PPACA, summarized by John Goodman.  It really does not look pretty.

• Science-Based Medicine discusses “Big Pharma,” and explains the FDA regulations that require drugs to “belong” to a disease… something that I didn’t previously know.

• InsureBlog discusses the travails of a health insurer offering a so-called 100% HSA/HDHP.  I have to wonder, from an economics point of view, whether people will be more judicious in their spending even though the money originally came from someone else (i.e. their HSA was topped up for them).  Endowment effects and whatnot.  If that is the case, and if the insurer can get the premium right to reflect the relative injudiciousness relative to “true” out-of-pocket spending, then this model could be a very real alternative to the current mainstream of first-dollar medical coverage.

• What are economics bloggers worried about?  Mark Perry lets us know.

• Hospitals tend to be big fans of pain charts, and making sure that pain is not overtreated.  Not everyone feels the same way about childbirth.  Amy Tuteur argues that the latter group are in fact demeaning the women they purport to want to empower.

• Finally, a tale of a near-mugging in Warsaw, and the compassionate and hilariously profanity-laced response of the local police.  Language most definitely not work-safe, and not family-friendly.

Around the Mediverse: April 28, 2010

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

• Remember that big fuss over companies restating their earnings to reflect changes in tax treatment of various Medicare Part D subsidies?  Remember how Henry Waxman was about to hold hearings in which he could grill the responsible CEOs for daring to suggest that the PPACA might not be all unicorns and rainbows?  Well, it turns out that they were right and he was wrong.  Who would have thought?

• This week a new fuss, one with a great deal more legitimacy in my eyes, was kicked up by Arizona’s new illegal alien legislation.  Free Exchange took on the question of whether open immigration is compatible with a welfare state / social safety net, a topic that gets a good deal of discussion among libertarians who tend to favour the former and oppose the latter.  Two Canadian bands almost came to Twitter-blows on the subject… sort of… in what is one of those stories that would only happen in Canada, and only be reported in the Toronto Star.  On the flip side, there was also discussion of the effects of how the idiosyncratic way in which the US defines tax residency encourages some to renounce citizenship.  I can personally attest to the arcane maze into which US tax residency determination can degenerate with very little effort.  Not fun.

• Going back to the subject of Congressional hearings, two bloggers at the Economist explain why Goldman Sachs and the financial services industry generally aren’t as evil as people seem to want them to be.

• There’s been a lot of talk about reforming physician pay and medical organization, but not a lot of emphasis on new and innovative models of health insurance provision.  (As I discuss in this post, the PPACA will probably do more to ossify the present state of health insurance than anything else)  That’s why this post from the Health Business Blog, highlighting a value-based, market-oriented, real insurance offering in Fresno, CA is so heartening.

• WhiteCoat brings us the story of a case in which a physician was sued, and settled, for malpractice.  It sounds pretty vanilla until you read that the physician was out of the country at the time the alleged malpractice was committed by a supervisee midwife who failed to contact the physician covering for the one who got sued.  Malpractice affects physician behaviour through fear more than it does through changing actual risk.  With stories like these, is it any wonder that the fear is still there?  Also on the subject of lawsuits is this post by Amy Tuteur that suggests liability concerns as a major driver of increases in C-section rates.

• There’s been some interesting discussion on the question of bartering with physicians.  I can’t say that I endorse the idea wholeheartedly, but it has its place in a free market to the extent that it’s accepted.  For two takes on this issue, see this post at Movin’ Meat, along with the first comment, and this comment at the WSJ Health Blog.

• Apropos to today’s earlier post on the importance of “business” to physicians’ roles in medical practice come articles explaining common myths about entrepreneurship, myths about capitalism more generally, and how the tale of the Lorax can be interpreted as a message about the importance of clearly defined and enforceable property rights.

• Video of Margaret Thatcher’s last Question Time as Prime Minister.  Epic.  Also epic is Macbeth’s decision to seek the advice of a physician concerning the whole Macduff prophecy thing.

• Scott Greenfield at Simple Justice is probably my favourite lawyer I’ve never met.  Two of his posts from this past month, taken together, explain the reasons for my own discomfort with the way the victims’ rights movement is playing out in the US and Canada.

• Ed Glaeser takes on the real-life consequences of preservationism gone mad in New York City.

• Jason Shafrin at Healthcare Economist has made some pretty pie charts detailing the breakdown of Medicare and Medicaid expenditures on categories such as physicians, hospitals, drugs, etc.  While I knew intuitively that physicians constitute a small piece of the pie, it was still surprising to see it represented visually.  It also suggests a way to win over skeptics of various payment reforms:  if, as it seems, much of the cost of certain types of physician care is incurred downstream (as opposed to fees paid to the physician), then payment reform that seeks to lower overall costs by changing incentives should also be able to guarantee higher income for those types of physicians.  Call it gainsharing, maybe?

• Bringing “Around the Mediverse” to a close for the week is this post from the Health Business Blog that features a HIT company that thinks that technology should be adapted to the physician’s workflow, not the other way around.  It saddens me that it’s refreshing to see this from someone in the HIT field.

You’ll also notice that A Cartoon Guide to Becoming a Doctor has been added to my blogroll and to the links on the sidebar.  If you’re looking for more visual stimulation from your medblog collection, that’s a fantastic place to get it!

Around the Mediverse: April 21, 2010

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

• Dinosaur, at her new blog, has another post explaining her position that palliative care need not be a subspecialty operating the way it does now.

• The econoblogs might offer this as an example of “markets in everything:”  publicly funded programs in WA have to compete for funds. (via Reason’s Hit & Run blog)

• Over the past couple of weeks I’ve been following a fascinating debate on the policy implications of behavioural economics over at the Volokh Conspiracy.  Here’s the article that started it all, a post at Volokh on libertarian paternalism more generally, a bit about regulators, and a discussion of Richard Thaler’s response to the criticism.  The collection of links here is one-sided, but if you haven’t already read Nudge, do so to get the other point of view (and more generally, you should just read the book).

• Also from Volokh is an intelligent take on the constitutionality (or lack thereof) of the personal health insurance mandate (there’s also video!)

• A Croatian patient wakes from a coma speaking fluent German.

• In discussing American wage stagnation, Richard Posner makes some excellent points about money-based vs. standard-of-living based approaches to measuring economic wellbeing.  He also proposes an interesting rationale for why an economic conservative/libertarian may want to pragmatically support government-led reductions in wage inequality.  Relatedly, Jeff Miron takes on the question of libertarian-friendly anti-poverty spending programs.

• Edwin Leap discusses one of the frequently ignored drivers of Emergency Department use:  other physicians.  To be fair, most of those other physicians would probably cite liability concerns, and most of those could do so legitimately.   Still, it’s something to keep in mind when looking at ED utilization patterns.

• Megan McArdle and the WSJ Health Blog discuss the recent moves by some health insurers to reclassify expenses to satisfy new rules requiring minimum medical-loss ratios.  In my view, things like nursing hotlines and wellness programs are “medical” expenses moreso than “administrative,” but reasonable people disagree.

• Dr. Grumpy keeps us abreast of the latest developments in psychoanalytic psychology.

• John Tierney gives us “7 New Rules to Live By” for Earth Day, demolishing pervasive myths about organic food, GMOs, and nuclear power.  I’ve been harping on about these for the last couple of years (especially the first two) to anyone who would listen, so it’s gratifying to see that my views on the issues aren’t completely crazy.

• Coyote brings us an example of a proponent for creating another of my least favourite types of “rights:”  positive rights to someone else’s goods or labour.  In this case, the “right” being bandied about is an alleged “positive right to travel.”  The comment was made at a conference with no direct policy implications, but the existence of that thought at the higher levels of EU is terrifying (but unsurprising).

• Of interest to anyone who may want to start a small medical practice in the next few decades, Overlawyered brings us information about proposed new restrictions on so-called “angel investors.”

• Hit & Run drills down a bit on something about last weeks maternal mortality statistics that didn’t get too much attention elsewhere (at least not in any of the newspapers or blogs that I follow):  some women’s health advocates tried to get the data held back for political reasons.

• Closing out this week’s edition is a post at InsureBlog that explains why the new health insurance exchanges might not work so well after all (via last week’s Health Wonk Review).

Also of note is the addition of Bittersweet Medicine, a relatively new addition to the mediverse, to the list of blogs that I follow and to the links over to your right.  Of immediate interest is the series on overrated medications (for instance, statins).  Hopefully there will be more of those in the future!

Around the Mediverse: April 14, 2010

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

• A letter to the editor of The Economist tells that “[t]he so-called precautionary principle is, in the words of risk-expert Bill Durodié, “an invitation to those without evidence, expertise or authority, to shape and influence political debates. It achieves that by introducing supposedly ethical or environmental elements into the process of scientific, corporate and governmental decision-making.”

• The Legal Satyricon asks if drunk driving (sans collision/fatality) is a victimless crime (via the New York Personal Injury Law blog)

• The propensity of the US Congress to spend time and resources “investigating” issues of little policy import (at least in my opinion) never ceases to amaze me.  First it was steroid use in Major League Baseball.  More recently we saw hearings to investigate the application of generally accepted accounting principles.  Now, we have investigations into an airline that has the temerity to charge passengers for carry-on baggage.

• Bob Centor points out that increasing medical school enrollment won’t be enough to solve projected future shortages of physicians, especially in primary care.  He looks at increasing the number of primary care residency slots and improving pay for primary care physicians and residents.  I would argue that this might not even go far enough:  if the slots are there, who’s to say they’ll be taken unless the job gets much better than it is now?

• Eugene Volokh tells of litigation that arose after an accident victim was mistaken as dead many, many, many times.  I’m not one to second-guess decisions made under tricky circumstances (well, maybe I am), and I’m all for reducing “unnecessary medical tests” (whatever those are), but can it really hurt to double-check the pulse?

• Economix explains the real reason for the original Boston Tea Party.  In a similar vein, Cracked.com recently featured an article on other little-known facts about the American independence movement.  As always, Cracked.com uses language not safe for work.

• An alternate take on schizophrenia from a behaviourist perspective, entitled “Schizophrenia Is Not An Illness.”  Provocative?  To someone like me with only limited exposure to “traditional” approaches to mental illness, yes.  The three-part series makes some interesting points and is well worth the read.

• In 1964, President Lyndon Johnson placed an order for new pants.  The tape and transcript of the phone call are … quite something.  Be warned that LBJ uses graphic language to describe the desired specifications of the pants being ordered.  He also belches without saying “excuse me,” and admits to carrying a knife to work.

• A lot of health care revolves around providing reassurance and peace of mind (kinda like real insurance is supposed to, but that’s another topic for another day).  Sometimes that’s for the patient’s benefit and sometimes for the physician’s.  Oftentimes, it’s for both.  Of course, peace of mind can be an expensive thing to come by.   This story from ACP Internist illustrates this perfectly.

• There exists a jurisdiction not too far from Florida that has recently imposed a health insurance mandate on some of the people present there.  Those subject to the mandate who don’t already have insurance will have to buy a product that doesn’t cover pre-existing conditions and features payout caps.  Guess where this is, I challenge you!

• Don’t believe everything you read online, even from a somewhat-reputable source.  This is especially true when it’s AOL recommending “medical tests that could save your life.”  Or not.

• Reason explains, in graphical form, a subject near and dear to my heart:  US immigration law.

• And finally for this week, hot off the presses internets, the Library of Congress announces that it will archive every public tweet, ever.