I don't understand the title, this writer performs the act of "getting healthcare is dangerous" after she reports on healthcare?
I get that she "stops dieting", which is something different, I guess, from her normal behavior, and sure, the writer probably does start ignoring new health studies after reporting on healthcare, but then the list of seven things becomes just paragraph titles, completely unrelated to the original heading of the story...
I'm all for grabbing extra pageviews, but this format wasn't well executed, given the content.
I like the "stop dieting" and graph about what causes vs protects against cancer. The "don't get healthcare" is ridiculous though. But then again, especially in the US unnecessary back surgeries for example are insanely common...
Read it carefully - the chart implies roughly equal weighting between 'cause' and 'prevent' for some foods, but the axes are scaled very differently either side of the dividing line.
I believed they are scaled equally. Each 'step' from the middle indicates an increase or decrease in risk by a factor of 2. If you're at 0.5, you're half as likely to get cancer; 2, twice as likely. 0.1 is 10x less risk, 10 is 10x more risk.
The graph was also created by Vox and includes the words 'cause' and 'prevent' for exaggeration, but the individual studies mostly imply correlation.
"First of all, some studies are just poorly designed or hopelessly biased. Second, even the best individual studies have their flaws and limitations. This isn't because all science is bad or untrustworthy. It's because it's an iterative process, and it takes many studies to get at the truth of the matter. Individual studies will almost never give the final word on a particular question. That's just how science works."
It's pretty basic, but I think a lot of people lack this insight and it causes them to lose faith in all of science when they see contradictory studies.
I don't know about the author, but I buy my insurance not for my yearly cholesterol checks, but in case I need to hop on a plane and get treatment at a major medical center.
Narrow networks are unequivocally bad for people needing specialist care, which happens to be the main reason for health insurance.
I wouldn't be trusting Vox for reporting on anything important like Healthcare. Anyone who tries to sell you the idea that a "narrow network" is better has no idea what they are talking about.
Nobody buys their insurance for yearly cholesterol checks.
They think they do, and a lot of the ecosystem (providers, employers, politicians) reinforce that idea, but it's not something that actually exists.
That's because regular, routine costs (like new tires for your car) are NOT underwriteable. You can't insure for them, nor can you buy insurance for them.
If your insurance company is providing new tires every year or giving you wellness checkups every year, you're paying cash money for that somewhere. Even though they say it's an insurance benefit. It's not. Because math.
It's very difficult to have any kind of discussion about this when even this most basic of accounting identities is misunderstood.
To be fair, annual checkups (of many varieties), are not covered solely because people can't math.
If an annual checkup reduces the risk of a high-value payout then it makes very much financial sense for the insurance company to pay for the annual checkup for you, as an incentive for you to get one.
In fact, if the average insuree is very unlikely to pay directly for an annual checkup and the annual checkup helps to reduce the likelihood of high-dollar-value insurance claims, then it is reasonable for a "free" annual checkup plan to be cheaper than one that does not offer such "free" benefits.
Note: I am not disagreeing with your statements that the insuree is definitely paying for regular costs, nor that people don't math well. I am just raising some of the nuance around what behavior makes sense for an insurance company given irrational insurees.
Actually, if the insuree is rational, it especially makes sense for the insurance company to pay for the annual checkup. If the insurance company only covers me when I get really sick, I lose money by going for the annual checkup -- I'm "better off" waiting to get really sick, and then having them cover all of my expenses.
Just an addition: rationality in economics assumes a logical[0] ordering of preferences and behavior which maximizes value within this ordering.
[0] Think transitivity: I prefer A to B and I prefer B to C; I must not prefer C to A. There's more nuance, but this is enough for the intuition. Without this ordering, maximizing value makes no sense.
"Narrow" doesn't mean "inadequate". It just means that instead of having access to 75% of doctors in your area, you only have access to 25%. But you still have multiple specialists in each area, and you still have hospitals you can go to. Most people don't even scroll past the first page of results in a doctor search anyway, so would having access to 200 dermatologists provide much difference versus having access to 50?
Very little of what we do in modern medicine can't be done by local hospitals. Most diseases have well-understood treatment protocols that don't vary much between hospitals or doctors. Cutting edge treatments are only necessary in a very small percentage of cases, which often increases costs because if a hospital has a new piece of expensive equipment, they're going to be more inclined to use it, even in cases where it's not necessary and the old technology is better understood.
There is a false belief in this country that more health care or more advanced technology actually creates better outcomes for patients. In many cases, all the new technology creates are profits for the hospitals and medical device companies.
I live 20 minutes outside of New York City. I put up with an extremely high cost of living for easy access to the incredible resources of a great city. In my new, "narrow" plan, I can only see doctors in my home county. Outside of ER visits, I cannot see a single doctor within the confines of NYC. I've never had to make such a choice before.
For routine stuff, my local doctor is fine. But when I broke my ankle, I didn't go my local hospital. I went to one of the foremost orthopedic hospitals in the world. That, in a nutshell, is why I live where I live. But I could not do that under my current insurance.
Would my outcome have been any different if I'd seen a local doctor, as opposed to a world-class doctor? We'll never know, but I can't stand not having the option.
Couldn't you just buy your own private health insurance that does cover that doctor or hospital? I'm guessing it might be for the same reason your insurance company (or your employer) doesn't want to: it's too expensive for what you get.
I like having options too, I'd really like the option of driving a new mercedes instead of 14 year-old toyota, for the same amount of money, but I don't think it's my employer or anyone else's responsibility to make it happen.
Except under our current law, premiums have gone up by 50% in order to pay for subsidized insurance. So for the average person, they got hit with a huge price increase at the same time they saw a large decrease in value (access to specialists). http://www.forbes.com/sites/theapothecary/2014/06/18/3137-co...
In my case, a family member went to a local oncologist who prescribed a series of treatments. She went for a second opinion to MD Anderson in Houston (a few states away) and was told by their team this treatment was ludicrous and they prescribed an entirely different series of treatments. My family member is now just fine, but if they had stayed with the local specialist who knows. But if I get sick I want access to places with the best long term survival rates, not whichever doctor happened to move next door.
The new laws had nothing to do with the price increases; rapidly increasing premiums coupled with reduced benefits are a trend that stretches back to the mid-90s. Obamacare actually caused a temporary slowdown in premium hikes, though they have since picked back up to the previous pace. I don't have the data in front of me right now, but I've looked it up in the past enough times.
And yes, Obamacare did increase costs for young, healthy people. But one day, those young, healthy people are not going to be so young or healthy; and the system will need new young, healthy people to help subsidize the cost of health care for the old and sick.
Or to put it another way: if we as a society don't want to deny life-saving health care based on a person's ability to pay, we have to make everyone pay all the time. And honestly, it's cheaper overall if people have less hesitation to go to the doctor and get their medical issues treated before they become serious and life-threatening, so we should pay to treat the non life-threatening conditions as well because it's a better use of money.
But here's the thing: while a broken ankle may not be routine for you, it is routine for pretty much any orthopedist.
It's simply not sustainable to have every person in the NY metro area all want to go to the same hospital when they break their ankle.
But if you want to understand the real problem, ask yourself by what criteria is the "foremost orthopedic hospital" considered better? I know this will sound insane, but most medical quality metrics for hospitals and doctors don't take patient outcomes into account. Due to a combination of HIPAA rules and the way follow-up care is often performed by practitioners from multiple hospitals/private practices/therapists, it's nearly impossible to track patient outcomes even if you wanted to.
So if the quality of a hospital isn't determined by patient outcomes, what is it determined by? The government uses a combination of patient volume, malpractice claims, accident rate, rate of hospital acquired infections, cost efficiency, scheduling availability and survey data (they're more concerned about cost effectiveness as it relates to Medicare than anything else). For any other source, the hospital probably just paid a bunch of money to be listed in the top spot on a "top orthopedic hospitals" list.
If you're going to write an article with highlighted, bolded, enlarged exerpts to distract me from the main text, could you please put those exerpts in the right place? It's really jarring when I'm reading something about health insurance only to be interrupted with some segue about dietary studies that would have been more relevant 10 paragraphs earlier.
I don't think you'll really find a definitive answer on saturated fat. Reason being we know that foods very high in saturated fat are not healthy, but there are no natural foods with zero saturated fat (that I know of) so it's hard to imagine saturated fat is "unsafe at any level" like lead, which makes it much more difficult to handle.
Consider this: People are different. The answer may be specific to you.
One area that's getting some awareness in the literature is that some people are normally sensitive to insulin and some people are resistant to it. Now, I'm not talking about the people with conditions like hypoglycemia and diabetes. I'm talking about regular people have different insulin responses.
This means that the carb/protien/fat makeup of a given diet is going to have different results in the two groups of people.
IF you don't control for that in a study, you'll get confusing and inconsistent results.
Further, these studies are just at the level of "fat" not individual oils and the micronutrients.
It's possible coconut oil is very health for some people as part of a specific diet and terrible for other people as part of a different diet (or even the same diet.)
Consider this: many diseases correlate strongly with obesity.
Obesity correlates strongly (well, causates, but causation -> correlation even though correlation -!> causation) with calorie consumption.
Calorie consumption correlates strongly with food consumption of all types.
People who eat more (saturated fat | coconut oil | salt | carbohydrates | fat | protein | the brain tissue of Emperor Penguins that have naturally died) tend to eat more food, which leads to obesity, which leads to health problems.
Basically more studies need to control for obesity. It's appalling how few do.
Regarding #3. The advise I get from my family (5 people in the medical field) is that hospitals will kill you. You go to the hospital to fix your problem and get out as fast as you can. You will heal faster at home and you will sleep better too.
this. I broke my ankle a few years back and needed surgery, the staff in the recovery room were surprised that I discharged myself the same day rather than stay overnight, and didn't look especially happy when the reason I gave was that I didn't want to get sick.
Wow, this made me realize journalists can really write about anything without being concerned about spreading harmful, false information. I don't get the feeling the author has gained a more responsible approach to writing, just fresher blurbs to put in their health articles.
Journos are - near universally - holding themselves to lower standards than we expect them to be.
At the more respectable papers and wire services, standards will be OK but with quality lower than someone well informed on the topic would be pleased with. (Time crunch, lack of experience in the topic domain, lack of access, etc)
The largest problem is that they don't correct faulty reader expectations. They're going to write authoritative articles and demand to be taken seriously even if they write for Gawker.
Blogs exist somewhere on a scale between "owned by WaPo" to "basically a tabloid that isn't printed on a broadsheet to tip you off." They generally tell themselves their standards are good enough to call themselves "Journalists" but but have glaring "It's OK if I X" holes where it actually matters for what they cover.
I'm surprised there's so much hating on this article. I guess it's not the most original thing ever, but I think most of the points (with the possible exception of #8) are pretty well known and accepted. Fad diets are mostly crazy, overuse of antibiotics is rampant and harmful, overscreening can be a problem...
Maybe intent was good, but some advices are harmful. For example, 1 and 7. While in general it's not lie, but they can lead to thoughts "eat everything you want, just try to eat more "healthy" things, and "don't go to screenings at all".
If you tell someone to be careful not to fall off the right side of a bridge, and they then run away and fall off the left side, does that mean your advice was harmful?
Just because someone might overreact doesn't mean you shouldn't warn them.
I'm dubious about the "over-screening" problem. At the moment it may be that we would overreact to every pre-cancerous spot. But surely once we're used to screening and have done the studies over years, we'll know which cancers can be ignored and which ones need to be treated. [This assumes of course that whole body screening can be made very cheap and easy]
If you look for problems, you will find them. Medicine is a science, but it's not an exact science, so something that's a problem in one person may be normal for another person. There are also so many external factors that go into a diagnosis and recommendation that a simple scan can never give the whole story. Most often doctors do tests just because they can bill for them and it increases the amount of money they make per patient -- this is one of the biggest reasons the US spends so much on health care.
And there's no effort going in to doing these studies you describe. Sure, someone somewhere may be doing something, but there's not a critical mass of dollars behind it like there are in pharmaceuticals, medical devices, etc. Health care privacy laws also make it nearly impossible to do these kinds of studies. I used to work for a startup that tried this -- they eventually found a market in Canada and Europe but they ended up going under along with all of their competitors because nobody is willing to pay for these types of studies unless you can prove either a cost reduction or improved quality of care at the same cost.
Look at the thyroid cancer graph: over twenty years the detection rate has increased by about 15x without any concomitant decrease in mortality.
With any diagnostic measure, you must ask whether the information it produces is actionable. If anything, they way you've phrased it is backward: first we find a new treatment (via research) and once it gives us an action to perform, then we can justify the screening. If catching a cancer earlier helps, screen. If not (prostate or breast screenings too early in life), don't.
Obviously if you have family history, risk factors, or something with high specificity like a BRCA mutation, you treat. But many of those things are discovered with a simple history/physical (H&P), which is the important screening your primary physician should be performing.
But notice that pretty much every screen has a false positive rate. So some percentage of the healthy people screened are going to be incorrectly told that their sick, and therefore get treated for an illness they don't have. The more people you screen, the more that's going to happen. And when the treatments are things like surgery, chemotherapy, radiation, etc, that's a pretty big deal.
Also, not everything that shows up in a screen was going to be a problem. It could be that it might have never been a problem. Quoting Wikipedia about mammography:
>> While this ability to detect such very early breast malignancies is at the heart of claims that screening mammography can improve survival from breast cancer, it is also controversial. This is because a very large proportion of such cases will not progress to kill the patient, and thus mammography cannot be genuinely claimed to have saved any lives in such cases; in fact, it would lead to increased sickness and unnecessary surgery for such patients.
Medical friends here advise against the modern day trend of getting lots of tests "just in case" - even routine scans in healthy people can flag up unrelated stuff, which then causes stress, and potential for unrequired further tests and invasive procedures.
One chap in the office went in for a well-man scan, ended up thinking he was going to die due to a tangent one doctor took him on (turned out to be a boring congential thing; he was perfectly healthy with it).
When you have a problem, sure, get it checked. But, don't go looking for problems and tests for problems!
41 comments
[ 3.2 ms ] story [ 54.9 ms ] threadI get that she "stops dieting", which is something different, I guess, from her normal behavior, and sure, the writer probably does start ignoring new health studies after reporting on healthcare, but then the list of seven things becomes just paragraph titles, completely unrelated to the original heading of the story...
I'm all for grabbing extra pageviews, but this format wasn't well executed, given the content.
If I already knew these seven things, am I qualified to be a healthcare reporter for Vox?
The graph was also created by Vox and includes the words 'cause' and 'prevent' for exaggeration, but the individual studies mostly imply correlation.
It's always a good idea to ask your doctor "what happens if we don't do anything? If I don't take these meds / have this surgery"
It's pretty basic, but I think a lot of people lack this insight and it causes them to lose faith in all of science when they see contradictory studies.
Narrow networks are unequivocally bad for people needing specialist care, which happens to be the main reason for health insurance.
They think they do, and a lot of the ecosystem (providers, employers, politicians) reinforce that idea, but it's not something that actually exists.
That's because regular, routine costs (like new tires for your car) are NOT underwriteable. You can't insure for them, nor can you buy insurance for them.
If your insurance company is providing new tires every year or giving you wellness checkups every year, you're paying cash money for that somewhere. Even though they say it's an insurance benefit. It's not. Because math.
It's very difficult to have any kind of discussion about this when even this most basic of accounting identities is misunderstood.
If an annual checkup reduces the risk of a high-value payout then it makes very much financial sense for the insurance company to pay for the annual checkup for you, as an incentive for you to get one.
In fact, if the average insuree is very unlikely to pay directly for an annual checkup and the annual checkup helps to reduce the likelihood of high-dollar-value insurance claims, then it is reasonable for a "free" annual checkup plan to be cheaper than one that does not offer such "free" benefits.
Note: I am not disagreeing with your statements that the insuree is definitely paying for regular costs, nor that people don't math well. I am just raising some of the nuance around what behavior makes sense for an insurance company given irrational insurees.
(the jargon rational economic actor maximizes value, not dollars)
[0] Think transitivity: I prefer A to B and I prefer B to C; I must not prefer C to A. There's more nuance, but this is enough for the intuition. Without this ordering, maximizing value makes no sense.
Very little of what we do in modern medicine can't be done by local hospitals. Most diseases have well-understood treatment protocols that don't vary much between hospitals or doctors. Cutting edge treatments are only necessary in a very small percentage of cases, which often increases costs because if a hospital has a new piece of expensive equipment, they're going to be more inclined to use it, even in cases where it's not necessary and the old technology is better understood.
There is a false belief in this country that more health care or more advanced technology actually creates better outcomes for patients. In many cases, all the new technology creates are profits for the hospitals and medical device companies.
For routine stuff, my local doctor is fine. But when I broke my ankle, I didn't go my local hospital. I went to one of the foremost orthopedic hospitals in the world. That, in a nutshell, is why I live where I live. But I could not do that under my current insurance.
Would my outcome have been any different if I'd seen a local doctor, as opposed to a world-class doctor? We'll never know, but I can't stand not having the option.
In my case, a family member went to a local oncologist who prescribed a series of treatments. She went for a second opinion to MD Anderson in Houston (a few states away) and was told by their team this treatment was ludicrous and they prescribed an entirely different series of treatments. My family member is now just fine, but if they had stayed with the local specialist who knows. But if I get sick I want access to places with the best long term survival rates, not whichever doctor happened to move next door.
And yes, Obamacare did increase costs for young, healthy people. But one day, those young, healthy people are not going to be so young or healthy; and the system will need new young, healthy people to help subsidize the cost of health care for the old and sick.
Or to put it another way: if we as a society don't want to deny life-saving health care based on a person's ability to pay, we have to make everyone pay all the time. And honestly, it's cheaper overall if people have less hesitation to go to the doctor and get their medical issues treated before they become serious and life-threatening, so we should pay to treat the non life-threatening conditions as well because it's a better use of money.
It's simply not sustainable to have every person in the NY metro area all want to go to the same hospital when they break their ankle.
But if you want to understand the real problem, ask yourself by what criteria is the "foremost orthopedic hospital" considered better? I know this will sound insane, but most medical quality metrics for hospitals and doctors don't take patient outcomes into account. Due to a combination of HIPAA rules and the way follow-up care is often performed by practitioners from multiple hospitals/private practices/therapists, it's nearly impossible to track patient outcomes even if you wanted to.
So if the quality of a hospital isn't determined by patient outcomes, what is it determined by? The government uses a combination of patient volume, malpractice claims, accident rate, rate of hospital acquired infections, cost efficiency, scheduling availability and survey data (they're more concerned about cost effectiveness as it relates to Medicare than anything else). For any other source, the hospital probably just paid a bunch of money to be listed in the top spot on a "top orthopedic hospitals" list.
(I still have no clue)
One area that's getting some awareness in the literature is that some people are normally sensitive to insulin and some people are resistant to it. Now, I'm not talking about the people with conditions like hypoglycemia and diabetes. I'm talking about regular people have different insulin responses.
This means that the carb/protien/fat makeup of a given diet is going to have different results in the two groups of people.
IF you don't control for that in a study, you'll get confusing and inconsistent results.
Further, these studies are just at the level of "fat" not individual oils and the micronutrients.
It's possible coconut oil is very health for some people as part of a specific diet and terrible for other people as part of a different diet (or even the same diet.)
Obesity correlates strongly (well, causates, but causation -> correlation even though correlation -!> causation) with calorie consumption.
Calorie consumption correlates strongly with food consumption of all types.
People who eat more (saturated fat | coconut oil | salt | carbohydrates | fat | protein | the brain tissue of Emperor Penguins that have naturally died) tend to eat more food, which leads to obesity, which leads to health problems.
Basically more studies need to control for obesity. It's appalling how few do.
At the more respectable papers and wire services, standards will be OK but with quality lower than someone well informed on the topic would be pleased with. (Time crunch, lack of experience in the topic domain, lack of access, etc)
The largest problem is that they don't correct faulty reader expectations. They're going to write authoritative articles and demand to be taken seriously even if they write for Gawker.
Blogs exist somewhere on a scale between "owned by WaPo" to "basically a tabloid that isn't printed on a broadsheet to tip you off." They generally tell themselves their standards are good enough to call themselves "Journalists" but but have glaring "It's OK if I X" holes where it actually matters for what they cover.
So exactly which part do you think is "harmful" and "false"?
Just because someone might overreact doesn't mean you shouldn't warn them.
And there's no effort going in to doing these studies you describe. Sure, someone somewhere may be doing something, but there's not a critical mass of dollars behind it like there are in pharmaceuticals, medical devices, etc. Health care privacy laws also make it nearly impossible to do these kinds of studies. I used to work for a startup that tried this -- they eventually found a market in Canada and Europe but they ended up going under along with all of their competitors because nobody is willing to pay for these types of studies unless you can prove either a cost reduction or improved quality of care at the same cost.
With any diagnostic measure, you must ask whether the information it produces is actionable. If anything, they way you've phrased it is backward: first we find a new treatment (via research) and once it gives us an action to perform, then we can justify the screening. If catching a cancer earlier helps, screen. If not (prostate or breast screenings too early in life), don't.
Obviously if you have family history, risk factors, or something with high specificity like a BRCA mutation, you treat. But many of those things are discovered with a simple history/physical (H&P), which is the important screening your primary physician should be performing.
Also, not everything that shows up in a screen was going to be a problem. It could be that it might have never been a problem. Quoting Wikipedia about mammography:
>> While this ability to detect such very early breast malignancies is at the heart of claims that screening mammography can improve survival from breast cancer, it is also controversial. This is because a very large proportion of such cases will not progress to kill the patient, and thus mammography cannot be genuinely claimed to have saved any lives in such cases; in fact, it would lead to increased sickness and unnecessary surgery for such patients.
https://en.wikipedia.org/wiki/Breast_cancer_screening#Critic...
When you have a problem, sure, get it checked. But, don't go looking for problems and tests for problems!