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Archive for September, 2008

Tuesday, September 30th 2008

The Bailout Has Nothing To Do With Medicine


I Nominate Scott Adams For Secretary of the Treasury

A $700,000,000,000 bailout of the ‘troubled’ financial sector failed a House vote yesterday. God willing, although we’re probably not so lucky, no rescue package will ever see the light of law.

The cries against the bailout seem to be getting louder or, more likely, simply more attention. And they should because the bailout is a terrible idea.

I’ll spare you a verbose defense of my claim above. I’m not smart enough and plenty have made arguments I agree with in published op/eds. Consider Jeffrey Miron’s on CNN right now (here’s his blog

[A] bailout transfers enormous wealth from taxpayers to those who knowingly engaged in risky subprime lending. Thus, the bailout encourages companies to take large, imprudent risks and count on getting bailed out by government. This “moral hazard” generates enormous distortions in an economy’s allocation of its financial resources.

Thoughtful advocates of the bailout might concede this perspective, but they argue that a bailout is necessary to prevent economic collapse. According to this view, lenders are not making loans, even for worthy projects, because they cannot get capital. This view has a grain of truth; if the bailout does not occur, more bankruptcies are possible and credit conditions may worsen for a time.

Talk of Armageddon, however, is ridiculous scare-mongering. If financial institutions cannot make productive loans, a profit opportunity exists for someone else. This might not happen instantly, but it will happen.

Further, the current credit freeze is likely due to Wall Street’s hope of a bailout; bankers will not sell their lousy assets for 20 cents on the dollar if the government might pay 30, 50, or 80 cents.).

Or this piece in Time Magazine

Let financial institutions fail, merge or be bought out. The faltering institutions will see their shares devalued and will be likely to be taken over by stronger institutions — as has already started happening. This consolidation of the financial sector is both efficient and inevitable; government action can only delay the adjustment. , which also makes good points.

Bankruptcy and consolidation in the financial sector is not a bad thing. Not with the way credit has been flowing. This country can afford, nay needs, a slow down. Sustaining the current lending spree is absurd.

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Thursday, September 18th 2008

Good To See Freedom Being Protected

The irony is killing me.

The Transportation Security Administration’s intrusion of individual privacy represents one of the biggest modern American civil liberty violations. Now their new primary operational center has been renamed the ‘Freedom Center’. I cannot make this shit up.


Can You Feel The Freedom Being Protected?

In anycase, here is the TSA on the renaming.

Sunday, September 7th 2008

"Better" Doctors Don't Mean Better Care


Wherein My MS Paint Skills Are Put To The Test

The more I read, the less I think the social scientists and policy wonks should have much to say about the delivery of healthcare in the United States.

True, I love policy debates, I love history, I love my amateurish attempts at economics. For this blog, I frequently cite and read the social sciences as if they were legitimate areas of study and had something meaningful to say.

But for the most part social science is a misnomer. Although guised up otherwise, things like sociology, political science, history, psychology, and even economics are typically not practiced as science but as philosophy.

I’ve been spurred to this piece by a blog post over at Overcoming Bias which is making its rounds across the social linking sites like Redditt and Digg. In the blog post Dr. Robin Hanson comments on a National Bureau of Economic Research working paper entitled, “Returns to Physician Human Capital: Analyzing Patients Randomized to Physician Teams.”

So I actually paid the five bucks and read the paper, but I want to first go over the fact that the paper is even drawing attention and what was said about it on Overcoming Bias,

[W]here data is silent I try to give medicine the benefit of the doubt, such as in assuming average values are higher than marginal values, and that top med school docs give more value than others. So I am shocked to report that in a randomized trial of 72,000 hospital stays by 30,000 patients, patients of top med school docs were no healthier

The question is where that expectation came from. No doubt, there are instances where very prestigious academic practices are sought out for specialty care or amongst the affluent.

But for the vast, vast, vast majority of care delivered in this country a prestigious name on a medical degree or a residency certificate means little. Certainly in terms of earning potential. Except in the fact that more prestigious schools send more students to competitive/higher earning specialties (which can be explained by the meritocracy of the system alone) and except in the fact that there are geographic differences in physician earnings, where you do medical school and where you train for residency have essentially no correlation to your future earnings as a physician.

You would think that if we, as a society, thought that “better” doctors delivered better care then the ultimate outcome would be in the way we reimbursed for healthcare. Alas.

My major point is that I’m not sure that this paper demonstrates anything that isn’t inherent to the understanding of the vast majority of Americans who make use of healthcare. For a former RWJF fellow to act so shocked at this kind’ve finding is a little surprising and may be an anecdotal demonstration of just how far non-healthcare professionals are from really understanding the non-quantifiable aspects of American healthcare.

I’m not sure why the paper was done or why anyone should be surprised by the results but on top of that the paper is full of flaws, mainly in its use of surrogate markers to try to define why group of resident physicians are “better” doctors.

The paper looks at a Veteran’s Affairs Hospital with teaching arrangements with two different internal medicine residency programs affiliated with two different medical schools. It looks at patient outcomes in patients treated by residents from the two different residencies. The paper considers one residency program considerably more prestigious, and its residents thus “better” doctors, than the other.

To probably most health care professionals the outcomes are not surprising. There are no outcome variations for the patients. Patients treated by the “better” doctors do not do better.

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Sunday, September 7th 2008

Tastes Like Cough Syrup…

Maybe I should stop drinking so much Red Bull.

[A]ccording to Dr. Scott Willoughby, of the Cardiovascular Research Center at the Royal Adelaide Hospital and Adelaide University, the results of the study were alarming.

“After one can it seemed to turn the young individual into one with more of the type of profile you would expect to see with someone with cardiovascular disease. People who already have existing cardiovascular disease may want to talk to their physician before they drink Red Bull in future,” the scientist said.

Okay, so the study is a joke with something like 30 participants and the reporting of it on this website is a joke as well…so maybe I’ll just keep chugging.