I recently produced a film, called "Money-Driven Medicine," based on the book of the same name by Maggie Mahar, which looks at the way that our business model for medicine has badly damaged the patient doctor relationship.
"What's that?" you may say. I thought that it was those damn government bureaucrats that were trying to get in between me and my doctor.
Well, the director of this film, Andy Fredericks, followed doctors all over the country who are deeply frustrated that the current system, whose goals favor profits over good, efficient and humane health care. In one scene, for example, a hospital refuses to share a possibly life-saving protocol with another hospital for fear it would lose its "competitive advantage." In many other sequences, doctors complain that, in the current system, they are forced to embrace wasteful and expensive (and extremely profitable) procedures while patients wonder why it is that they can quickly get expensive tests - like MRIs - but have to wait weeks to see primary care physicians (who are the most in demand) because so few doctors can afford to become general practitioners.
"Money-Driven Medicine" explores how a profit-driven health care system squanders billions of health care dollars, while exposing millions of patients to unnecessary or redundant tests, unproven, sometimes unwanted procedures, and over-priced drugs and devices that, too often are no better than the less expensive products that they have replaced.
More than two decades of research done by the Dartmouth Institute for Health Policy and Clinical Practice reveals that one out of three roughly one-third of our health care dollars - or nearly $600 900 billion of the $1.7 $2.6 trillion that we spend annually - is wasted on products and procedures that provide no benefit to the patient.
"But this isn't just a waste of money. This is hazardous waste - waste that is hazardous to our health," says Mahar, a healthcare fellow at the Century Foundation where she writes the healthbeat blog.
"When a patient is subjected to an ineffective treatment he is, by definition exposed to risk without benefit. We need to squeeze this waste out of the system. If we do, we have enough money to provide high quality, affordable and sustainable care for everyone."
Here's a clip from the film, in which Dr. Don Berwick, warns about the dangers of an unregulated competitive "war," in which, too often, the patient is "collateral damage."
In the days ahead, as insurance companies and pharmaceutical firms try to prevent any "government interference" in health care, it will be important to remember, that the goal of our health care system is not to reward providers; it is to deliver the best and most cost-effective health care to patients. Assuming that profit-oriented corporations always have patients' best interests at heart could be a fatal mistake.
Trump’s greatest gift to the GOP may be the distraction he’s provided from other party meltdowns.
Even though 2016 appears to be the year of painful, public disqualification from higher office, you may be forgiven for not noticing the extraordinary implosion of New Jersey Governor Chris Christie. After all, the Trump surrogate and White House Transition chair has benefitted from his early endorsement of the Republican presidential nominee in unusual fashion: Christie’s power in the Grand Ole Party has decreased, rather than increased. The likelihood of a plum position in the Trump administration—Attorney General, perhaps, since Christie was spurned as the Republican running mate—is decidedly dim, what with the presently apocalyptic predictions about November 8th.
Instead, Trump’s gift to Christie has been shadow: the top Republican’s national meltdown has obscured that of the one-time rising Republican star and sitting New Jersey governor. But make no mistake—Christie’s is a fall of epic proportions, precipitated by an unfathomably petty revenge plot. The contrast of the two, the top-heavy-ness of the fallout compared to the insignificance of the initial transgression, would be comic, were it not so tragic. Remember that in November of 2012, Governor Christie had a 72 percent approval rating. Today, it stands at 21 percent.
Some researchers believe that the microbiome may play a role in regulating how people think and feel.
By now, the idea that gut bacteria affects a person’s health is not revolutionary. Many people know that these microbes influence digestion, allergies, and metabolism. The trend has become almost commonplace: New books appear regularly detailing precisely which diet will lead to optimum bacterial health.
But these microbes’ reach may extend much further, into the human brains. A growing group of researchers around the world are investigating how the microbiome, as this bacterial ecosystem is known, regulates how people think and feel. Scientists have found evidence that this assemblage—about a thousand different species of bacteria, trillions of cells that together weigh between one and three pounds—could play a crucial role in autism, anxiety, depression, and other disorders.
The rise of Donald Trump has left the speaker of the House, and the Republican Party, in an almost impossible situation.
What happens to the Republican Party after November 8, particularly if Donald Trump loses? One clue comes from a recent Bloomberg Poll: When asked which leader better represents their view what the Republican Party should stand for, 51 percent of likely voters who lean Republican or identify as Republican picked Trump, while 33 percent picked House Speaker Paul Ryan (15 percent said they weren’t sure.)
Paul Ryan: The highest ranking Republican elected official, the former vice presidential standard bearer, perhaps the leading elected policy intellectual in the GOP, who is now being attacked regularly by the party’s current presidential standard bearer; who has Breitbart.com calling him a secret supporter of Hillary Clinton, and Sean Hannity calling him a “saboteur” who needs to be replaced; who has both conservative Freedom Caucus members and other discontented Trump-supporting colleagues ripping him and threatening to vote against him when the vote for Speaker occurs on the House floor on January 3 next. The Paul Ryan, who has struggled manfully to walk the fine line between Trump supporters and Trump himself, getting distance from Trump without renouncing him, and who has tried even harder to turn the focus to the policy plans of his House party.
Services like Tinder and Hinge are no longer shiny new toys, and some users are starting to find them more frustrating than fun.
“Apocalypse” seems like a bit much. I thought that last fall when Vanity Fair titled Nancy Jo Sales’s article on dating apps “Tinder and the Dawn of the ‘Dating Apocalypse’” and I thought it again this month when Hinge, another dating app, advertised its relaunch with a site called “thedatingapocalypse.com,” borrowing the phrase from Sales’s article, which apparently caused the company shame and was partially responsible for their effort to become, as they put it, a “relationship app.”
Despite the difficulties of modern dating, if there is an imminent apocalypse, I believe it will be spurred by something else. I don’t believe technology has distracted us from real human connection. I don’t believe hookup culture has infected our brains and turned us into soulless sex-hungry swipe monsters. And yet. It doesn’t do to pretend that dating in the app era hasn’t changed.
In the 1970s, a new wave of post-Watergate liberals stopped fighting monopoly power. The result is an increasingly dangerous political system.
It was January 1975, and the Watergate Babies had arrived in Washington looking for blood. The Watergate Babies—as the recently elected Democratic congressmen were known—were young, idealistic liberals who had been swept into office on a promise to clean up government, end the war in Vietnam, and rid the nation’s capital of the kind of corruption and dirty politics the Nixon White House had wrought. Richard Nixon himself had resigned just a few months earlier in August. But the Watergate Babies didn’t just campaign against Nixon; they took on the Democratic establishment, too. Newly elected Representative George Miller of California, then just 29 years old, announced, “We came here to take the Bastille.”
In the Republican nominee’s nostalgia-fueled campaign, older voters see their last chance to bring back the 1950s. But he could be starting to lose them, too.
PANAMA CITY, Florida—The crowd at the Donald Trump rally was a sea of gray and white. They hobbled on walkers and canes into the massive outdoor amphitheater, searching for a place to sit on the lawn.
They were old enough to remember a different America—an America that was great. A place of strength and confidence, where men were men and women were women, where people respected the flag and their elders and prayed to God. That was not the America they saw today.
"I am 72 years old and I have seen our country absolutely fall apart," Jim Smith, a gray-haired grandfather with an eagle on his T-shirt, told me. Smith retired to the beach after a career in the Army that took him all over the world; at one point, he worked for NATO running logistics in Bosnia. But today, he did not like what he saw all around him.
Just why was Tom Hanks dancing in a black-and-orange suit on Saturday Night Live so funny?
This weekend’s episode of Saturday Night Live offered a mini masterpiece: a gloriously silly Halloween-themed piece revolving around a “Haunted Elevator” ride and its unusual star attraction. Beck Bennett and Kate McKinnon played a couple looking for spooky thrills who instead found something far more bewildering: a pumpkin-suited man who would randomly appear alongside two cheerful skeletons and perform a dance routine. “Who are you?” asked a frustrated Bennett after the man (played by Tom Hanks) appeared for the second time. “I’m David Pumpkins!” came the reply.
McKinnon followed up: “Yeah, and David Pumpkins is … ?”
Answering a common question from a polarizing election cycle
Our major party candidates have historically high disapproval ratings. So I am often asked, usually by people in “blue” enclaves, “How can anyone vote for him?” and by people in “red” enclaves, “How can anyone vote for her?” Since I live in coastal California, and because so many more Americans presently intend to vote for Hillary Clinton, rather than Donald Trump, who is disapproved of by significantly more people, I hear “how can anyone vote Trump” more than the reverse.
And I myself could never vote Trump, so I get the confusion on some level––I might even share it if I hadn’t spent time with so many Trump supporters who are good people, not “deplorables” (though there is a faction of deplorable Trump supporters). Still, the answer I’ve started giving Clinton voters is probably as effective for similarly confounded Trump supporters. Without further ado, here it is:
For centuries, global differences in alcohol intake between men and women have been striking, with men consistently drinking several times as much as women.
The alcohol gap is a case of gender more than sex. Females and males metabolize alcohol somewhat differently, but the differences far exceeded any physiologic basis. Sharon and Richard Wilsnack, in the department of psychiatry and behavioral science at the University of North Dakota, wrote a comprehensive book on gender and alcohol in 1997, and according to them, differences in alcohol use have been central to societies’ symbolizing and regulating gender roles.
“Gender differences in alcohol consumption are found everywhere, to such an extent that they can be considered one of the few universal gender differences in human social behavior,” wrote researchers from Finland’s Alcohol and Drug Research Group in 2004. The Wilsnacks said as much again in 2009 after leading an international research collaboration on gender and alcohol in 35 countries: “More drinking and heavy drinking occur among men, more long-term abstention occurs among women, and no cultural differences or historical changes have entirely erased these differences.”
Rodrigo Duterte flew to China and signed billions in deals, said he would separate ties with the U.S., then took it all back.
Just what is Philippines President Rodrigo Duterte thinking? Last week Duterte visited with China’s leader, Xi Jinping, and then appeared to trample on his country’s relations with the U.S., telling 200 Chinese business leaders in the Great Hall of People, "In this venue, your honors, in this venue, I announce my separation from the United States."
"Both in military—not maybe social—but economics also, America has lost," he said.
The Philippines has been the U.S.’s closest ally in Southeast Asia since it became independent in 1946. It once celebrated its independence on July 4 (now June 12), and for a while that day was also called Filipino-American Friendship Day. Filipinos hold America in such high regard, in fact, they have a more favorable opinion of the U.S.than the U.S. does of itself. That’s why Duterte’s words have puzzled so many people: Are they the words of a politician who’s pitting two superpowers against each other? Are they another controversial comment from a man who specializes in them? Does this signal the end of the U.S.-Philippines relationship? Maybe. Yes. Too soon to tell.