Tuesday, January 29, 2013

The Open and Closed Mind

More than three years after Sarah Palin made the false claim that the Affordable Care Act included “death panels” that would decide whether people would receive life-saving medical treatment, 40% of Americans still believe it. A new experiment by Brendan Nyhan, Jason Reifman and Peter Ubel considers the death panel myth in the context of the perseverance effect, a cognitive error in which people's beliefs about reality persist even though the evidence on which they were based has been discredited.

In one perseverance study, participants tried to distinguish between real and fake suicide notes. In fact, regardless of what they said, half the people were told they were right most of the time (the “success” condition), while the others were usually told they were wrong (the “failure” condition). Later, the participants were debriefed. It was explained that the feedback was false and that they had been randomly assigned to success and failure conditions. Even though they understood the debriefing, the “successful” people still believed they were better at the task than those who had “failed” thought they were.

Perseverance affects people's reactions to scientific studies that support or contradict their beliefs. Another experiment involved students with contrasting attitudes, some who believed that capital punishment was a deterrent to murder and others who rejected this claim. People in both groups read summaries of two fictitious studies, one which supported the deterrence hypothesis and one which didn't. You might think reading mixed evidence would lead people to moderate their beliefs. However, both pro- and anti-deterrence participants became more convinced of their original beliefs—a backfire effect. The two groups' beliefs became more polarized.

Perseverance studies seem to suggest that fact-checking politically biased claims is a losing effort. Recent research suggests that more educated and well-informed people show greater perseverance, since having more information allows them to explain away contradictory findings more easily. The Nyhan study is in that tradition. Here is Dr. Ubel explaining the study.


The chart below shows the results. On the left are the low knowledge participants. Without the correction, those who liked Palin believed the death panel myth, but the rebuttal was effective in disabusing them of this belief. However, the high knowledge Palin supporters believed the death panel myth more with the correction than without it. The correction backfired.


Just a word of caution. I was fully prepared to believe this study; however, the more I thought about it, the more I sympathized with the high information Palin supporters. The rebuttal to Palin's claim read (in its entirely) as follows:

However, non-partisan health care experts have concluded that Palin is wrong. The bill in the House of Representatives would require Medicare to pay for voluntary end-of-life counseling sessions, but there is no panel in any of the health care bills in Congress that judges a person's “level of productivity in society” to determine whether they are “worthy” of health care.

Should a well-informed Republican really be satisfied with this rebuttal? If I were in their shoes, I might want to ask some additional questions. Who are these “non-partisan experts?” The correction addresses Palin's claim about end-of-life counseling, but what about the Patient-Centered Outcomes Research Institute, which is charged with evaluating the effectiveness of medical treatments, and the Medicare Independent Payment Advisory Board, which is supposed to refuse to pay for expensive but ineffective treatments? How much indirect control will they have over the treatment patients actually receive? I personally hope these groups will help to eliminate wasteful procedures, but since they haven't met yet, we don't really know.

I'm not questioning the existence of perseverance, or that it makes researchers' lives a lot more difficult. However, another way to read this study is that well-informed people may require more detailed counterarguments than these authors provided.

Wednesday, January 23, 2013

Legalized Bribery

Ever wonder why health care costs so much in this country, and why we get such poor outcomes in return? Here's a small piece of the puzzle.

The New York Times reports that an obscure paragraph in the recent “fiscal cliff” bill extends a delay in implementation of Medicare price controls on Sensipar, a drug used by kidney dialysis patients, for two years. The drug is manufactured by Amgen. The delay will cost Medicare—and ultimately taxpayers—$500 million. The section of the bill (Section 762) is not tranparent and does not mention Amgen by name. It's one of many examples of pork that are buried in a bill that was supposed to reduce the deficit.

Here are the details. Currently, Medicare pays for dialysis drugs individually. They determined that this created an incentive to overprescribe medication that was useless and possibly harmful. The change, now postponed, was that Medicare would pay a single, bundled rate for dialysis treatment.  That was a threat to Amgen's profits.

According to the Times, this decision was made by Senator Max Baucus (D-MT), chair of the Senate Finance Committee, and Senator Orrin Hatch (R-UT), the ranking Republican on the committee. It was subsequently approved by Senate Minority Leader Mitch McConnell (R-KY) and Vice President Joe Biden, who negotiated the “fiscal cliff” agreement. Amgen has made over $5 million in political contributions since 2007, including $67,750 to Senator Baucus, $59,000 to Senator Hatch, $73,000 to Senator McConnell, and $141,000 to President Obama's two presidential campaigns.

Sen. Mitch McConnell
(or possibly a turtle)
The Times quotes aides to Senators Baucus and Hatch and an Amgen spokesperson as saying that the delay was justified because it would “give Medicare and health care providers the time they need to accommodate complicated changes in federal reimbursement for kidney care.” The price restraints were originally scheduled to begin in 2012. Congress granted Amgen a two year delay until 2014. The “fiscal cliff” bill extends that delay until 2016. How much time do they need?

An aide to Senator Baucus added that, “What is the best policy for Montanans and people across the country is at the heart of every decision Chairman Baucus makes.” But none of the people contacted attempted to justify the decision on medical grounds.

Amgen is the world's largest biotech corporation, with $15.6 billion in revenue in 2011. It has 74 lobbyists in Washington, including former chiefs of staff of both Senators Baucus and McConnell. Senator Hatch's leading staff member on health care policy is a former Amgen employee.

On December 19, Amgen pleaded guilty to illegally marketing Aranesp, an anti-anemia drug, for purposes the FDA had explicitly not approved. The $762 million settlement was a new record for a biotech company.

I think incidents like this pose a serious threat for single-payer advocates. One of the major arguments against single payer, which resonates strongly with the general public, is that the federal government can't be trusted to run a health care system that will provide quality medical care at a reasonable price. We usually try to counter that argument by pointing out that all other countries with single-payer systems achieve better health outcomes than we do at lower cost.

However, the United States is not like other industrialized countries. It's possible that our level of political corruption is so much higher than other countries as to make us not comparable to them. If so, it's impossible to predict how single payer would fare in this country. Of course, despite our corruption, Medicare is still cheaper than private insurance. However, if Congress ever passes a single payer bill, it is important that it contain safeguards that insulate the system from corporate and political interference.

Update (1/31/13)

The liberal organization Progressives United has latched onto this story and is asking people to sign a petition to the CEO of Amgen asking him to give back the $500 million. (Good luck on that!) The petition can be found here.

Coursera

You should be aware of a valuable resource that you can take advantage of free of charge on the internet. Coursera describes itself as a “social entrepreneurship company,” which makes college courses available online. They are offering 214 courses (so far) in virtually all academic fields, taught by professors at 33 universities.

Right now, I'm in my ninth week of a 12-week course, “Think Again: How to Reason and Argue,” taught by two philosophy professors, Walter Sinott-Armstrong of Duke University and Ram Neta of the University of North Carolina. There are three to nine video lectures each week. Each lecture is followed by an ungraded quiz. There are four graded tests, which determine whether you pass the course and get a certificate. If you flunk a test, you can retake an alternate version. There are discussion forums with other students. The textbook is optional, and I seem to be doing fine without it. Other courses are structured differently. Some require papers. The difficulty level seems to be comparable to a typical undergraduate course. I'm spending about an hour a day on average in this course.

There are several courses about health care policy. I'm planning to take “Health Policy and the Affordable Care Act,” taught by Ezekial Emanuel of the University of Pennsylvania. I'm also looking forward to “Introduction to Sustainability,” with Jonathan Tomkin of the University of Illinois.

Is anyone interested in my field, social psychology? You could take “Social Psychology” with Scott Plous of Wesleyan University, or you could take “A Beginner's Guide to Irrational Behavior,” taught by social psychologist Dan Ariely of Duke. I recommend both instructors. As a jazz fan, I'm intrigued by “Introduction to Improvisation,” by vibraphonist Gary Burton. Unfortunately, I don't play an instrument.

Lurking in the background is the question of how these “entrepreneurs” plan to make money out of this website. According to the New York Times, two possibilities are to charge colleges and universities for allowing their students to take these courses for credit, or to charge students whose universities will accept these courses as transfer credits. Of course, its also possible that they will start to charge their internet consumers directly. In the meantime, this is one of the greatest bargains on the web.

I'm Back

In August, I broke my hip—an injury I recommend that you all avoid, if possible. While the forced inactivity of recuperating from a broken hip might seem like an ideal time to blog, the injury had an unfortunate effect on my morale.

The experience hasn't been a total loss. I learned how unpleasant it is to be partially helpless. Being an invalid is at least a part-time job. My physical therapy routine takes a couple of hours each day, and routine tasks like showering and dressing were originally a chore. Most importantly, you need a lot of help and support. Thank you, Tina.

I also learned a few things about our health care system. I'm finding out how much everything costs. (Fortunately, it will almost all be covered.) I received a fair amount of overtreatment. Some of it can be attributed to an excess of caution, i.e., my hip was X-rayed far too many times. Other charges are simply bill-padding, i.e., the general practitioner who sticks his head in your hospital room for 15 seconds each morning to ask how you're feeling. Cost: $115 per day, $68.39 of which was actually paid ($54.71 by Medicare and $13.68 by me).

Finally, this was my first sustained experience with opiates and their side effects. While it's unrealistic to think I could have gotten through this injury without painkillers, at some point you have to stop taking the medication. I finally broke the habit due to a misunderstanding with my doctor. He implied that after I stopped taking the pills, he would allow me to drive. He didn't, but being able to feel my pain—and when it was going away—was a good thing at the time.

I've been driving for quite a while now, and I'm getting around pretty well with the aid of a cane, but when I go without it, I still walk with a limp. Full recovery is supposed to take 6 to 8 months, so I'll be seeing some of you in the Spring.

As in the past, I will cross-post any blog entries on Thinking Slowly that deal with health care policy here on the PUSH website.  In addition to resuming Thinking Slowly, I'm also hoping to realize my intention of starting a blog about jazz and blues music. I call it Blues and the Abstract Truth, and here's where you can find it. My posts may be intermittent for a while, but I hope to eventually get both blogs up to speed. Please bear with me.

Monday, January 21, 2013

New Podcamp Presentation on Social Media for Nonprofits Immediate Needs




Ali McMurtrie of Haitian Families First discussed at PodCamp her use of social media to aid relief efforts after the earthquake in 2010.  You can follow her on twitter at @alimcmutrie

Also David DeAngelo of the blog 2 Political Junkies and Jon Delano of KDKA Pittsburgh gave a good workshop on Old and New Media at PodCamp on how they get their message out.  You can see the talk here.



**Related Posts**

 

PodCamp 7 Presentation on Social Media for Non Profits

 

Crowdsourcing at Red Blue Voice.com

Saturday, January 19, 2013

Healthy Artists Julie Sokolow Featured on Michael Moore.com

Julie Sokolow's poster contest was a big success with the winning poster being featured at the right.  Her documentary film project Healthy Artists is featured on Michael Moore.com with an article by her and can be read below.  Other Healthy Artist videos can be seen here at the Videos from Healthy Artists tab above.

“Healthy Artists” Film Series Captures the Heart of Single-Payer

 

**Related Posts**


Healthy Artists Video on Bicyclists Injury

 

Santorum: No One Has Ever Died Because They Didn’t Have Health Care | The New Civil Rights Movement

 

Monday, January 14, 2013

Strengthening Medicaid Huddle

The Pennsylvania Health Access Network or PHAN will be having a strategy on the northside of Pittsburgh tomorrow with details below.  You can RSVP to the event here.  Gov. Corbett has decided not to create a statewide exchange and so far hasd not said how he will decide on Medicaid expansion.  So far 10 states have said that they are definitely not participating and five are leaning towards not participating.

Where the States Stand
Via: The Advisory Board Company

Strengthening Medicaid in Pennsylvania is a WIN, WIN, WIN for Everyone!
The Affordable Care Act provides new funding for states to make sure working and low-income Pennsylvanians have real security and stability in their health coverage. By accepting these new funds and strengthening our Medicaid coverage:
  • We could cover up to 682,000 uninsured Pennsylvanians and improve the health of the Commonwealth -- that's a WIN for health and wellness!
  • We would bring in $17 billion in new federal funding -- that's a WIN for our economy!
  • We would care for and increase the independence of thousands of seniors, children, families, and persons with disabilities -- that's a WIN for our moral character!


Tuesday, January 15th, 2-4PM at Bistro to Go
415 East Ohio Street, Pittsburgh, PA 15212 (near Allegheny General Hospital). Metered parking is available on street. A public parking lot is located nearby, at the corner of Middle and Foreland Sts. Find public transit options here. There is no cost to attend. Please RSVP!

**Update**

Yesterday Arizona Gov. Jan Brewer announced that her state will participate in Medicaid expansion.  Given that she has participated in the federal suit against the affordable care act and she has supported strong anti immigration laws in her state, her reversal suggests that there is hope for efforts in Pennsylvania.

**Related Posts**

The Supreme Pennsylvania Medicaid Decision

Medicare and Medicaid Are superior to private insurance in certain ways

Thursday, January 10, 2013

Sustainability Salon on Marcellus Shale Drilling





Last months Sustainability Salon on healthcare was such a success we had to announce the upcoming one this weekend at Maren Cooke's house on Marcellus Shale Drilling.  Details are below.  Please RSVP to her and ask for directions at maren.cooke@gmail.com

Well, we've survived the end of the world, the solstice and various other holidays rolled right along, and now we're in 2013!  It must be time for another Sustainability Salon.  In case anyone didn't get the word in my email of December 10th, the Salon originally announced for this Saturday was pushed back to next Saturday the 12th.

Note again that this one and the next won't focus on a single topic, but we will have some film screenings including Gas Rush Stories (by local filmmaker Kirsi Jansa, who will be here for Q&A) and the award-winning YERT film (likewise with Mark Dixon on hand).  Which film(s) will be on which date has yet to be finalized;  I'll send out another email late next week with that info.  But in both cases, we'll be here with the usual stimulating conversation, delectable potluck food and drink, and music-making through the evening.  Time is, as usual, 3-10 p.m.;  RSVPs are, as usual, strongly requested (for yesses and maybes, ideally by email with "salon" in the Subject line).

Happy new year to one and all,
 
-- Maren.