The KHIT Blog: Dr. Aaron Carroll on "Repeal and Replace"

Wednesday, January 25, 2017

Dr. Aaron Carroll on "Repeal and Replace"

From The Incidental Economist. One of my many requisite stops. Always fine content there. Nice summary of the GOP alternative propositions, including those of the controversial and contentious Trump HHS Nominee Dr. Tom Price.

The health space blogosphere is on fire this week with anxious speculation over the fate of "ObamaCare." See my prior post on the topic.

Meanwhile, The Celebrity Apprentice Administration is off to a wild, disconcerting start.

READING LIST UPDATE

I'm deep into this fine book.

Highly recommended, based on my study thus far. Interesting stuff therein on the intertwined topics of "big data" / "computational journalism." Relevant to health policy as well, given the new administration's reported week one federal agencies' gag orders.

My Pinterest Page characterization:

Among other things, an utter (albeit implicit, unintended) refutation of "Libertarianism," and concomitant validation of the ever-present Gresham's Dynamic risk.

There will be a nexus with these two books below, in addition to a number of other titles in my recent stash.

The new Trump administration is staffing up with Science Deniers at the cabinet level and taking early steps toward increased opacity.

UPDATE

What is the Scientists' March on Washington

Welcome! We want to thank you all for your incredible outpouring of support for this march. We are working to schedule a March for Science on DC and across the United States. We have not settled on a date yet but will do so as quickly as possible and announce it here.

Although this will start with a march, we hope to use this as a starting point to take a stand for science in politics. Slashing funding and restricting scientists from communicating their findings (from tax-funded research!) with the public is absurd and cannot be allowed to stand as policy. This is a non-partisan issue that reaches far beyond people in the STEM fields and should concern anyone who values empirical research and science.

There are certain things that we accept as facts with no alternatives. The Earth is becoming warmer due to human action. The diversity of life arose by evolution. Politicians who devalue expertise risk making decisions that do not reflect reality and must be held accountable. An American government that ignores science to pursue ideological agendas endangers the world.

Please bear with us as pull together our mission statement and further details. Many more updates to come on Monday.

Twitter: @ScienceMarchDC
Facebook: https://www.facebook.com/groups/1862739727343189/
Reddit: /r/scientistsmarch
Get Email Updates
To help: https://goo.gl/forms/zAdY02dBEz3Ykii42
Contact: scientistsmarchonwashington@gmail.com

Count me in.

For openers, concerned people minimally simply must closely read Shawn Otto's book "The War on Science." Reciting again the Amazon blurb:

"Wherever the people are well informed," Thomas Jefferson wrote, "they can be trusted with their own government." But what happens when they are not? In every issue of modern society--from climate change to vaccinations, transportation to technology, health care to defense--we are in the midst of an unprecedented expansion of scientific progress and a simultaneous expansion of danger. At the very time we need them most, scientists and the idea of objective knowledge are being bombarded by a vast, well-funded, three-part war on science: the identity politics war on science, the ideological war on science, and the industrial war on science. The result is an unprecedented erosion of thought in Western democracies as voters, policymakers, and justices actively ignore the evidence from science, leaving major policy decisions to be based more on the demands of the most strident voices.

Shawn Otto’s compelling new book investigates the historical, social, philosophical, political, and emotional reasons why evidence-based politics are in decline and authoritarian politics are once again on the rise on both left and right, and provides some compelling solutions to bring us to our collective senses, before it's too late.

We now perhaps stand on at precipice of a destructive U.S. "Soviet Science 2.0 / Lyskenoism 2.0" that bodes ill for every aspect of the STEM space (and beyond) in our country.

Our Science Denier in Chief:

Is Anyone Actually a Scientist?
Forget the terrible “I’m not a scientist” schtick. Trump’s comments on climate change suggest no one is a scientist.

My favorite Trumpism is “nobody really knows.” He says it all the time. Did Russia interfere in the U.S. presidential election? “Nobody really knows.” How big is ISIS? “Nobody really knows.” Why did President George W. Bush invade Iraq? “Nobody really knows.” How can we identify potential terrorists? “Nobody really knows.” Most of the time, “nobody really knows” means Trump doesn’t want to, or isn’t prepared to, answer the question. (That’s why he says it so often.)

Climate change is different. “Nobody really knows” is simply Trump’s official position on global warming. It’s one of the rare times he uses his catchphrase offensively, rather than to get himself out of a jam. He doesn’t say it with a shrug and a casual toss of his hands. He leans in. To borrow a well-worn phrase from Trump supporter(ish) Donald Rumsfeld, Trump considers climate change a “known unknown“—the fact is that nobody knows about it...

I don't think we can overstate the risk here. Time to push back forcefully.
____________

More to come...

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Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
___

"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[I]t is one small step from using the computer for "helping" doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the "good," facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
___

"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
___

"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
___

"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
___

"'Solutions' exist only in mathematics."

- Karen Martin
___

"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
___

"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
I cite a ton of news and web sources spanning the breadth of relevant technical and policy domains, sometimes at substantial length. I believe I remain well within the bounds of "Fair Use," as [1] I am not doing any of this for profit, [2] I always provide attribution and links -- which, [3] far from negatively impacting any copyright holders' commercial interests, might actually increase traffic to and interest in their offerings.

Nonetheless, should I post anything of yours regarding which you have any objection, just let me know and I will remove it forthwith.

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Wednesday, January 25, 2017

Dr. Aaron Carroll on "Repeal and Replace"

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