Opioids: Where Your Doctor Is Trained Impacts What He/She Prescribes for You

Standard

A new study by economists at Princeton University shows that where a doctor is trained effects the prescriptions he or she writes.

The study focused on opioids, and differences in prescription-writing between graduates of top and bottom-ranked medical schools. Key findings:

  • Doctors graduating from lower ranked medical schools write a much larger volume of opioid prescriptions than those from top medical schools.

From 2006 to 2014, “If all general practitioners had prescribed like those from the top-ranked school [Harvard], we would have had 56.5% fewer opioid prescriptions and 8.5% fewer overdose deaths,” said Janet M. Currie, the Henry Putnam Professor of Economics and Public Affairs at Princeton’s Woodrow Wilson School of Public and International Affairs. Currie conducted the study with Molly Schnell, a Princeton Ph.D. candidate in economics.(1)

  • Doctors who receive additional training in pain management write fewer opioid prescriptions than their peers.
  • Doctors trained in the Caribbean write more opioid prescriptions than foreign-born doctors trained elsewhere outside the US.
  • More recent medical graduates are writing fewer opioid prescriptions than are older physicians.  That again raises the question of how well some veteran doctors are keeping up with new trends and issues.

A counter-argument is that doctors lack good alternatives to opioids for management of pain.(3) However, according to the Princeton research, many doctors may simply not understand the choices they are making in writing a script or the options that may be available.

Why should the impact of training be limited to opioid prescriptions? Why shouldn’t it impact other treatment and drug choices?

What you need to consider:

The framed degree on your doctor’s wall is more than a decoration. You need to read it. If the degree is from a school with which you are unfamiliar, you need to get a conversation going about what other training he/she has taken. If the answers aren’t suitable, you need to consider finding another doctor.

A list of the top medical schools for primary care is available at

https://www.usnews.com/best-graduate-schools/top-medical-schools/primary-care-rankings

In the 2017 rankings, the top 20 for primary care (there are separate rankings for research, but the focus in this article is on patient care) are (4):

  1. University of Washington
  2. University of North Carolina – Chapel Hill
  3. University of California – San Francisco
  4. Oregon Health and Science University
  5. University of Michigan
  6. University of California – Los Angeles
  7. University of Minnesota
  8. (tie) Baylor
  9. (tie) University of Colorado
  10. (tie) University of Pennsylvania
  11. (tie) University of Texas, Southwest Medical Center (Dallas)
  12. University of California – San Diego
  13. University of Pittsburgh
  14. (tie) University of Massachusetts – Worchester
  15. (tie) University of Wisconsin – Madison
  16. Harvard University
  17. University of Nebraska
  18. (tie) University of California – Davis
  19. University of New Mexico
  20. East Carolina State University (Brody)

 


Sources:

  1. Molly Schnell, Janet Currie. Addressing the Opioid Epidemic: Is There a Role for Physician Education? NBER, August 2017 DOI: 10.3386/w23645
  2. Princeton University, Woodrow Wilson School of Public and International Affairs. “Doctors trained at lowest-ranked medical schools prescribe more opioids.” ScienceDaily. ScienceDaily, 14 August 2017. <www.sciencedaily.com/releases/2017/08/170814134811.htm>
  3. Malcolm Thaler, MD, “Why Is Opioid Addiction Happening to So Many of Us?” Live Strong, 29 August 2016. http://www.livestrong.com/article/1012275-opioid-addiction-happening-many-us/?utm_source=aol.com&utm_medium=referral&utm_content=opioid-addiction-happening-many-us&utm_campaign=AOL-Wellness
  4. https://www.usnews.com/best-graduate-schools/top-medical-schools/primary-care-rankings

 

Situational American Morality

Standard

A new study from the University of Illinois at Chicago has implications for both politicians and advertisers — and should scare anyone who cares about ethics.

The study involved having consumers

. . . read a political monologue about federal funding for Planned Parenthood that they believed was previously aired over public radio.

Respondents were randomly assigned one of two feedback conditions where upon completion they were informed that the monologue they had just read was either true or false.

Consumers were then asked whether they felt the monologue was justified. The bottom line:

  1. If the consumer agreed with the monologue, they were less critical of it, regardless of whether they were told it was true or false.
  2. If the consumer disagreed with the monologue, they were more critical of it regardless of whether they were told it was true or false.

In other words, in today’s America, it doesn’t matter if someone is telling the truth or lying as long as the consumer agrees with what they are saying. Functionally, that’s a blank check for a politician or advertiser to say anything as long as it includes something the consumer wants to hear.

Unfortunately, this “culture of lying” has consequences. It affects where people want to live, work and spend their money.

As an Airbnb host, we’ve been getting an earful from foreign travelers who don’t want to live here as well as workers who are asking for transfer back to their home countries. We have a doctor who views the level of medical errors in the US as unacceptable and disgusting. We have the Irani who says that, if she becomes ill, she will return to Iran for treatment rather than seek treatment in the US. We have a mother from Europe who is leaving so her daughter won’t become “Americanized”. We have the black teacher who grew up in the US and now works in Saudi Arabia, and says that her quality of life is better there than it ever was in the US.

We have the realtor from Kansas who lives in an American enclave near Mexico City and has seen a 41% increase in sales to Americans moving south this year. Mexico claims that it has 2 million Yanquis living there, most undocumented immigrants. South Korea has close to 1 million Yankee civilians; there are other large pockets in UK, Saudi Arabia, Costa Rica, Australia and other countries. The US Government itself is mum on the number of Americans leaving the country. (All of these numbers exclude military and government personnel stationed outside the US.)

A primary complaint among expats is that they want to escape what the US political culture has become. That brings us back to our topic — the moral acceptability of lying.

For some of us, lying remains unacceptable regardless of the excuse.


Sources:

  1. Allison B. Mueller, Linda J. Skitka. Liars, Damned Liars, and Zealots. Social Psychological and Personality Science, 2017; 194855061772027 DOI: 10.1177/1948550617720272
  2. University of Illinois at Chicago. “We tolerate political lies for shared views, study suggests.” ScienceDaily. ScienceDaily, 3 August 2017. <www.sciencedaily.com/releases/2017/08/170803145640.htm>

The Latest Bearing Sign for the US Economy

Standard

The Federal Highway Administration reports that highway travel has declined from theben_franklin last quarter of 2016. That fits with weak consumer spending data from the first quarter of this year — but is a surprise to many economists.

Retail sales at gasoline stations are down 4.8% from this time a year ago. Those sales include gasoline, snacks and other items stations sell.

In reporting this, the Wall Street Journal speculates on a number of possible causes, including immigration enforcement.

The Journal doesn’t cite two obvious causes:

  • The decline in tourist visits to the US — down 16% from a year ago, and
  • Uncertainty about healthcare costs that may be causing consumers to cut spending.

The drop-off in tourism affects all industries that serve tourists:

  • Hotels and recreational facilities
  • Transportation, including air, rental cars and gasoline
  • Restaurants

The decline in this industry is a big deal and affects a lot of jobs as well as city and state tax  revenue.

It doesn’t look like consumer spending is going to drive economic growth.  If it doesn’t, is there anything else that can? Historically, the answer largely is no.

Further, Trump has alienated trading partners who might be interested in seeing our economy recover — Mexico, Canada, China, Germany. The downside of “America First” might be “America Alone”.


Sources:

  1. “Americans Tap Breaks on Driving,” The Wall Street Journal, 27-28 May 2017, p. B12.
  2. Kate Taylor, “Tourism in the US has drastically declined since Trump was elected,” Business Insider, 17 May 2017. http://www.businessinsider.com/trumps-rhetoric-hurt-us-tourism-and-retail-2017-5

How Safe Is Your Kitchen?

Standard

An exploration of a sample of kitchens in Philadelphia by a research team at Drexel findsth that most have serious food safety violations that could affect the health of those who cook and eat there. How does yours compare?

The study: the researchers visited 100 homes with a visual checklist that inspectors use for health inspections for restaurants.

What they found:

  • In 97% of the homes, raw meat was stored improperly. In some cases, juice from the raw meet was dripping down on ready-to-eat food.
  • In 43% of the homes, raw meet was stored at an improperly high temperature, allowing bacteria to flourish.
  • Traces of pests were found in 65% of the kitchens.
  • Fecal coliform bacteria was present in 44% of the kitchens.
  • E. coli was found in 15% of the kitchens.
  • At least one foodborne pathogen was discovered in 45% of the kitchens, and 12 percent had more than one type. Listeria was found in 15%.

The key problem areas were sinks, sponges, dishcloths and refrigerators set to a too-high temperature.

Recommendations:

  1. Check the temperature setting for the fridge.
  2. Microwave your sponges for one minute each day.
  3. Disinfect the sink.
  4. Wash hands before handling food.

Common sense would be nice, too!

It’s hard to complain about healthcare costs when we’re making ourselves sick!

Disclosure: My son attended Drexel University; I’ve very impressed with that school.


Sources:

  1. Patricia A. Borrusso, Jennifer J. Quinlan. Prevalence of Pathogens and Indicator Organisms in Home Kitchens and Correlation with Unsafe Food Handling Practices and Conditions. Journal of Food Protection, 2017; 80 (4): 590 DOI: 10.4315/0362-028X.JFP-16-354
  2. Drexel University. “Most home kitchens in Philadelphia study would earn severe code violations: Bacteria-laden sponges and poor raw meat storage main culprits.” ScienceDaily. ScienceDaily, 9 May 2017. <www.sciencedaily.com/releases/2017/05/170509132844.htm>.

ACA Repeal: Here we go again

Standard

According to one report, VP Pence has offered three changes to the repeal bill to win Freedom Caucus support for the Trumpcare bill:

  • Elimination of requirements for what insurers must cover
  • Eliminating coverage for pre-existing medical conditions
  • Eliminating limits on what insurers can charge people with medical conditions

Whether the bill can retain any support among moderates in the GOP with these changes is questionable. These provisions will cause problems for hospitals and healthcare providers, and result in more people having no health insurance coverage, and may allow a sharp increase in insurance prices for consumers, as the Congressional Budget Office has predicted.

This simply makes a terrible bill worse.


Sources:

  1. Marlene Satter, “Freedom Caucus would support health care bill that kills 3 ACA provisions,” BenefitsPro, 10 April, 2017. http://www.benefitspro.com/2017/04/10/freedom-caucus-would-support-health-care-bill-that?kw=Freedom%20Caucus%20would%20support%20health%20care%20bill%20that%20kills%203%20ACA%20provisions&et=editorial&bu=BenefitsPRO&cn=20170413&src=EMC-Email_editorial&pt=Consumer%20Driven%20PRO

What the CBO Report on the American Health Care Act Actually Says (updated)

Standard
rollover082712
Photo Courtesy of Holden Police Department

By now. most people have seen headlines or soundbytes about the report.  The Congressional Budget Office is a nonpartisan group. The head of the CBO was actually appointed by the GOP. The purpose of the office is to provide Congress with a source of “objective” information about the financial impact of legislation that is independent from information provided by the Executive Branch. In a complex world, this actually makes sense.

 

What the CBO report actually says:

  • Health insurance costs for individuals will under the new act (the AHCA is also known as “Trumpcare”), will increase through the year 2020 and may decrease after that.  The CBO expects increases in health insurance premiums under the new law of between 15% and 20% for 2018 and 2019 under the new law.  However, the CBO argues that by 2026, premiums might be 10% lower than under the ACA.
    • Some professionals refer to these as “hockey stick” forecasts, with a positive result occurring sometime in the remote future.  That could happen, but usually unforeseen events preempt the desired result.
  • Healthcare costs should decline for people in their 20s, but will increase sharply for older Americans.  The proposed tax credits will be insufficient to cover the cost increase.
  • The CBO estimates a $337 decrease in the Federal deficit from the AHCA law, mostly due to the repeal of Medicaid expansion and the end of subsidies for health insurance.  (As noted, the tax credits are smaller than the current subsidies.)  That averages out to about $33.7 billion per year.
    • The current US deficit is $441 billion in the current fiscal year.  Obviously, any reduction is good, but a savings of less than 10% of the deficit isn’t a cause for celebration.
    • The US budget deficit is expected to expand by over $10 trillion over the next decade, after shrinking during the Obama administration.
  • The Medicaid rollback will cost 14 million people their healthcare coverage immediately.  That plus the increase in out of pocket expense will ultimately mean that 24  million people will be forced to do without health insurance.
    • The CBO expects that some states will lose Federal funding for Medicaid in 2020 by their failure to provide the matching funds required under the new law.  That will further reduce Federal spending.
    • The matching funds requirement simply moves part of the tax burden from the Federal government to the states, and may require increases in state taxes.
  • Existing law requires the CBO to provide guidance on the impact of the law on the economy.  However, the CBO claims it has not had sufficient time to do this.
    • My argument is that anything that takes money away from consumers will be a drag on economic recovery.  This law does, by raising health care out-of-pocket expenses for most people.

Sources:

  1. Congressional Budget Office, “Cost Estimate,” 13 March 2017.  https://www.cbo.gov/publication/52486 I’ve downloaded a pdf of the report from the CBO website, and will share it on request.
  2. Emily Stephenson, “U.S. deficit forecast to shrink in 2017 but climb over next decade,” Reuters, 24 January 2017.  http://www.reuters.com/article/us-usa-congress-budget-idUSKBN158217

The Employee Benefits Divide

Standard

There are immense divisions in US society:ben_franklin

  • Rich versus poor
  • More educated versus less
  • Old versus young (ageism lives)
  • Urban versus rural (fading since most people live in urban areas, but still very real)
  • Ethnic and racial

We can add big employer versus small business to the list.

Large employers are adding benefits for employees that small businesses simply can’t afford.

American Express announced an increase in paid parental leave to five months with added surrogacy and IVF benefits, and Ernst & Young expanded parental leave from three to four months for parents of all genders and added adoption, fertility and surrogacy benefits.

Basically, if you have fertility issues, it really pays to work for one of these large financial services firms.

The larger division is a shift in focus in large companies from the cost of benefits to the total well-being of the employee. That shift has benefits for these companies in terms of worker retention and productivity.

Small companies pay a price for their focus on cost in terms of employee turnover, learning curves for new employees that affect productivity, and errors that affect customer relationships. However, they simply can’t afford some of the benefits that large companies can offer. Nor do they get the favorable pricing for benefits that insurers give to their largest clients.

The size divide isn’t clean. There are small companies that recognize how important their employees are.  I know of one diner (a class of eatery for which New Jersey is famous) that offers a good benefits package to staff, but that’s unusual in food service establishments.

Conversely, large retailers tend to treat employees as replaceable. In one recent study by the ACSI, retailers closing stores were seeing improvements in customer satisfaction ratings. My guess is the stores that were  under-performing had the lowest individual store ratings for customer satisfaction, but the ASCI data aren’t sufficient to address that.  Why not? Minimum wage employees with limited benefits and no career path aren’t motivated to deliver for customers. People do what they are incented to do.

What you need to consider:

  • Students need to think about the kind of company for which they will work in the future.  College is less optional if benefits matter.
  • Small businessmen need to get creative about ways they can invest in employees. The old mentality that “having a job is sufficient motivation” is simply a way to guarantee mediocre staff. Good people can always find another job. When there is turnover, the best are the first ones out the door.

Sources:

  1. Ann Clark, “Top 5 best work benefit trends for 2017,” BenefitsPro, 6 March 2017. http://www.benefitspro.com/2017/03/06/top-5-best-work-benefit-trends-for-2017?kw=Top+5+best+work+benefit+trends+for+2017&et=editorial&bu=BenefitsPRO&cn=20170312&src=EMC-Email_editorial&pt=Benefits+Weekend+PRO&t=employee-paid&page=2
  2. American Customer Satisfaction Institute, “ACSI: Retailers Improve Customer Satisfaction Amid Store Closings,” 28 February 2017. http://www.theacsi.org/news-and-resources/press-releases/press-2016/press-release-retail-2016