Book Club: An American Sickness

The U.S. healthcare system is a hot mess. Even people who know things are convoluted and expensive might not realize the extent: we pay far more for just about all aspects of healthcare here than anywhere else, and our outcomes are worse pretty much across the board (see this article from the Commonwealth Fund for details).  As tempting as it is to implicitly trust that you’ll get the best care in the world right here, the facts would suggest otherwise. Every other major developed economny in the world as some form of universal access. So why do Americans cling to the idea that our healthcare market is somehow sacred, and that a market-based approach is the answer? I’ve talked about why healthcare is not just another commodity before, but it’s still true.

Elisabeth Rosenthal, a physician turned journalist who has worked for the NYT and Kaiser Health News, wrote a book last year. In it, she exposes a lot of the causes and effects of the major malfunctions in our healthcare system. Much of this is illuminating— examples about hospital conglomerates and pharmaceutical pricing are spot-on. But what seems to lack punch is the explanation for why this upside-down, losing system persists. When healthcare is treated like every other business, greed drives, incentives are bonkers, and lobbyists shape policy. When healthcare is considered as a public service, things are different. But once powerful people are making obscene amounts of money, it’s nigh impossible to unring that bell. Are there market failures? Big time. Can the people affected muster enough influence to combat the big-money lobbying of professions and industry that have become accustomed to fat-cat money? Fat chance.

Aother quibble: Rosenthal is mercelessly physician-centric. She doesn’t consider the unique added value of team-based healthcare or other professional expertise, choosing instead to lump unique professions like NPs and PAs together as “extenders”. Barf. Dr. Rosenthal, I wish you’d take a broader view of health.

That said, give it a read. It’s interesting/depressing. And you might pick up some useful tips for your nex hospital visit, knock on wood.

What we talk about when we talk about research findings in the news

What happens when journalists report the findings of a scientific study to the general public? Often, the findings are stated out of context, broadly interpreted, and stripped of the nuance and uncertainty that characterize much of scientific research.  Should this scare us back from publicizing findings to a wider audience than you might typically find in a scientific journal? Or is publicity critical to uptake?

What is our responsibility as scientists to communicate our findings, not only through dedicated dissemination and implementation planning, but also through the popular press?

Here’s a recent example. JAMA published the findings of a study by Mandager et al.  on the association of cardiorespiratory fitness (CRF) with long-term mortality. CRF was measured by exercise treadmill testing in a sample of over 120,000 patients who were having this test done anyway as part of their care (that means these people were mostly being evaluated for symptoms potentially related to cardiovascular disease). The investigators quantified CRF as peak estimated METs. They separated by sex and age to calculate percentiles and then stratified CRF based on those percentiles. They used public and hospital records to determine mortality. Median follow-up was 8.4 years. The investigators concluded that CRF was significantly inversely associated with all-cause mortality (i.e., the fitter you are, the less likely you are to die). They went on to state that low CRF was as risky as or riskier than diabetes, CAD, or smoking. They also noted, importantly, that “there does not appear to be an upper limit of aerobic fitness above which a survival benefit is no longer observed”, but “there continues to be uncertainty regarding the relative benefit or potential risk of extreme levels of exercise and fitness”. They go on to offer several other sensible caveats, including that the study population may not be representative of the general population, and there are potentially significant unmeasured factors in this retrospective study. All things considered, though, this seems to represent very good news: a modifiable factor is strongly associated with increased longevity in a large sample with a long follow-up.  Bravo!

So how did this get reported in the popular press? Gizmodo’s headline reads “No Such Thing As Too Much Exercise, Study Finds”.

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The Badass Female Project: Tesseract Edition

Meg Murry is an early (1962!) female sci-fi heroine of children’s literature: Madeline L’Engle’s  A Wrinkle in Time is a true classic. I remember reading this book as a kid and really loving it, but I didn’t remember it as science fiction. Yet it clearly is. To me, that suggests how much it succeeds. And this is science fiction with some actual science— physics and time/space travel, inpsired by Einstein—  not with futuristic weapons and spaceships like so much of what we’re inundated with.

So, Meg: what makes her so compelling, keeping this book in the zeitgeist all this time? Meg is awkward, physically. She has no confidence herself, and she wishes she could fit in (like anyone who was ever a teenage girl). She’s smart but can’t always work the way she’s “supposed” to, she’s angry, she gets in fights (fiery!), she’s impatient.  She’s fiercely loyal to her brother and her father.  And like many other badass females, she ultimately relies on love and integrity to fight the power. She puts herself through what she knows will be difficult circumstances because she knows she is the one who can succeed. She never set out to be a hero, but she sure acts like one. Meg is counseled to rely on her “faults” when she needs them— and that she does, to great effect, rescuing her father and her brother from frightening forces of evil.

Frightening, indeed:

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high score screen

In praise of being a generalist

There’s something undeniably alluring about being highly accomplished at something. Being the best. Being at the top of your field, your game, your performance. But there’s an opportunity cost to this kind of excellence— the time and focus you dedicate to one thing, you are not dedicating to anything else. Can single-minded focus actually undermine your effectiveness? It depends on what you are doing. . .

Let’s think about this through the lens of running for a moment. We are not all 100m sprinters, even though that’s impressive, and you can win cash and medals and huge endorsements and titles like “the fastest man in the world.” But is Usain Bolt, impressive as he is, better at everything than you are? Is he a better human than you are? His speed is truly amazing, but it’s just speed. This is why obstacle course races are cool— you have to be fast, but you also have to be tough, have power, have strength, have skills. Even the crossfit games (as mixed as my feelings are about crossfit) are a good example of testing a broad set of competencies rather than a narrow one.

I’ve been thinking about this a lot because I am not, shall we say, a highly focused individual. I am curious, a bricoleur, a person who loves to say yes and follow side trails. My grandmother once wrote a poem about my twin sister and me, where she was the arrow and I was the hummingbird. She was a smart lady, my grandmother.  Continue reading

workspaces that work

What helps you be healthy, happy, and productive when you need to be in the zone— whether that’s at your job, in your creative workspace, or somewhere else? Many of us spend a ton of time working at our desks— almost as much overall as we spend in bed, sometimes. And as with sleep, work goes better if we get the environment right.

For me, a big piece is being able to move around. I fidget, shift position, stand, sit, stretch, cross/uncross my legs, squat, sit on the floor, sit in half-lotus on my office chair. . . as I’ve heard Kelly Starrett Say, the best position is the next position. While I’m all about the ergonomics experts who will adjust your mouse and your monitor and whatnot, I think the best solution is generally to avoid spending too much time in one position to begin with. Variations on office furniture that help this? Sitting on something like a ball instead of a chair, a standing/adjustable desk, a treadmill/bike desk, stools/footrests, and my personal favorite— the headset, so you can take calls while moving around.

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The Badass Female Project: She volunteers as tribute

Katinss Everdeen: Undeniably a badass. I am mostly interested in the first Hunger Games book— I found they got less interesting as the series continued. I thought the movies were fine (great cast!) but didn’t have anything of value to add to the books. Female author, check! But the movies? Written and directed by dudes. One great thing about The Hunger Games movies is that they allowed a prickly, young, female protaganist who was not treated as a sex symbol to lead. Yes, it’s true of the book, too, but it’s more unusual coming out of the Hollywood hit machine. But I’m a book person, when it comes down to it. So sue me.

Back to Katniss: she is willing to break rules from the get-go. She is quick to judge — and call out— injustice, which in her future world on the brink of rebellion, is everywhere. She has useful and subversive skills (archery? Neat. Foraging? Maybe even neater). She is undaunted by fear, perhaps to a fault. She isn’t ever cowed by authority (especially that which is taken, not earned). She also views herself as a protector and a provider, stepping into danger without thinking twice when she wants to help family or friends.  Even before she is pushed (or did she jump?) into the center of a major situation, she is subversive, slipping out of the allowed bounderies to hunt because food is scarce, and trading in the black market. She’s not concerned about acting like a “girl”, either— she’s willing to be the stronger and more skilled one, unlike a traditional female sidekick. She’s not submissive, she doesn’t need rescuing, and she (spoiler alert) doesn’t have to die for that sin. It’s a low bar, but clearing it isn’t all that common. Continue reading