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Health Costs, Health Policy, Medicine and Society, Public Health, Research, Stanford News

Competition keeps health-care costs low, Stanford study finds

Competition keeps health-care costs low, Stanford study finds

The term market competition usually sparks a mental image of business suits and ties, not white coats and stethoscopes. Yet even the health-care system plays by the rules of the economic market place.

A new study, conducted by Stanford researchers Laurence Baker, PhD; M. Kate Bundorf, PhD; and colleagues, provides important evidence that less competitive health-care markets are more likely to charge higher prices for office visits. The article was published today in The Journal of the American Medical Association.

There’s a push through the private sector and through Medicare to encourage the formation of larger practices, which could improve the efficiency of the health-care system, said Bundorf.  The researchers sought to understand what effect these larger practices have on health-care spending.

To make the comparisons, the researchers used a database to establish the prices paid by PPOs for the most commonly billed office visits within 10 physician specialties. Next, they adapted a standard economic competition measure to calculate physician practice competition for different U.S. regions.

As I wrote in a release today:

Studying a measure that averaged prices across multiple types of office visits, in their most conservative model, being in the top 10 percent of areas with the least competition was associated with 3.5 to 5.4 percent higher mean price. The researchers point out that in 2011, privately insured individuals in the United States spent nearly $250 billion on physician services. In that context, these small percentage increases could translate to tens of billions of dollars in extra spending.

The study’s findings show the importance of developing policies that will encourage a balance between the quality of care and health-care spending. As Baker explained, “Sometimes it can be tempting to say our goals for the health care system should be only about taking care of patients and doing it as well as possible – we don’t want to worry about the economics. But the truth is we do have to worry about the prices because the bill does come even if you wish it wouldn’t.”

Previously: What’s the going rate? Examining variations in private payments to physicians

History, Medicine and Society, NIH, Public Health

“Don’t go to bed with a malaria mosquito:” exploring World War II medical posters

"Don't go to bed with a malaria mosquito:" exploring World War II medical posters

After exploring Stanford’s collection of historical medical images last week after a tour of the School of Medicine, I got hooked. Hooked on historical medical images — a quirky interest tailor-made for the internet. Turns out the National Institutes of Health’s U.S. National Library of Medicine maintains a massive image library, one that includes some fabulous propaganda posters from World War II, including the lady mosquito with the alluring proboscis (above).

Others in the World War II poster collection focus on venereal diseases, recruiting nurses and doctors, encouraging blood donations and even curbing noise or visiting the dentist.

And that’s just World War II posters. Its Flickr collection is tantalizing, kicking off with a series of medical oddities reminiscent of Philadelphia’s Mütter Museum. It’s quite addictive – just warning you.

Previously: A trip down memory lane: Stories from the early days of the School of Medicine, #ACT4NIH seeks stories to spur research investment and Examining the impact of psychological distress on soldiers’ spinal injuries
Images courtesy of U.S National Library of Medicine

Medical Education, Medicine and Society, Neuroscience, Science, Stanford News

Studying science at Stanford is a dream come true for one California man

Studying science at Stanford is a dream come true for one California man

new grad students

Tawaun Lucas grew up in Compton, East LA, a city with a reputation – whether deserved or not – for producing gangsters, not neuroscientists. It’s a reputation Lucas just ignored.

A high-school athlete who dreamed of playing  in the NFL or going to the Olympics, the 22-year-old instead joined this year’s entering class of neuroscience graduate students at Stanford with a new set of aspirations.

Dreams change, Lucas explained me when I interviewed him for a story I wrote about the 135 new bioscience graduate students starting the fall semester at Stanford. As I describe in the story:

Lucas only changed his aspirations from sports to science after being sidelined by injuries his sophomore year at California State University-Northridge, where he was on a scholarship as a track athlete. But starting Stanford’s neurosciences PhD program is a dream come true, he said. “Stanford was always my first choice,” he said. “I applied to 12 schools.” When he got the acceptance call from Stanford, he said he nearly dropped the phone. “I almost teared up and cried,” he said. “It was surreal. I can’t even describe the experience.”

Lucas’s mother worked as a bus driver for the Long Beach school district. His dad was a maintenance worker. No one in his family went to college, and he wasn’t a particularly good student in high school, so the path to studying neuroscience at Stanford was an unexpected one. But programs for underrepresented minorities in the sciences helped him along the way, as did his own fascination with human behavior and the study of the brain:

His interest in science didn’t develop until his undergraduate years. He was living at home at the time with his parents, working as a bank teller while attending Cal State Northridge.  He began to turn his energies to academics when athletics was no longer an option. “Once I figured out what I wanted to do, I became focused,” he said. He chose to study psychology because the environment he grew up in had sparked his curiosity about human behavior. “I grew up in an urban area around some pretty crazy people who made some pretty weird decisions,” he said. “I began to wonder why do people, say, raised in Compton or Watts, for example, make different choices than someone raised in, say, Manhattan Beach? Is it socioeconomic? Psychological? Is there a genetic element?

Anthony Ricci, PhD, a professor of otolaryngology and member of the Stanford Neurosciences Institute, who played a role in encouraging Lucas to apply to Stanford and is part of an institution-wide effort to encourage diversity in the sciences, emphasized just how important diversity is to future advances in science:

“A person’s background is really important to how they think about a problem,” Ricci said. “If everyone were white, middle-class, Harvard-trained, they might think too much alike. Science needs people who think differently.”

Previously: First-year science graduate students enter brave new world and No imposters here: Stanford grad students reassured as they begin school
Photo by Norbert von der Groeben

Health Costs, Health Policy, In the News, Media, Medicine and Society, NIH

#ACT4NIH campaign seeks stories to spur research investment

#ACT4NIH campaign seeks stories to spur research investment

ACT4NIH_Samples_FINAL

No ice buckets are involved in the latest push for investment in medical research. Instead Act for NIH: Advancing Cures Today, a Washington D.C.-based non-profit led by a former National Institutes of Health staffer, is a good ‘ol fashioned media campaign using data, stories and images, including a haunting photo of a presumably sick child captaining its home page.

The need is real. NIH funding has failed to keep pace with inflation or with investments by other nations including China. Now, only one in six research proposals, the lowest ever, are accepted, according to Act for NIH.

The campaign’s goal is simple: “We advocate an immediate, significant funding increase for the NIH, followed by steady, predictable budget growth in the future.”

Not so simple, of course, is the actual funding hike. That’s why the campaign is hunting for stories, as well as money. It urges supporters to photograph themselves besides a ACT for fill-in-the-blank poster. ACT for cancer, for hope, my grandfather, for AIDS – you name the reason to support research, action (and money) is needed.

Science released an interview with leader Patrick White today. White admitted the group lacks a formal plan, but it does have momentum, thanks to the backing by real estate developers Jed Manocherian.

It’s launch comes just in time for the 2015-16 federal budget cycle, which usually begins with the president’s budget proposal in February.

Becky Bach is a former park ranger who now spends her time writing about science and practicing yoga. She’s an intern with the Office of Communications and Public Affairs. 

Previously: How can health-care providers better leverage social media to improve patient care?, NIH network designed to diagnose, develop possible treatments for rare, unidentified diseases and Federal investments in research and higher education key to U.S. maintaining innovation edge
Photo by Act for NIH

Events, Medicine and Society, Stanford News, Videos

How Stanford Medicine celebrated TEDMED

How Stanford Medicine celebrated TEDMED

Earlier this month, TEDMED, an annual global event dedicated to exploring the promise of technology and potential of human achievement in health and medicine, was held simultaneously in San Francisco and Washington D.C. Stanford Medicine served as a medical research institution partner for the event and hosted a reception to cap off Day Two of the three-day conference; the video above captures the evening’s activities and offers a taste of the future of biomedicine.

Previously: Abraham Verghese discusses stealing metaphors and the language of medicine at TEDMED and Stanford Medicine partners with TEDMED on “first-ever gathering on the West Coast”

Aging, Health Policy, In the News, Medicine and Society

No one wants to talk about dying, but we all need to

No one wants to talk about dying, but we all need to

“Dying in America is harder than it has to be.”

That’s the headline of one of the stories published following the release of the Institute of Medicine’s 500-page report titled “Dying in America.” The report tackles head-on the difficult topic of how to provide individualized, appropriate care for patients with advanced serious illness in a country that is grappling with out-of-control health care costs.

Patients should, and can, take control of the quality of their life through their entire life, choosing how they live and how they die

Its conclusion: The system needs a major overhaul.

“Our current system is broken,” said David M. Walker, co-chair of the 21-member committee that authored the report and former U.S. Comptroller General from Bridgeport, Conn. “It does not result in the type of quality of care that people deserve and desire and it’s much more costly. Systematic changes are needed for more compassionate, affordable care.”

No easy solutions exist, the authors said at an hour-long press conference announcing the release of the report yesterday. Instead, they plan to spend the next year getting their message out to the public with far ranging goals for change: from more comprehensive coverage of palliative care by medical insurance, to more hours of palliative care education in medical and nursing schools, to improved communication between health care providers and their patients about their end-of-life care choices – along with a payer-system that reimburses for those conversations.

It’s a controversial topic that broke out into the public debate five years ago during the passage of the Affordable Care Act, when opponents of the bill claimed that a proposal for Medicare to reimburse doctors for counseling patients about living wills and advance directives would lead to bureaucrats setting up “death panels” to determine who deserved care.

But it’s also a topic that can no longer be ignored, authors of the report said. Too many Americans are suffering unnecessarily and as the elderly population continues to grow with the aging of the baby boom generation, these problems will continue to multiply.

“For most people, death does not come suddenly,” said Philip Pizzo, MD, co-author of the report and former dean of Stanford’s medical school, in an email to me discussing the conclusions of the report. “Instead, dying is a result of one or more diseases that must be managed carefully and compassionately over weeks, months, or even years, through many ups and downs.”

Physicians and other health care professionals can provide well-rounded care at the end of life to relieve patient pain, maximize functioning, alleviating emotional stress, and ease the burden of loved ones – all in a manner that is consistent with individual choices, he said.

“Patients should, and can, take control of the quality of their life through their entire life, choosing how they live and how they die,” Pizzo said.

But it’s not happening today.

“Studies show that doctors want to die in comfort at home at the end of life, but subject patients to high-intensity ineffective treatments,” he said. “Why?”

Previously: Study: Doctors would choose less aggressive end-of-life care for themselves, Former School of Medicine dean named to expert panel to reform end-of-life care in America, Communicating with terminally ill patients: A physician’s perspective and On a mission to transform end-of-life care

Events, Medicine and Literature, Medicine and Society, Patient Care, Stanford News

Abraham Verghese discusses stealing metaphors and the language of medicine at TEDMED

Abraham Verghese discusses stealing metaphors and the language of medicine at TEDMED

Abraham Verghese TEMED

Few of us pay close attention to metaphors used in the language of medicine. Instead, our focus is typically on words relating to symptoms, test results and diagnoses. But as Stanford physician and author Abraham Verghese, MD, explained last week at TEDMED in San Francisco (which was co-sponsored by Stanford Medicine), metaphors, particularly as they relate to medicine, are significant because “they explain our past… [and] share our present and, perhaps most importantly, the metaphors we pick predicate our future.”

Verghese took conference attendees through a “grand romp through medicine and metaphor” during a session titled “Stealing Smart,” which featured seven speakers and their stories on how stealing something from another field, such as the principles of video game design, could improve medicine. As a child with “no head for math,” Verghese was drawn to the written word and developed a love for metaphors. His physical and metaphorical journey into medicine originated with his childhood reading and, as he sheepishly admitted, his reading list “had a certain prurient bias.” In fact, he selected the novel that set the course of his life, Of Human Bondage by W. Somerset Maugham, because the title “had great promise.” Despite it’s lack of salacious content, the book made a lasting impression on Verghese.

He recalled reading about how the protagonist, a boy named Philip who was born with a clubfoot, overcame great adversity to become a physician. The character was intrigued at the variety of patients he meets in the wards of the hospital and marvels at their willingness to open up about their personal lives at a time of distress. In describing the doctor-patient relationship, the author writes, “There was humanity there in the rough.” Those words spoke deeply to young Verghese and “implied to [him] that not everyone could be a brilliant engineer, could be a brilliant artist, but anybody with a curiosity about the human condition, with a willingness to work hard, with an empathy for their fellow human being could become a great physician.” He added, “I came into [the profession] with the sense that medicine was a romantic passionate pursuit. I haven’t stopped feeling that way, and for someone who loved words anatomy was such fun.”

Verghese reveled in the abundance of medical metaphors throughout his training. The prevailing metaphor in anatomy was that of a house, while the overarching metaphor of physiology was that of a machine. When it came to describing symptoms, there was no shortage of metaphors: the “strawberry tongue” associated with scarlet fever, the “peau d’orange” appearance of the breast in breast cancer and the “apple-core” lesion of colon cancer. “That’s just the fruits – don’t get me started on the non-vegetarian stuff,” he joked.

But all of the metaphors noted in his talk are 60-100 years old, and when it came to naming one from more recent times Verghese was at a loss. He said:

In my lifetime, and I suspect in yours, we’ve seen so many new diseases – AIDS, SARS, Ebola, Lyme… We have so many new ways at looking inside the body and scanning the body, such as PET and MRI, and yet, strangely, not one new metaphor, that I can think of… It’s a strange paucity because we are so imaginative. The amount of science that has been done in the last 10 years eclipses anything that was done in the last 100 years. We’re not lacking in imagination, but we may be lacking in metaphorical imagination.

This dearth of metaphor has two consequences, he said. The first is that Congress isn’t funding biomedical research to the level that is necessary to advance new discoveries and treatments. The second is that patients are “not as enamored with our medicine and our science as we might think they should be,” he said. Verghese implored the audience to “create metaphors befitting our wonderful era discovery.” He encouraged those in the crowd and watching the livestream online to accept this challenge, saying, “I want to invite you to name things after yourself. Go ahead! Why not?”

As he closed the talk, Verghese shared the metaphor that has guided his life by saying:

It’s the metaphor of a calling. It’s the metaphor of a ministry of healing. It’s the metaphor of the great privilege we’re allowed, all of us with anything to do with health care, the privilege of being allowed into people’s lives when they are at their most vulnerable. It’s very much about the art of medicine. And we have to bring all the great science, all the big data, all the wonderful things that we’re going to be talking about [at this conference] to bear one human being to another… We have to love the sick. Each and everyone of them as if they were our own. And you know what? They are our own, because we are all humanity there in the rough.

Previously: Abraham Verghese urges Stanford grads to always remember the heritage and rituals of medicine, Inside Abraham Verghese’s bag, a collection of stories and Stanford’s Abraham Verghese honored as both author and healer

Medicine and Society, Medicine X, Patient Care, Technology

What makes a good doctor – and can data help us find one?

What makes a good doctor - and can data help us find one?

Ornstein panelWhile much conversation at Medicine X focused around the doctor-patient relationship, ProPublica reporter Charles Ornstein posed to conference attendees this morning a more fundamental question: How do you find a doctor? “This is trickier than you think,” he said and proceeded to discuss how data can yield helpful information for those looking for (or assessing their current) physician. He outlined some of the information – mostly involving doctor-industry relationships and physician-prescribing practices – that ProPublica has gleaned from federal databases, and he outlined questions that patients might want to ask their doctors about such things. (“So my doctor has a relationship with a company. But how is that affecting my care?” he said.)

Ornstein spent a good amount of time discussing the importance of making information – presumably not just information on negative things, such as whether a doctor appears to over-prescribe a certain medication or has ever been disciplined, but also about thoughts on physicians’ care from patients – more widely available.“We all want doctors who are good at what they’re doing clinically, and it’s time for us to stop making that a secret,” he said, before making his closing statement that “Data should be freed so we can make better health-care decisions.”

In the panel session – moderated by our own Paul Costello – that followed, several important points were made. First, Vivian Lee, MD, PhD, MBA, dean of the University of Utah School of Medicine and CEO of University of Utah Health Care, reminded the audience that the “majority of doctors are not bad apples” and can improve on things if given the chance. University of Utah makes patient-survey information publicly available, and she described the six-month period before this service was launched as a time where doctors worked to boost their level of care. Almost every doctor received at least 4 out of 5 stars by the time the rankings went online, she said.

Panelist Carly Medosch, a patient advocate who has had Crohn’s disease for 20 years, expressed support for access to physician data but pointed out that she doesn’t have time to dig through “tons and tons of research” – she not only has a regular job but a second job managing her disease. And “If I’m taken to the ER for a ruptured intestine I don’t have time to ask questions” about, for example, a doctor’s industry relationships, she pointed out. It was an important reminder that access to data alone might not greatly benefit the average chronically ill patient.

Towards the end of the session, the panelists shared their own ideas of what makes a good doctor, with Ornstein listing good clinical outcomes and empathy as two must-haves. Numerous attendees took to Twitter to express their own thoughts, including patient advocate Liza Bernstein, who offered at least 10 criteria. (My personal favorite: “What kind of PERSON are you? Yes, always, top of your field, but are you a #mensch?) Given the complexity of the issue, as outlined during the panel, I think this attendee hit the nail on the head by tweeting:

What makes a good doctor? Medicine is not a monolith. There is no simple, single answer, regardless of data availability.

More news about Stanford Medicine X is available in the Medicine X category.

Previously: Medicine X aims to “fill the gaps” in medical education, Relationships the theme of the day at Stanford’s Medicine X, Stanford Medicine X 2014 kicks off today and Medicine X spotlights mental health, medical team of the future and the “no-smartphone” patient
Photo of Ornstein (far right) and panelists by Stanford Medicine X

Medicine and Society, Medicine X, Patient Care, Technology

Relationships the theme of the day at Stanford’s Medicine X

Relationships the theme of the day at Stanford's Medicine X

Larry Chu long shot

Medicine X began today with a theatrical bang as quotes from past speakers filled the main presentation hall and flashed across on the stage against an electrifying soundtrack. In welcoming both old and new friends to the conference, Larry Chu, MD, associate professor of anesthesia at the School of Medicine and executive director of the conference, repeated a sentiment from last year’s event, saying, “You belong here with us – we all care about health care.”

Stanford’s premier conference on emerging health-care technology and patient-centered medicine, the event attracted more than 400 patients, health-care providers, technologists, researchers and entrepreneurs to engage in moon shot thinking about the future of medicine and health care. Several hundred more watched the conference webcast.

“We’ve seen information technologies transform lives in so many ways; now it’s time to harness this power to improve health,” Lloyd Minor, MD, dean of the medical school, told the audience in the morning. He encouraged attendees “to think big” and to use their time at Medicine X to identify collaborators to take their ideas from concept to reality.

Collaborations and relationships were the theme of the day, with sessions focused on how engaged patients and their doctors can become the medical team of the future, how the pharmaceutical industry and patients can work together in the drug discovery and clinical trial process, how chronic-disease patients use self-trackers as a sort of partner in their care, and how developers of digital technologies are collaborating with those who might not have an obvious voice. As one Twitter user commented, “Most common words at #medx conference so far: transparent, engaged, relationships, connected.”

Medicine X continues tomorrow and Sunday. If you’re unable to attend the conference in person, you can participate in plenary sessions virtually through a high-quality streaming webcast; registration for the Global Access Program webcast is free. We’ll also be live tweeting the keynotes and other proceedings from the conference; you can follow our tweets on the @SUMedicine feed or follow the hashtag #MedX.

More news about Stanford Medicine X is available in the Medicine X category. 

Previously: Stanford Medicine X 2014 kicks off todayCountdown to Medicine X: 3D printing takes shapeCountdown to Medicine X: Specially designed apps to enhance attendees’ conference experience and Countdown to Medicine X: How to engage with the “no smartphone” patient
Photo by Stanford Medicine X

Medicine and Society, Medicine X, Technology

A call to make digital-health technologies available to everyone

A call to make digital-health technologies available to everyone

In light of my conversation last month about the “no-smartphone patient,” I found this recent Forbes piece on the need to develop culturally sensitive digital-health technologies of interest. Contributor Rob Szczerba writes:

In recent years, technologies involving smart phones and data analytics have become an essential component of how healthcare is delivered throughout the world.  Moreover, some believe these tools hold special promise for people from poor communities, seniors, and ethnic and racial minorities.  In some cases, people from these groups are more likely to have chronic conditions that can be expensive to treat in the short- and long-term.  Unfortunately, many of the innovators developing health technologies are not well-equipped to understand the special needs of these groups.

Rohit Bhargava and Fard Johnmar, co-authors of ePatient 2015, describe this problem as “multicultural misalignment.”  They warn that digital health technologies, such as mobile and wearable devices, will be much less effective if they are not optimized to account for differences in age, gender, culture, ethnicity, knowledge, and literacy.  They believe that preventing multicultural misalignment is vital, suggesting that we must work hard to ensure “health innovations benefit all segments of society.”

As a reminder, Stanford’s Medicine X conference – where this topic will be discussed – begins tomorrow.

Previously: Countdown to Medicine X: How to engage with the “no smartphone” patient

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