Category Archives: Medicine & Health

Some Nuance on Opioids

We need both quantitative and qualitative subtlety about the opioid epidemic. Dr. Marcia Angell brings both in this review of a cluster of related books. Since you’re busy trussing a sheep or stuffing a souffle I’ll executive summarize it:

  1. Street drugs now kill many more people than prescription painkiller addiction.
  2. Prescription painkillers are the only way to make a breath breathable for those in significant pain

If you’re looking for some light holiday reading, prose that reminds you of the season’s glitter, flip through Angell’s writing on medical approaches to addiction.

Peace and love to all.

Advertisements
Tagged , , ,

Ottessa Moshfegh Proves I’m the Zeitgeist

Note: this post was composed almost entirely before nearly every person I know, women or not, carrying a traumatic past or not, was triggered all f-ing day yesterday and most of today by the spectacle of a composed, poised, intelligent woman trying to fight an iceberg of low-information, woman-hating PEOPLE WHO RUN OUR GOVERNMENT. However, perhaps a literary theory-type post celebrating as heroic a woman who withdraws from this constant heartbreak in a yearlong chemical haze may be well-timed?

Continue reading

Tagged , , , , ,

Worldbuilding

As a parent, a day-gigging child health policy specialist, and a night-gigging radical lefty former academic, I enjoyed this piece on how to reject the politicization and moralization of children.

With innocence as its baseline, the liberal idea of children seeks to make natural (but also to moralize) a property relation between child and parent. “Innocence” is code for powerless — a way to fetishize the child as both dependent and sub-human. This idea of the child is indistinct from private property. 

Continue reading

Tagged , ,

Health Policy Post! My Actual Day Job!

I work at a state Medicaid agency that’s planning to cut payments to doctors who can get that dough back by improving their patient outcomes. It’s generally called “paying for value.” Its opposite, “paying for volume,” pays docs for the number of services they provide, rather than their patients’ improved ability to bike to the river.

Clearly we need to pay for health care quality instead of for however many brains one can stuff into an MRI machine.

But we also know that social factors–jobs, education, immigration status, housing and food security–determine up to 80% of a person’s health. Not their doctor. Not their genes. Not their kale smoothies or meditation apps.

So paying doctors for outcomes may not make much sense for doctors who primarily serve people with low wage jobs in polluted neighborhoods and who generally live without the kind of accumulated advantages that allow me, for example, to hit the bookstore for something to read on the airplane, which I’m flying tomorrow to a small town with a fantastic pastry shop and a famous theater.

Dhruv Khullar points out that scoring doctors who take public insurance against doctors who don’t, and paying them less when their patients inevitably can’t manage their chronic conditions as well, will probably result in lower-income people getting worse care.

And we haven’t yet figured out how to use the health care system to address people’s actual health needs: food, safe and secure housing, child care, decent wages.

I’ve been saying this around the office for a while, that value-based payments may punish doctors for poverty the same way that teacher evaluation systems punish teachers for poverty.

But Dr. Khullar is a doctor published in the New York Times, and I’m a pee-yoo-rocrat blogging for about 3 readers (hi guys!).

So not that I can do much about it, but I’ll spend my Fourth of July thinking about how to leverage health care funding streams to mitigate social inequity. Also cake. Happy Fourth.

Tagged , , ,

The Joy of Cooking Facts

This lovely paean to Joy of Cooking  crushes both the bogus science critiquing the cookbook and the broader cultural problem of trying to get reliable science about food and health. Continue reading

Tagged , , , , ,

Keep Your Heads Up, Friends

1000-1500 kids are about to walk past my office building to the state capitol to demand that government value their lives at least as much as they value guns. I hope they can bring this fight to help kids in Flint have clean fucking water for the first time in years.

Some of the best articles I’ve read recently, all verging on the political:

Continue reading

Tagged , , , , , , ,
Advertisements
%d bloggers like this: