Category Archives: health market quality

data saving lives, EF, health market quality

RWJF: Making Sense of the Medicare Physician Payment Data Release: Uses, Limitations, and Potential – The Commonwealth Fund

Making Sense of the Medicare Physician Payment Data Release: Uses, Limitations, and Potential – The Commonwealth Fund.

PDF: 1789_Patel_making_sense_Medicare_phys_payment_data_release_ib

Overview

In April 2014, the Centers for Medicare and Medicaid Services released a data file containing information on Medicare payments made to physicians and other providers. Though an important achievement in promoting greater health system transparency, limitations in the data have hindered key users, including consumers, payers, and providers, from discerning meaningful information from the file. This brief outlines the significance of the data release, the limitations of the dataset, the current uses of the information, and proposals for rendering the file more meaningful for public use.

complex adaptive systems, data saving lives, EF, health market quality, healthcare, healthy habits, nutrition, policy, politics, quantified self, rapid learning health systems

Creating a Market for Disease Prevention

 

http://thevitalityinstitute.org/news/focus-on-pharma-creating-a-market-for-disease-prevention/

Focus on Pharma: Creating a Market for Disease Prevention

SustainAbility Newsletter “Radar” | Oct 30, 2014

Should pharmaceutical companies be in the business of producing pills, or of making people well? The answer is both. Elvira Thissen argues that with diminishing returns in medicines it is time for pharma companies to move away from philosophical discussions on prevention and adapt to new realities instead.

[…]

The Business Case for Prevention

A recent report by The Vitality Institute – founded by South Africa’s largest health insurance company – estimates potential annual savings in the US of $217–303 billion on healthcare costs by 2023 if evidence-based approaches to NCD prevention are rolled out.

At an estimated global cost of illness of nearly US$1.4 trillion in 2010 for cardiovascular disease and diabetes alone, there is a market for prevention. In the UK, the NHS spends 10% of its budget on treating diabetes, 80% of which goes to managing (partly preventable) complications. Reducing disease incidence represents a considerable value to governments, insurance companies and employers.

Some sectors are already eyeing the value of this market.

[…]

For access to the full article and SustainAbility newsletter, click here.

health market quality, healthcare, healthy habits

On PSA Testing

http://www.australiandoctor.com.au/opinions/guest-view/why-do-doctors-keep-silent-about-their-own-prostat

Simon Chapman’s ebook: Let-sleeping-dogs-lie

http://www.australiandoctor.com.au/news/latest-news/nhrmc-finally-releases-its-psa-advice

For every 1000 low-risk, 60-year-old men tested annually over a decade:

  • Two will avoid dying of prostate cancer before age 85
  • Two will avoid metastatic prostate cancer before age 85
  • 87 will have a false-positive test leading to an unnecessary biopsy, and 28 will suffer significant side effects as a result
  • 28 will be “overdiagnosed” with a prostate cancer that would likely otherwise have remained asymptomatic
  • 25 will be “overtreated”, 7-10 of whom will be left impotent or incontinent as a result
  • PSA testing has “no discernible effect” on overall mortality

The figures are largely unchanged from a draft version released last

Not sure what to say about PSA testing?

David Brill 6 comments

The NHMRC has finalised its PSA testing advice for doctors, in what is claimed to be the best summary of the evidence to date.

Released Tuesday, the document provides a backgrounder for GPs to discuss both the benefits and harms of PSA testing with asymptomatic men.

Following an extensive literature review, with input spanning general practice, urology and oncology, the guide provides a list of statistics to use in conversation with patients (see below box).

Professor Ian Olver (pictured), a member of the NHMRC’s expert advisory group, said the group was “as confident as we can be” in the figures.

“We’re trying to say that the reason this can’t be promoted as a population test for everyone is that there are benefits and risks that have to be balanced. Every man has to decide where that balance lies for him,” said Professor Olver, CEO of the Cancer Council Australia.

“We’re providing an evidence-based tool for practitioners to be able to have that discussion.”

For every 1000 low-risk, 60-year-old men tested annually over a decade:

  • Two will avoid dying of prostate cancer before age 85
  • Two will avoid metastatic prostate cancer before age 85
  • 87 will have a false-positive test leading to an unnecessary biopsy, and 28 will suffer significant side effects as a result
  • 28 will be “overdiagnosed” with a prostate cancer that would likely otherwise have remained asymptomatic
  • 25 will be “overtreated”, 7-10 of whom will be left impotent or incontinent as a result
  • PSA testing has “no discernible effect” on overall mortality

The figures are largely unchanged from a draft version released last year, although the NHMRC has now stressed that the document “is not a substitute for relevant clinical practice guidelines and therefore does not contain recommendations”.

Meanwhile, GPs will have to wait until December for full consensus clinical practice guidelines, which are currently being developed by the Cancer Council Australia and Prostate Cancer Foundation of Australia.

These guidelines also have broad, multidisciplinary representation, and it is hoped they will provide some resolution to a debate that has divided Australia’s medical colleges in recent years.

complex adaptive systems, data saving lives, EF, health market quality, healthcare, healthy habits, meaning, nutrition, policy, politics, rapid learning health systems, storytelling

Dr Atul Gawande – 2014 Reith Lectures

Lecture 1: Why Do Doctors Fail?

Lecture 2: The Century of the System

Lecture 3: The Problem of Hubris

Lecture 4: The Idea of Wellbeing

http://www.bbc.co.uk/programmes/articles/6F2X8TpsxrJpnsq82hggHW/dr-atul-gawande-2014-reith-lectures

Dr Atul Gawande – 2014 Reith Lectures

Atul Gawande, MD, MPH is a practicing surgeon at Brigham and Women’s Hospital and Professor at both the Harvard School of Public Health and Harvard Medical School.

In his lecture series, The Future of Medicine, Dr Atul Gawande will examine the nature of progress and failure in medicine, a field defined by what he calls ‘the messy intersection of science and human fallibility’.

Known for both his clear analysis and vivid storytelling, he will explore the growing importance of systems in medicine and argue that the future role of the medical profession in our lives should be bigger than simply assuring health and survival.

The 2014 Reith Lectures

The first lecture, Why do Doctors Fail?, will explore the nature of imperfection in medicine. In particular, Gawande will examine how much of failure in medicine remains due to ignorance (lack of knowledge) and how much is due to ineptitude (failure to use existing knowledge) and what that means for where medical progress will come from in the future.

In the second lecture, The Century of the System, Gawande will focus on the impact that the development of systems has had – and should have in the future – on medicine and overcoming failures of ineptitude. He will dissect systems of all kinds, from simple checklists to complex mechanisms of many parts. And he will argue for how they can be better designed to transform care from the richest parts of the world to the poorest.

The third lecture, The Problem of Hubris, will examine the great unfixable problems in life and healthcare – aging and death. Gawande will argue that the reluctance of society and medical institutions to recognise the limits of what professionals can do is producing widespread suffering. But research is revealing how this can change.

The fourth and final lecture, The Idea of Wellbeing, will argue that medicine must shift from a focus on health and survival to a focus on wellbeing – on protecting, insofar as possible, people’s abilities to pursue their highest priorities in life. And, as he will suggest from the story of his father’s life and death from cancer, those priorities are nearly always more complex than simply to live longer.

Five things to know about Dr Atul Gawande

Find out about Atul Gawande ahead of his 2014 Reith Lectures…

1.

In 2010, Time Magazine named him as one of the world’s most influential thinkers.

2.

His 2009 New Yorker article – The Cost Conundrum – made waves when it compared the health care of two towns in Texas and suggested that more expensive care is often worse care. Barack Obama cited the article during his attempt to get Obamacare passed by the US Congress.

3.

Atul Gawande’s 2012 TED talk – How do we heal medicine? – has been watched over 1m times.

4.

Atul Gawande has written three bestselling books: Complications, Better and The Checklist Manifesto.

The Checklist Manifesto is about the importance of having a process for whatever you are doing. Better focuses on the drive for better medicine and health care systems. Complications was based on his training as a surgeon.

5.

In 2013, Atul launched Ariadne Labs – a new health care innovation lab aiming ‘to provide scalable solutions that produce better care at the most critical moments in people’s lives everywhere’.

EF, health market quality, healthcare, policy, rapid learning health systems

 

Professor Guy Maddern’s tips on protecting yourself in surgery

1. If you are away from a major hospital, get yourself to one. A particular problem, Professor Maddern says, exists when rural patients resist transfers to major hospitals because they don’t want to leave their families.

2. Lose weight and don’t smoke.The proportion of deaths where obesity was a factor increased slightly this year. “An operation done on a thin person relative to a fat person can have a completely different outcome,” Professor Maddern says. This is particularly important for older people, who have the most operations.

3. Go to a hospital that performs a lot of the type of surgery you are going to have, particularly if it is complex. Remember, practice makes perfect.

http://www.canberratimes.com.au/national/health/one-in-10-surgery-deaths-due-to-flawed-care-or-injury-caused-by-treatment-20141203-11z5y1.html

One in 10 surgery deaths due to flawed care or injury caused by treatment

Date December 3, 2014

Health Editor, Sydney Morning Herald

View more articles from Amy Corderoy

Dangerous: Surgery risks can outweigh benefits.

Dangerous: Surgery risks can outweigh benefits. Photo: Nic Walker

More than one in 10 deaths during or after surgery involved flawed care or serious injury caused by the treatment, a national audit has found.

The Australian and New Zealand Audits of Surgical Mortality shows delays in treatment or decisions by surgeons to perform futile surgeries are still the most common problems linked to surgical deaths.

But surgery also appears to be getting a little safer, with the audit, which covers almost every surgery death in Australia, finding fewer faults with the medical care provided to patients than it has in the past.

Audit chair Guy Maddern said of the deaths where there were concerns, about 5 per cent involved serious adverse events that were likely to have contributed to the person’s death.

In about 8 per cent of cases, the audit found some area of care could have been delivered better.

“These are the sorts of deaths where it was a difficult surgery, and instead of going straight to an operation, maybe additional X-rays and imaging should have been pursued, or maybe the skill set of the team that was operating could have been more appropriate,” he said.

“Sometimes, of course, the result would have been exactly the same.”

Professor Maddern said some surgeons, particularly in general surgery, orthopaedics, and, to a lesser extent, neurosurgery, still needed to work on deciding not to proceed with surgeries where the risks outweighed the benefits.

“People are thinking a little bit longer and harder about whether an operation is really going to alter the outcome,” he said. “These are the types of cases where you know before you begin that it is not going to end well.”

However, in some areas with many patients with complex conditions, things were just more likely to go wrong.

The report, which includes data from nearly 18,600 deaths over five years, found in 2013 the decision to operate was the most common reason a death was reviewed.

Overall, delays in treatment, linked to issues such as patients needing to be transferred or surgeons delaying the decision to operate, were still the most common problem, and in about 26 per cent of the deaths no surgery was performed.

Between 2009 and 2013, the report shows a decrease in the proportion of patients who died with serious infection causing sepsis from 12 per cent to 9 per cent, while significant post-operative bleeding decreased from 12 per cent to 11 per cent. Serious adverse events halved from 6 per cent of deaths in 2009 to 3 per cent in 2013.

Every public hospital now participates in the audit, along with all private hospitals in every state except NSW. However, Professor Maddern said he was pleased NSW private hospitals had agreed to participate in future.

Doctors are now provided with regular case studies from the audit, in which de-identified information about the death is provided, so they can learn from any mistakes.

“What we are seeing is an overall decrease in deaths associated with surgical care, which may be due to many things, and we think the audit is helping,” he said. “It’s making people think twice.”

Professor Guy Maddern’s tips on protecting yourself in surgery

1. If you are away from a major hospital, get yourself to one. A particular problem, Professor Maddern says, exists when rural patients resist transfers to major hospitals because they don’t want to leave their families.

2. Lose weight and don’t smoke.The proportion of deaths where obesity was a factor increased slightly this year. “An operation done on a thin person relative to a fat person can have a completely different outcome,” Professor Maddern says. This is particularly important for older people, who have the most operations.

3. Go to a hospital that performs a lot of the type of surgery you are going to have, particularly if it is complex. Remember, practice makes perfect.

complex adaptive systems, health market quality, healthcare, policy, politics

Blumenthal on Health Reform: Foolish, Courageous, or Both

http://www.commonwealthfund.org/publications/blog/2014/dec/health-reform-foolish-courageous

Health Reform: Foolish, Courageous, or Both

Thursday, December 4, 2014

By David Blumenthal, M.D.

Some supporters of the Affordable Care Act (ACA) are worried they’re paying a political price for health care reform. The political fallout should come as no surprise.

The history of comprehensive health reform shows unequivocally that it’s a short-term political disaster. That’s why so many political leaders have either avoided the issue, or regretted engaging it. Franklin D. Roosevelt, arguably one of our most politically adept presidents, turned his back on national health insurance in 1934 when advisors argued for including it in the Social Security program. He continued to dodge it for most of his long presidency. Both Jimmy Carter and Bill Clinton paid heavy political prices for their proposed national health care programs.

Health reform’s political toxicity is all about math and voting.  Even prior to the ACA, more than 80 percent of Americans under 65 had health insurance, and most were satisfied with their coverage and regular care. These are people—better educated, employed, with middle to higher incomes—who vote, especially in mid-terms. The elderly, of course, have Medicare and they too are generally satisfied with their insurance and care. The 20 percent who didn’t have insurance before the law was passed were—and are—much less likely to show up at the polls. They tend to be younger, less-educated, and less well-off.

Then there’s the nature of health care as an issue: highly personal, highly consequential, and incredibly complex and confusing. Health care is about people’s deepest hopes and fears, for themselves and for their loved ones. And the health care system has become a multi-layered maze of huge insurance chains, enormous and acquisitive provider organizations, government regulation, and constantly changing therapeutics.

This makes it easy for opponents of health reform to stir opposition by arguing—fairly or not—that any new program will make things worse for people who are satisfied with their insurance and their care. This is precisely why President Obama felt the need to promise, inaccurately as it turned out, that every American who liked their insurance plan would be able to keep it under the ACA.

And supporters of reform have difficulty explaining any new program and motivating its beneficiaries to take advantage of it. Witness the large numbers of uninsured Americans who remain unaware of the availability of subsidized insurance through the ACA marketplaces.

So, to put it crudely, why would any sane politician push a program likely to scare and confuse large numbers of people who vote, in order to help small numbers who don’t?

There are two possible responses. One is that it’s the right thing to do, since a lack of insurance is essentially a death sentence for millions of Americans. Doing the right thing, however, can be politically costly: when Lyndon Johnson pushed through the Civil Rights Act in 1965, he gave away the southern United States to the other party for a generation.

A second argument for braving health reform is practical: it simply has to be done to make our health system viable. The private health insurance industry in the United States, and our health system as a whole, have been in a downward spiral that threatens the interests of all Americans, including the now contentedly insured. Prior to the ACA’s enactment, more and more people were losing insurance, or being forced—because of huge premium increases—to purchase coverage that offers less and less protection.

For some years now, insured Americans have been the proverbial frog in the cooking pot, barely noticing as the water slowly approaches the boiling point. A health care system in which, year after year, the cost of insurancerises faster than workers’ wages is not sustainable for anyone.

Relatively little attention has been paid to ACA reforms that attempt to make the system sustainable by tackling fundamental problems with the health care delivery system and with the structure of the private insurance markets. The reason may be that insurance markets and delivery systems—their problems and solutions—are complex and much less interesting than the political battles surrounding covering uninsured Americans, and whether currently insured Americans may face cancellation of their plans. While the major long-term political gains to supporters of health reform may lie in these delivery system and insurance reforms, President Obama and many current congressmen and senators will likely be long gone when and if those gains materialize.

So ACA supporters have every right to be concerned about the politics of health reform. Each will have to decide for themselves whether health reform was foolish, courageous, or both.

In the meantime, millions of Americans now have health insurance who didn’t before, and the cost of health care is increasing at the lowest rate in 50 years.

health market quality, healthy habits, nutrition, policy, rapid learning health systems

Croakey: Impact of big food health washing

 

http://blogs.crikey.com.au/croakey/2014/12/01/as-nutritionists-enable-health-washing-by-coca-cola-a-call-to-end-unhealthy-sponsorship/

As nutritionists enable health-washing by Coca-Cola, a call to end unhealthy sponsorship

MELISSA SWEET | DEC 01, 2014 10:00AM | | PRINT

When Big Food companies engage in health-washing tactics, what are the consequences for the reputations of the health organisations and health professionals involved?

It’s a question the Nutrition Society of Australia and its members might be pondering, after having Coca-Cola as a gold sponsor of their recent annual scientific meeting.

As the World Cancer Congress in Melbourne this week puts the spotlight on the implications of rising obesity rates for cancer, health advocate Todd Harper highlights the contribution of soft drinks to obesity, and argues that health organisations need to look for healthier funding sources.

***

Todd Harper, CEO of Cancer Council Victoria, writes:

No sporting club or health event would accept sponsorship from a tobacco company in Australia today, even if it was allowed.

We know that smoking kills, and so do everything possible to reduce its visibility to ensure younger people aren’t encouraged to take up the habit.

Obesity is also a known risk factor for many cancers, as well as other chronic diseases, yet organisations and events continue to accept sponsorship from the very companies peddling products that contribute to this significant health issue.

Despite this, some organisations focused on health, and particularly healthy kids, see little problem in holding their hands out for money from soft drink companies.

Our recent Cancer in Victoria: Statistics and Trends 2013 report revealed uterine cancer rates are steadily rising; a cancer for which obesity is a principal risk factor. Obesity is also a risk factor for breast, bowel, oesophageal, pancreas, uterine, kidney, gallbladder and thyroid cancers.

In fact, we recently learned from the World Health Organization (WHO) that nearly half a million new cancer cases around the world can be attributed to high Body Mass Index each year – including more than 7000 in Australia. (A new study by the International Agency for Research on Cancer found that nearly half a million new cancer cases per year can be attributed to high body mass index (BMI). The study was published on November 26 in The Lancet Oncology. Using its methodology, more than 7000 new cancer cases in Australia per year can be attributed to high BMI.)

The number of Victorians diagnosed with cancer is projected to double by 2024-2028 to more than 41,000 cases a year, with obesity considered a significant contributor to this. It’s a problem that we can’t ignore.

Many people are aware of the dangers of smoking, and the link between smoking and cancer – which is why we’ve seen such a rapid decline in smoking rates. At the same time we are seeing an equally rapid rise in the number of people who are overweight or obese. We need the same awareness about this as a risk factor if we are to stop more cancers before they start.

Drinking soft drinks contributes to higher kilojoule intake, weight gain and obesity. With one can of Coke containing 10 teaspoons of sugar, each can consumed increases the risk of being overweight.

The WHO recommends the consumption of sugary drinks should be restricted, as do Australia’s recently reviewed dietary guidelines, while the World Cancer Research Fund recommends consumption should be avoided entirely. Leaders in cancer control are meeting in Melbourne this week for the World Cancer Congress, and the challenges related to rising global obesity will be firmly on the agenda.

In the meantime, Coca-Cola continues to sugar-coat its image; fooling the community into believing it is part of the solution to the obesity epidemic.

Rather than being part of the solution like it claims, this multi-billion dollar company is trying to veil the impact of its products by positioning itself as a promoter of physical activity. This is merely a distraction from the fact that it continues to promote its sugary drinks as being part of a healthy diet.

Disturbingly, the company has aligned itself with organisations that encourage healthy active lifestyles, such as the Bicycle Network.

The decision by Bicycle Network to enter into a partnership with Coca-Cola attracted strong criticism from public health experts after a piece in Croakey a year ago, yet the partnership continues. This is especially problematic considering the ‘Happiness’ program is targeting teenagers, a group particularly susceptible to marketing and the highest consumers of these drinks.

Similarly, the Nutrition Society of Australia, the peak scientific nutrition group in the country, has Coca-Cola as a gold sponsor for its Annual Scientific Meeting underway in Tasmania.

This is disappointing on a number of levels, not least of all the fact that one of the themes for the conference is ‘Diet and cancer: what does the evidence show?’

Coca-Cola’s attempts to link itself with these organisations won’t reduce the consumption of sugary beverages and won’t make a gram of difference in reducing overweight and obesity.

Wouldn’t it be better to create alternative sponsorship sources for health-promoting organisations?

As was done with the banning of tobacco sponsorship and the creation of alternative funding sources through VicHealth, it’s time for some similarly creative thinking.

Creative thinking that will kick Coca-Cola out of sponsoring health-promoting activities, and create healthier options for organisations like the Nutrition Society and Bicycle Network.

My fear is that unless we take such action, we run the risk of limiting the impact of important health programs such as the Rethink Sugary Drinkcampaign, encouraging a switch to water and reduced-fat milk; and theLiveLighter campaign, which aims to help people make simple lifestyle choices to improve their overall health and cut their cancer risk.

These programs are vital yet are minnows in the campaign to win the healthy hearts and minds of the public when faced with the corporate might of the highly processed food and drink companies, but with some creative thinking and political will, the scales can be tipped in favour of a healthier way.

• Todd Harper is CEO of Cancer Council Victoria.

data saving lives, EF, health market quality, policy, quantified self, rapid learning health systems

Creepy data

 

http://www.theguardian.com/technology/2014/dec/05/when-data-gets-creepy-secrets-were-giving-away

When data gets creepy: the secrets we don’t realise we’re giving away

We all worry about digital spies stealing our data – but now even the things we thought we were happy to share are being used in ways we don’t like. Why aren’t we making more of a fuss?
ben goldacre illustration data security
We have few sound intuitions into what is safe and what is flimsy when it comes to securing our digital lives – let alone what is ethical and what is creepy. Photograph: Darrel Rees/Heart Agency for the Guardian

Ben Goldacre

But these are straightforward failures of security. At the same time, something much more interesting has been happening. Information we have happily shared in public is increasingly being used in ways that make us queasy, because our intuitions about security and privacy have failed to keep up with technology. Nuggets of personal information that seem trivial, individually, can now be aggregated, indexed and processed. When this happens, simple pieces of computer code can produce insights and intrusions that creep us out, or even do us harm. But most of us haven’t noticed yet: for a lack of nerd skills, we are exposing ourselves.

At the simplest level, even the act of putting lots of data in one place – and making it searchable – can change its accessibility. As a doctor, I have been to the house ofa newspaper hoarder; as a researcher, I have been to the British Library newspaper archive. The difference between the two is not the amount of information, but rather the index. I recently found myself in the quiet coach on a train, near a stranger shouting into her phone. Between London and York she shared her (unusual) name, her plan to move jobs, her plan to steal a client list, and her wish that she’d snogged her boss. Her entire sense of privacy was predicated on an outdated model: none of what she said had any special interest to the people in coach H. One tweet with her name in would have changed that, and been searchable for ever.

An interesting side-effect of public data being indexed and searchable is that you only have to be sloppy once, for your privacy to be compromised. The computer program Creepy makes good fodder for panic. Put in someone’s username from Twitter, or Flickr, and Creepy will churn through every photo hosting service it knows, trying to find every picture they’ve ever posted. Cameras – especially phone cameras – often store the location where the picture was taken in the picture data. Creepy grabs all this geo-location data and puts pins on a map for you. Most of the time, you probably remember to get the privacy settings right. But if you get it wrong just once – maybe the first time you used a new app, maybe before your friend showed you how to change the settings – Creepy will find it, and your home is marked on a map. All because you tweeted a photo of something funny your cat did, in your kitchen.

medical records

Pinterest
Many people will soon be able to access their full medical records online – but some might get some nasty surprises. Photograph: Sean Justice/Getty

Some of these services are specifically created to scare people about their leakiness, and nudge us back to common sense: PleaseRobMe.com, for example,checks to see if you’re sharing your location publicly on Twitter and FourSquare (with sadistic section headings such as “recent empty homes” and “new opportunities”).

Some are less benevolent. The Girls Around Me app took freely shared social data – intended to help friends get together – and repurposed it for ruthless, data-driven sleaziness. Using FourSquare and Facebook data, it drew neat maps with the faces of nearby women pasted on. With your Facebook profile linked, I could research your interests before approaching you. Are all the women visible on Girls Around Me willingly consenting to having their faces mapped across bars or workplaces or at home – with links to their social media profiles – just by accepting the default privacy settings? Are they foolish to not foresee that someone might process this data and present them like products in a store?

But beyond mere indexing comes an even bigger new horizon. Once aggregated, these individual fragments of information can be processed and combined, and the resulting data can give away more about our character than our intuitions are able to spot.

Last month the Samaritans launched a suicide app. The idea was simple: they monitor the tweets of people you follow, analyse them, and alert you if your friends seem to be making comments suggestive of very low mood, or worse. A brief psychodrama ensued. One camp were up in arms: this is intrusive, they said. You’re monitoring mood, you need to ask permission before you send alerts about me to strangers. Worse, they said, it will be misused. People with bad intentions will monitor vulnerable people, and attack when their enemies are at their lowest ebb. And anyway, it’s just creepy. On the other side, plenty of people couldn’t even conceive of any misuse. This is clearly a beneficent idea, they said. And anyway, your tweets are public property, so any analysis of your mood is fair game. The Samaritans sided with the second team and said, to those worried about the intrusion: tough. Two weeks later they listened, and pulled the app, but the squabble illustrates how much we can disagree on the rights and wrongs around this kind of processing.

The Samaritans app, to be fair, was crude, as many of these sites currently are:analyzewords.com, for example, claims to spot personality characteristics by analysing your tweets, but the results are unimpressive. This may not last. Many people are guarded about their sexuality: but a paper from 2013 [pdf donwload] looked at the Facebook likes of 58,000 volunteers and found that, after generating algorithms by looking at the patterns in this dataset, they were able to correctly discriminate between homosexual and heterosexual men 88% of the time. Liking “Colbert” and “Science” were, incidentally, among the best predictors of high IQ.

Sometimes, even when people have good intentions and clear permission, data analysis can throw up odd ethical quandaries. Recently, for example, the government has asked family GPs to produce a list of people they think are likely to die in the next year. In itself, this is a good idea: a flag appears on the system reminding the doctor to have a conversation, at the next consultation, about planning “end of life care”. In my day job, I spend a lot of time working on interesting uses of health data. My boss suggested that we could look at automatically analysing medical records in order to instantly identify people who are soon to die. This is also a good idea.

But add in one final ingredient and the conclusion isn’t so clear. We are entering an age – which we should welcome with open arms – when patients will finally have access to their own full medical records online. So suddenly we have a new problem. One day, you log in to your medical records, and there’s a new entry on your file: “Likely to die in the next year.” We spend a lot of time teaching medical students to be skilful around breaking bad news. A box ticked on your medical records is not empathic communication. Would we hide the box? Is that ethical? Or are “derived variables” such as these, on a medical record, something doctors should share like anything else? Here, again, different people have different intuitions.

shopping centre

Pinterest
Many shopping centres can now use your mobile data to track you as you walk from shop to shop. Photograph: Christian Sinibaldi/Guardian

Then there’s the information you didn’t know you were leaking. Every device with Wi-Fi has a unique “MAC address”, which is broadcast constantly as long as wireless networking is switched on. It’s a boring technical aspect of the way Wi-Fi works, and you wouldn’t really care if anyone saw your MAC address on the airwaves as you walk past their router. But again, the issue is not the leakiness of one piece of information, but rather the ability to connect together a thread. Many shops and shopping centres, for example, now use multiple Wi-Fi sensors, monitoring the strength of connections, to triangulate your position, and track how you walk around the shop. By matching the signal to the security video, they get to know what you look like. If you give an email address in order to use the free in-store Wi-Fi, they have that too.

In some respects, this is no different to an online retailer such as Amazon tracking your movement around their website. The difference, perhaps, is that it feels creepier to be tracked when you walk around in physical space. Maybe you don’t care. Or maybe you didn’t know. But crucially: I doubt that everyone you know agrees about what is right or wrong here, let alone what is obvious or surprising, creepy or friendly.

It’s also interesting to see how peoples’ limits shift. I felt OK about in-store tracking, for example, but my intuitions shifted when I realised that I’m traced over much wider spaces. Turnstyle, for example, stretches right across Toronto – a city I love – tracing individuals as they move from one part of town to another. For businesses, this is great intelligence: if your lunchtime coffeeshop customers also visit a Whole Foods store near home after work, you should offer more salads. For the individual, I’m suddenly starting to think: can you stop following me, please? Half of Turnstyle’s infrastructure is outside Canada. They know what country I’m in. This crosses my own, personal creepiness threshold. Maybe you think I’m being precious.

There is an extraordinary textbook written by Ross Anderson, professor of computer security at University of Cambridge. It’s called Security Engineering, and despite being more than 1,000 pages long, it’s one of the most readable pop-science slogs of the decade. Firstly, Anderson sets out the basic truisms of security. You could, after all, make your house incredibly secure by fitting reinforced metal shutters over every window, and 10 locks on a single reinforced front door; but it would take a very long time to get in and out, or see the sunshine in the morning.

Digital security is the same: we all make a trade-off between security and convenience, but there is a crucial difference between security in the old-fashioned physical domain, and security today. You can kick a door and feel the weight. You can wiggle a lock, and marvel at the detail on the key. But as you wade through the examples in Anderson’s book – learning about the mechanics of passwords, simple electronic garage door keys, and then banks, encryption, medical records and more – the reality gradually dawns on you that for almost everything we do today that requires security, that security is done digitally. And yet to most of us, this entire world is opaque, like a series of black boxes into which we entrust our money, our privacy and everything else we might hope to have under lock and key. We have no clear sight into this world, and we have few sound intuitions into what is safe and what is flimsy – let alone what is ethical and what is creepy. We are left operating on blind, ignorant, misplaced trust; meanwhile, all around us, without our even noticing, choices are being made.

• Ben Goldacre’s new book, I Think You’ll Find It’s a Bit More Complicated Than That, is published by Fourth Estate. Buy it for £11.99 at bookshop.theguardian.com

Topics

data saving lives, EF, health market quality, healthy habits, nutrition, research methodology

Jeffrey Braithwaite on Microlifes and Micromorts

Punchy.

http://www.jeffreybraithwaite.com/new-blog/2014/11/20/youll-be-dying-to-hear-about-this

You’ll be dying to hear about this

There’s lots of death in the world. Transport is risky, for instance—planes, automobiles, trains and ships can crash, maiming or killing passengers. You don’t have to go much further than seeing the road toll, or hearing about Malaysian Airlines Flight MH17 shot down over the Ukraine, or watching the TV scenes of the Costa Concordia, run aground just off Isola del Giglio near the coast of Italy, to appreciate that death is never far away.

Then there’s infectious diseases. You can all-too-readily catch a cold, or the flu, or TB, or lately, the Ebola virus. And there seem to be never-ending wars and skirmishes in the Middle East; and terror, spread by fundamentalists.

Each of these, depending on fate, can hasten someone’s demise. Wrong place, wrong time, wrong circumstances.

Lifestyle issues can cause problems for your risk profile too—but these are slower, and more stealthy. Think of smoking, drinking too much, eating yourself into a coma or just gross obesity, or the more insidious dangers of sitting at a computer for years on end with little exercise. These can translate over time into heart or lung disease, diabetes, and cancer.

Whether you are active or passive, things you do or don’t do can shorten your lifespan, or kill you a little or a lot faster than you would otherwise last. So what levels of risk do you actually, quantitatively, face in your own life?

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Stanford University decision scientist Ron Howard in the 1970s presented a novel way to calculate this risk. He introduced the idea of the micromort, defined as a one-in-a-million likelihood of death.  This is such an evocative unit of measurement that it deserves a little further attention.

If you live in the US or another relatively rich, OECD-style country, with good law and order, legislation that keeps society relatively risk free (such as with environmental and public health issues sorted out, effective building codes, and so forth), a well-educated population, access to health care, and a buoyant GDP, you can expect a micromort of one on any particular day. Another way of saying this is that’s the standard expected death rate for any individual today in any one 24 hour period: a microprobability of one in a million is your index of baseline risk.

These are great odds for you, today, as you read this; you are very likely to get through it. Congratulations if you do.

What circumstances lead to an elevated risk? Say if you do dangerous things or even just live life to the full? How does your micromort level get upgraded?

In the United States, you accumulate an extra 16 micromorts each time you ride a motorcycle 100 miles, for instance. Or 0.7 micromorts are added for each day you go skiing; so go for a week and you’ve added five more.

Or you might decide to do something a little more strenuous. With hangliding, the additional risk of dying equates to eight micromorts per flight; or skydiving, nine per freefall.

They are relatively benign compared to moving up to base-jumping. Do so, and you rapidly earn many more risk points: 430 micromorts per jump, in fact.

Marathon running, anyone? That will be seven micromorts to your debit account for each run. Even walking 17 miles adds one micromort, as does a 230 mile car trip, and add another one for every 6,000 mile train trip. But the puzzle is, it’s not always clear how to treat these: the walking introduces an element of risk (you could be out and about and get run over, or be struck by lightning) but it’s also beneficial (it contributes to improved health).

Perhaps even more interesting, there are microprobabilities associated with accumulated chronic risks in contrast to these other single-shot event risks. These are lifestyle choices and behaviors that incrementally add a little more risk through exposure. They won’t kill you if you have bad luck on a given day, but will slowly have an effect—and may claim you in the end.

Every half a liter of wine exposes you to a micromort because it can accrue into cirrhosis of the liver. Each one and a half cigarettes does the same, but the menace here is cancer or heart disease. Even eating 100 char-broiled steaks, 40 tablespoons of peanut butter or 1,000 bananas sneaks up on you in the form, respectively, of cancer risk from benzopyrene, liver cancer risk from aflatoxin B or cancer risk from radioactive potassium-40.

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Hang on though. I doubt I’ve done much to help anyone.

Because a clear problem is that people aren’t very good at doing these kinds of statistics, or applying them to their own lives—and are even less capable of acting on them. We can readily appreciate that skiing or motorcycling add some risk for the time you are doing them compared to the everyday activities of being at work or hanging out at home, yet many people are undeterred. People even cheerfully find ways of taking on more risk, such as by climbing Everest, driving fast cars, or having unsafe sex.

Everyone knows about that steadily accumulated risk, too: not too many of us are blind to the fact that drinking too much alcohol can lead to liver disease or smoking to lung cancer over time. And although both have been falling for decades, this hasn’t stopped millions of people indulging. There’s 42.1 million US smokers at last count, or 18.1% of the population, and on average each adult US citizen consumes 8.6 liters of alcohol annually.

This is not the best performance internationally but is by no means high by international standards, and Eastern Europeans smoke more heavily, and really give hard booze like vodka a nudge.  Nevertheless, both activities contribute to what public health people quaintly call excess deaths and the rest of us know by “their drinking or smoking (or both) killed them eventually.”

But what does it actually mean that you expose yourself to increased risk if you go out walking regularly or eat bananas?  We need another way of looking at this, because it’s too hard to do the sums.

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Enter the University of Cambridge medical statistician David Spiegelhalter and his colleague Alejandro Leiva who invented the idea of a microlife. This is another unit of risk which has the calculation built in for you. It is half an hour of your life.

If you increase your risk by one micromort, then this shortens your life by half an hour. These calculations apply to people on average, and work out for entire populations, but any one of us might be lucky or unlucky, depending on our individual characteristics. Any particular risk doesn’t convert exactly to the specific individual. But with enough people in the US (beyond 316 million now) and on the planet (7 billion and rising), there’s a relentlessness accuracy about the statistics.

So now let’s do some life expectancy math with Spiegelhalter. Smoke a pack a day? You lose up to five hours a day. Accumulated, that’s up to eight years off your life. Have six drinks a day and that binge costs you one half hour allocation—a shortened life by ten months or so. Stay eleven pounds overweight and you sacrifice half an hour every day you do so (another ten months across your lifespan), as you do if you watch TV for two hours. Your coffee habit at 2-3 cups daily takes away another half hour lot. So does every portion of red meat each day. Another ten months each time.

It’s not all negative. There’s good news. Eat five serves of fruit and vegetables every day and you gain up to a couple of hours each time. You get three years back. Exercise and the first 20 minutes per day earns you a surprising hour (there’s a good investment—a year and a half), and each subsequent 40 minutes adds up to one more half hour bonus to your credit (a bit more work but that seems a pretty good deal, too, to get a ten month return).

If you have a hobby, activity or diet and it’s not been dealt with so far, you can fill in some of the gaps with some good guesstimates. Do you have passive pursuits, akin to watching TV? This is a net deficit. Do you do active, exercise-oriented activities, such as weekly amateur netball, soccer, bowling or basketball—or just walking regularly? Add some lifespan.

These half hour allocations alter somewhat depending on your genetics of course (you can have lucky or unlucky genes) or your socioeconomic status (wealthy people typically live longer than poorer folks) or your gender (women on the whole live longer than men). That said, with this idea you are now able to alter your risk profile by changing your behavior with a tangible, calculable return.

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There’s a punchline to this, and it may be already occurring to you as you reflect on your own lifestyle and lifespan. There are a million microlives in fifty seven years of existence. That, for many of us, is roughly the adult allocation.

Let’s call that your life expectancy baseline. We can assume that you have had a reasonably healthy childhood (not so for everyone, of course, but true for many US children, and true for most readers). Then, from that point on, a large part of your healthy adult life is now measureable.

So: come out of your teens, reach your 21st birthday, and as the “jolly good fellow” and “happy birthday to you” songs subside, imagine you then have 57 years to go. That is, you have an allocation of 78 years in total, maybe a little longer, maybe a little shorter.

Yes, all sorts of unexpected things might happen along the way, but to some degree your lifespan is now no longer vague, but quantifiable. The actual life expectancy in the US indeed hovers around this: it’s 79.8 years overall, 77.4 for males and 82.2 for females. (It’s higher in some northern European countries and Japan, but that’s a story for another day).

However, you might be reading this thinking: Yikes. I’m not 21: I’m a bit older than that. In this case, you’ve already used up a proportion of your time left. Console yourself. At least you got through the riskiest stage of all: being a baby, up to one year of age, and childhood, up to six or so, when many things can go wrong.

But have you used what you were given so far, well? Or do you have a fair bit of regret?

To make an obvious point, however, this isn’t Doctor Who. You don’t have a Tardis to go back in time and fix the past. So stop any lamentations. Look forward.

By now, if you’ve come to value more readily each half hour and especially the cumulative effect of your lifestyle choices to date, don’t listen to me preaching. Feel completely empowered. You know what to do and how to alter your own numbers.

Now, all that’s left is to do the math. You’ll have a much clearer picture of your life and potential death than ever before. It’s your move: what’s next?

Further reading

Blastland, Michael and Spiegelhalter, David (2014). The Norm Chronicles: Stories and Numbers About Danger and Death. New York: Basic Books.

Howard, Ronald (1984). On fates comparable to death. Management Science 30 (4): 407–422.

Spiegelhalter, David (2012). Using speed of ageing and “microlives” to communicate the effects of lifetime habits and environment. British Medical Journal 345: e8223.

Spiegelhalter, David (2014). The power of the MicroMort. BJOG: An International Journal of Obstetrics & Gynaecology 121 (6): 662–663.

EF, health market quality, policy

FBI employing analytics in healthcare fraud investigations

 

http://www.fiercehealthpayer.com/antifraud/story/data-analysis-adds-new-dimension-old-school-fraud-investigations/2015-01-13

Data analysis adds new dimension to old-school fraud investigations

Billing data has become a useful tool in detecting hints of healthcare fraud, and then leading investigators in the right direction
January 13, 2015 | By

In 2010, the FBI organized an undercover sting of a Brooklyn medical clinic that was suspected of Medicare fraud. Agents installed a hidden camera in an air conditioning vent and watched employees pay kickbacks to patients in exchange for Medicare identification numbers, which they used to bill Medicare $50 million in fraudulent claims.

Agents eventually arrested 16 people in connection with the scheme and used the video evidence, along with audio and video from wired elderly clients, in their prosecution. However, it was data analytics that led them to the Brooklyn clinic in the first place, according to The Times.

Data analytics has helped investigators build cases and uncover fraud faster and easier, particularly in areas such as Detroit and Miami that have been hotspots for fraud schemes. In some cases, data mining has helped stop fraud even before criminal charges come to light.

“The idea of using real-time data to generate fraud cases is unique,” Leslie Caldwell, chief of the Department of Justice (DOJ) criminal division, told the newspaper.  “We have the ability to suspend–[when] there’s reasonable suspicion–[those] who are engaged in fraud even before they are prosecuted and indicted.”

The article points to the recruitment of Kirk Ogrosky, who spent time as a federal prosecutor in Miami. In 2006, the DOJ asked him to head the healthcare unit. Ogrosky accepted on the condition that the agency would “rethink the way they prosecute healthcare fraud, with an emphasis on real-time prosecutions.” Ogrosky began by searching for postal codes in which patient spending was three or four times the national average, and then employing old-school detective tactics to further the investigation.

“Most times, those zip codes would help generate a list of providers that had what I would call ‘medically impossible’ claims,” he told The Times. “[It was] like peeling an onion ring by ring–and yes, it always burnt my eyes at some point.”

Data analytics have since been used to uncover schemes related to chemotherapy drugs, home healthcare, and durable medical equipment. In Indiana, data-driven investigations have saved the state $85 million. FierceHealthPayer: AntiFraud previously reported on predictive models and algorithms such as the government’s Fraud Prevention System (FPS), which has led to more than $50 million in actual and projected savings in two years.

For more:
– read The Financial Times article