Half Sigma

Why aren't doctors paid by the hour?

A NY Times article documents the ridiculous way that doctors get paid.

But in suggesting alternatives, why does the article not mention the most common sense way to pay doctors? Based on how much time they spend with a patient, and on how much time they spend working on the patient's behalf in the patient's absence.

Of course, this would still encourage them to perform unnecessary but time consuming medical tests and procedures, but it still makes more sense than paying based on how many checkboxes they can check off on an insurance form. Pay by the hour is the most difficult method to game. And if patients have a percentage-based co-pay, time-based pay will give them an incentive to not waste the doctor's time.

With time-based pay, doctors would be willing to talk to you on the phone, saving patients the hassle of going into the office for minor issues that could be easily resolved over the phone.

Black women have bigger muscles. But...

So says regular commenter Peter. He wrote:

If you compare a black person and a white person of equal age, height and weight, the black person will have more muscle mass and less fat that the white person. Any doubts? Consider these three words: National Football League. And while this difference is more pronounced among males, it exists among females too. It is possible, therefore, that the typical 166-pound black woman has no more body fat than the typical 149-pound white woman, and as a result is at no higher risk for obesity-related health complications.

In another comment, Peter cited a Steve Sailer blog post on the topic.

I have no doubt that black women do indeed have more muscle, on average, than white woman, a fact easily observed by riding the subway in the summer months. But does the average black woman have 17 pounds more muscle than the typical white woman as Peter suggests? That's doubtful. I would guess that about half the weight difference is fat.

Peter then made a dubious leap of faith in assuming that because of the extra muscle, black women have "no higher risk for obesity-related health complications."

First of all, the research is fuzzy on whether a little extra weight is bad for you, or maybe even it's good for you. The research on whether muscle is good for you is non-existent as far as I know. None of the large scale studies that I've read about have attempted to categorize people's weight into muscle weight vs. fat and bone weight. For whatever reasons carrying extra fat weight leads to various diseases, it's not clear that carrying around extra muscle weight wouldn't also contribute.

Because muscles are currently fashionable, even on women (check out Madonna's muscles), Peter is assuming that what's fashionable must therefore be healthy. Not true. Cigars became recently fashionable, but that doesn't make them any more healthy.

If muscles were so good for us, then we would have evolved into super-muscled hulks. Muscles, obviously beneficial for men competing with each other for women, must come with some other less obvious but nevertheless detrimental effect.

A Harvard study of American life expectancy showed that Asian Americans had the highest life expectancy and black Americans the lowest life expectancy. Blacks tend to be more muscular than whites and Asians less so (a fact which doesn't help Asian men much in the American dating market), but the race with the least muscle has the highest life expectancy.

Should the nanny state outlaw salt?

According to the NY Times, a doctor's group wants the FDA to classify salt as a "food additive" instead of a substance "generally recognized as safe," thus making it illegal to add too much of it to food.

People should be outraged at this latest attempt to regulate our lives. Mankind managed to survive thousands of years without a government telling us how much salt we're allowed to eat. Furthermore, there's a good chance that the whole "salt is bad for you mantra" is really a big lie.

Medicare premiums increasing for the affluent

The government is raising Medicare premiums for individuals with more than $80,000 in income.

Sounds like a move in the right direction. How is it fair that young poor people are taxed so that rich old people get practically free healthcare?

If anything, this doesn't go far enough. If an old person has $40,000 of income, I don't see why he should pay only one quarter of what a young person has to pay for healthcare.

"Doctor only" contact lenses

There's an article (subscription required) about "doctor only" contact lenses in today's Wall Street Journal.

People who have ever purchased contact lenses online know that the optometrist charges a huge markup on lenses. You can buy the same lenses online for a fraction of the cost.

It seems that doctors and certain contact lens manufacturers have been trying to boost profits by establishing lines of "doctor only" lenses which can only be purchased from an opthamologist or optometrist. Obviously, the doctor can increase profits by prescribing these lenses because his patients can't buy them cheaply on the internet.

Yet another example of how the healthcare business tries to increase profits by preventing free market competition.

Drink coffee for your health

A NY Times article reports that coffee is good for you.

Coffee decreases the risk of Type 2 diabetes and also reduces the risk of cardiovascular disease.

Coffee lowers your chance of dying:

[A]fter controlling for age, smoking and alcohol consumption, women who drank one to five cups a day — caffeinated or decaffeinated — reduced their risk of death from all causes during the study by 15 to 19 percent compared with those who drank none.

One of the benefits of coffee is antioxidants:

[R]esearchers found that a typical serving of coffee contains more antioxidants than typical servings of grape juice, blueberries, raspberries and oranges.

As usual, whenever a study shows that something supposedly bad for you is actually good, there are doctors who refuse to acknowledge the truth:

“I wouldn’t advise people to increase their consumption of coffee in order to lower their risk of disease,” Dr. van Dam said ... .

Don't catch fat

There's a fascinating NY Times article about a virus that makes people fat.

So maybe the "obesity epidemic" is not a result of a recent lack of willpower or too many McDonald's, but rather a real epidemic caused by a virus.

Does high social status prevent aging?

From a BBC article:

A study of 1,552 volunteers revealed a low social status can accelerate the ageing process by about seven years.

...

At the womens' average age of 46, they found the difference between the telomere length of those classified as manual workers - correlating to women in the three lowest social groupings, and non-manual workers - the women in the highest three classes, was equivalent to seven biological years.

To check that this was not caused by genetic factors, the researchers looked at 17 pairs of identical female twins, who had begun life in the same socio-economic class but were currently in different social groups.

They found on average, the telomeres of the twin in the higher social class were significantly longer than those in the lower social group - the difference equated to about nine biological years.

This finding is consistent with other strange findings. For example Oscar winning directors live longer. Because all directors are financially well off, you can't attribute this to better healthcare.

Being successful seems to have a mysterious beneficial effect on the human body. So by sending your kids to a state school, maybe you aren't just ruining their career prospects, you're actually condemning them to an earlier death.

Modern man: bigger, fatter, healthier

The NY Times article du jour is about how people have gotten bigger and healthier.

We are informed that in 1850, the average man was 5'7.4" tall and weighed 146 pounds (considered a "normal" weight by the obesity police), and today the average man is 5'9.5" tall and weighs 191 pounds (considered to be "overweight").

The healthiness and life expectancy of the big and "overweight" modern man is much better than for the "normal" weight 1850 man.

The empirical data shows that "overweight" people have better health, but why look at empirical data when the "Americans are too fat" theory seems to make everyone feel better.

* * *

No one really knows why people are so much bigger today. One guy has a theory that it's better health of pregnant mothers.

Maybe the supposedly unhealthy food like Big Macs that we eat so much of today is actually good for us. Maybe it's the artificial hormones and antibiotics in the beef? No one knows.

Maybe big people have more children than small people? It's something that no one ever considers.

Does good health cause exercise?

People who exercise more are supposedly healthier, and "everyone knows" that exercise causes better health.

But I've always wondered if the opposite was the case, that good health causes people to enjoy exercising more.

Greg Mankiw expresses the same thoughts, demonstrating that he's one of the few bloggers in the blogosphere who is as deep a thinker as I am.

Crooked doctors and drug companies

This article in today's New York Times is about how doctor run charities are often scams in which drug companies pay kickbacks to doctors.

Yet another example of how our nation's charity laws are misused to benefit the wealthy. And how drug companies are more about marketing than they are about R&D or manufacturing.

NY Times criticizes McDonalds

There's an article in today's New York Time about McDonald's profitable turnaround. Unfortunately, the writer devotes about half the article to criticing McDonald's for making people fat. Obviously, the writer of the article hasn't been reading his own paper. In the past two years, we've learned that fatty foods don't hurt your health, it's actually healthy to be overweight, and one's weight is mostly genetic and there's no obesity epidemic.

The psychology of the low-fat lie

This article from U.S. News demonstrates that many so called experts have too much emotional attachment to the low-fat diet lie to give it up:

They're hardly a green light to go on a junk-food binge, though, researchers caution. For one thing, the women on the diet didn't hit their target; they whittled fat intake just to 29 percent of calories--from about 35 percent--by the end of the sixth year of the study. Moreover, the recommended diet made no distinction between "good" unsaturated fats and "bad"saturated fats and trans fats, whose importance to heart health has been recognized since the data-gathering started. And since all the women in the study were eating fairly healthfully beforehand, it's possible that the small changes in vegetable and grain consumption by the dieting group weren't big enough that any benefits registered. Rather than focus on total fat intake, Stefanick advises, go easy on foods containing saturated fats and trans fats and eat more vegetables and fruits and whole grains.

So despite the largest study of its kind ever done showing no benefit to lowering fat consumption, this Stefanick women is still parroting the same tired low-fat advice that has been proven to be bogus. She can't let the issue rest. Instead she's saying that that study was bad because the women in the study didn't reduce fat intake enough, or they ate they ate too much "bad" fat and not enough "good" fat. These good fat/bad fat theories have never been proven in a large scale study. Doctor Ravnskov has a website devoted to explaining how the low-cholesterol advice is false advice just like the low-fat advice.

Why do these diet myths persist? Because people want to believe that they can somehow control their health by doing the right thing. Doing something difficult, like avoiding tasty food, makes people feel like they are doing something. This feeling of doing something has to be based on self-deprivation.

Unlike the cholesterol myth, there is a lot of evidence that drinking alcohol is healthy and helps to prevent heart attacks. A study showed that men who had one heart attack reduced their chance of a second heart attack by a whopping 50% by drinking wine. Yet the American Heart Association refuses to endorse wine:

The American Heart Association recommends drinking only moderately and advises anyone who does not drink against starting to do so.

Last year the AHA published guidance to doctors advising them not to prescribe red wine as a way to ward off heart attacks.

US doctors have been advised not to tell their patients that drinking red wine is an effective way to ward off heart attacks.

It said the protective benefits of red wine remain uncertain, and that doctors should concentrate on promoting more proven methods to reduce risk.

I'm sure that the "proven" method referred to in the article is reducing cholesterol and fat, and that has surely not been proven. Basically, the AHA has been killing people by recommending courses of action that have been proven to have no effect on health, yet they refuse to recommend drinking wine which has been shown to be a very powerful ward against heart attacks.

Another "proven" method is lowering your weight, but this is also a myth. Remember the study earlier this year that showed that being "overweight" is actually healthier than the recommended weight.

So why doesn't the AHA recommend drinking wine? Because they can't bring it onto themselves to recommend something that people like to do.

The low fat lie

The front page news today at the New York Times is that a low fat diet does not improve your health:

The largest study ever to ask whether a low-fat diet reduces the risk of getting cancer or heart disease has found that the diet has no effect.

The $415 million federal study involved nearly 49,000 women ages 50 to 79 who were followed for eight years. In the end, those assigned to a low-fat diet had the same rates of breast cancer, colon cancer, heart attacks and strokes as those who ate whatever they pleased, researchers are reporting today.

Now you need to synthesize this information with the news that it's healthy to be "overweight". The conclusion is that you should eat whatever you feel like and try to gain some weight, and this will help you live longer.

What you also get out of this is that the health authorities have been lying to you, giving you advice based on scanty information that turns out to be completely bogus.

I should have gone to medical school

There's an article in today's NY Times about how the drug companies recruit college cheerleaders to be sales reps. Male doctors prescribe a lot more drugs when the sales rep is a beautiful, fit and flirty blonde.

This article reinforces three points that I make a lot in my blogs.

(1) Attractive young women (like Onya) have it really easy. As a pharmaceutical sales rep they can make over $60,000/year after one year on the job and also get a free company car. No actual science knowledge is needed. Meanwhile, some ugly nerdy kid with high grades and a major in chemistry is making half as much money, if he can even find a job at all.

(2) We live in a marketing economy in which marketing trumps any real work.

(3) The whole medical business is a big scam in which doctors prescribe drugs based on how they feel about the sales rep and not based on their own knowledge of drugs. Pharmaceutical companies are primarily marketing based companies which barely spend any money on R&D.

Paul Krugman clueless on obesity

Paul Krugman is on an anti-obesity kick, as demonstrated by his most recent column.

The anti-obesity movement has become the left’s latest cause, even though it’s based on pseudo-science. No one has a clue as to what food is truly “healthy.” People are living longer today than ever before, which creates the presumption that what we are eating today is pretty good stuff. The burden of proof should be on those who say we are eating the wrong stuff.

People lose weight on the Dr. Atkins high fat diet, which is the complete opposite result of what is supposed to happen when you eat a high fat diet.

Previous claims that being overweight causes hundreds of thousands of deaths per year in the U.S. turned out to be completely bogus.

Furthermore, the claim that people are getting fatter is also bogus.

Krugman compares obesity to cigarette smoking, but the two are not comparable. Smoking is a voluntary behavior the people can stop. But one’s body weight is to a large extent determined by one’s genes, and eating is not a bad behavior like smoking. You have to eat in order to live.

Krugman ought to go back to writing about stuff he knows about (allegedly economics) and leave obesity to people who have actually bothered to study the issue in an open minded manner.

Annual physicals a big waste of money

Research shows that “there's no evidence annual physicals for healthy people are useful.” Yet the vast majority of doctors give them anyway, with “65 percent of primary care doctors think[ing] they are necessary.”

This demonstrates several things about healthcare:

(1) Spending more money on healthcare doesn’t make us healthier if it's spent useless physicals and tests.

(2) Doctors make money when they see patients, so why are we surprised if they encourage people to pay for useless visits and tests?

(3) Doctors actually have no clue about what’s going on in medical research, and like most Americans lack the ability to think logically. Depend on your doctor to diagnose your symptoms if something is wrong with you, but don’t believe a word they say when they have general advice on what’s healthy. (For example, doctors are still giving bad advice about what's the correct weight.)

IQ and health

Marginal Revolution’s Tyler Cowen mentions an academic article which shows that IQ predicts better health:

Large epidemiological studies of almost an entire population in Scotland have found that intelligence (as measured by an IQ-type test) in childhood predicts substantial differences in adult morbidity and mortality, including deaths from cancers and cardiovascular diseases. These differences remain significant after controlling for socioeconomic variables.

How is it that liberals can continue to get away with saying that “IQ tests measure nothing but how well one does on the test,” when we see that IQ does such a great job predicting so many things?

It’s not clear to me why IQ causes increased life expectancy. Tyler Cowen assumes it’s because smart people do a better job self-diagnosing their own symptoms and following doctors’ instructions. I’m sure this is a part of it.

But we know that IQ is a biological trait determined by our genes. Maybe the same genes that cause higher intelligence also have other biological effects which lead to greater longevity?

There seems to be an inverse correlation between IQ and weight. Smart people are more likely to be skinny and stupid people more likely to be fat. Is this strictly a social class issue (it’s not classy to be fat), or is there some sort of biological connection? (Note that being a little overweight actually makes you healthier.)

Link: visit the web page of Linda Gottfredson who authored the article “Intelligence predicts health and longevity, but why?” along with many other interesting papers about intelligence.

Should you give your kids milk?

An article in the WaPo suggests not:

The study of more than 12,000 children nationwide found that the more milk they drank, the more weight they gained: Those consuming more than three servings each day were about 35 percent more likely to become overweight than those who drank one or two.

Ignoring the fact that “overweight” is actually healthier, the 35% increase tells us little because we don’t know how many children are considered overweight in the first place.

The article tries to scare us by telling us there’s a “growing problem of obesity among children.” I’ve posted before about how this is not true.

If I were a parent I’d be giving my kids as much milk as possible, because it promotes growth, and tall kids have a huge social advantage over short kids.

Should the government pay for Viagra?

Viagra is what I would call a “recreational drug.” No one needs to be taking it. Losing one’s sex drive used to be considered a normal part of getting older.

So I am sort of outraged that Medicaid is using my tax dollars to help poor people have sex. As if poor people weren’t already having enough sex.

Tyler Cowen mentions this in the context of a story about convicted sex offenders getting government paid Viagra. I think the bigger problem is that everyone with Medicaid is getting this benefit.

Do only conservatives think rationally about healthcare?

Somewhat liberal Matthew Yglesias writes:

But let's say conservatives are right. Let's say the main problems with the US healthcare system really are overconsumption (i.e., third party payment encourages people to use health care services they don't really need) ...

I don’t understand why it’s a conservative position to note that giving something away for free causes people to consume more of whatever is being given away. This is basic economics.

This sounds to me like a confession that only conservatives think rationally while liberals live in a fairyland.

Healthcare statistics and lies

Brad Plumer, Steve Verdon and Angry Bear have all written posts trying to compare healthcare results between the U.S. and other nations.

Let me make the following points, all related to stuff I’ve previously posted about:

(1) Infant mortality rates are a bad way to compare the U.S. to other developed countries.

(2) Angry Bear has a chart comparing obesity rates, and that’s largely a function of racial makeup, and furthermore, being fat is healthy. I posted a healthy height-weight chart based on the new study.

(3) Our healthcare system is already mostly socialized, so it doesn’t surprise me that another socialized system, perhaps built from the ground up to be socialized, works better.

(4) We could save billions on drugs if we had free market competition.

Glenn Reynolds and fat

Glenn Reynolds links to David Brook’s NYT column about the fat study which says it’s healthier to be “overweight” (see my previous post), but Glenn uses this as an excuse to try to hawk bodybuilding books at Amazon.com. Obviously Glenn doesn’t get it.

My favorite line from the Brooks column:

The shallowest people end up blissfully happy and they are so vapid they don't even realize how vapid they are because vapidity is the only trait that comes with its own impermeable obliviousness system.

It has nothing to do with fat, but it’s hilarious and true.

Instapundit links to fat story

Instapundit links to a story about the obesity study at Tech Central Station. I have previously written about this topic.

While I certainly would have liked to see my blog linked to, at least the story is getting some more attention. But unfortunately, not enough attention. As the author of the TCS article points out, “In a world without junk science, results like these would mark the end of the supposed obesity epidemic that is killing us by the thousands. Unfortunately the public health community is already busily discounting the CDC's numbers and telling us that whatever the science says, fat kills.”

People are so brainwashed by the anti-fat conspiracy that they can’t believe that the truth is actually true.

The "overweight" lie: where's the outrage?

People ought to be outraged by the lies being perpetrated by our government. No, I’m not talking about WMD in Iraq, I’m talking about the lies about what your weight should be.

I previously discussed the new study which shows that people classified as “overweight” actually have lower risk of death. The chart below shows the risk of death for the various categories:

Category	Deaths
Underweight (BMI < 18.5)	33,746
“Normal” (BMI 18.5 to < 25)	0
“Overweight” (BMI 25 to <30)	-86,094
Obese (BMI 30 to < 35)	29,843
Extremely Obese (BMI 35+)	82,066

Note the following amazing conclusions: (1) More deaths are caused by people being “underweight” than by people being “obese.” (2) More lives are saved by people being “overweight” than deaths caused by people being “extremely obese.”

If the number of people in the “normal” category is approximately 67% (a very rough approximation) of the number of people in the “overweight” category, and if all those people moved from the “normal” category to the “overweight category,” then 57,683 deaths would be prevented each year!

Of course, that’s not going to happen. But let’s suppose that, because of the government telling us that we need to lose weight in order to be healthy, one third of the people in the “normal” category would have otherwise been in the “overweight” category. Under this supposition, government lies have caused 19,228 deaths per year.

Let’s put this number in perspective. People are outraged over the 2,792 deaths caused by 9/11. Every single year, government lies about weight have caused the equivalent of nearly seven 9/11s!

People are outraged that 1,563 U.S. military deaths occurred because of our conquest of Iraq. More than twelve times that number of deaths have occurred every year because of government lies about weight.

Where’s the outrage? Why isn’t the whole blogosphere up in arms? Why isn’t Congress calling for hearings? Why aren’t people being punished for all of these preventable deaths?

The overweight lie

For years you’ve been told that you need to lose weight for your health. It turns out that this was a big lie. As stated by the AP:

Researchers at the Centers for Disease Control and Prevention reported that packing on too many pounds accounts for 25,814 deaths a year in the United States. As recently as January, the CDC came up with an estimate 14 times higher: 365,000 deaths.

Our government has been lying to us, but that’s not the whole story. The study, which is available online, shows that being overweight (a Body Mass Index [BMI] between 25 and 30) actually lowers the chance of dying.

That’s right, according to this data, a lot of Americans should be gaining weight for their health. Thus the headline of the NY Times article reads Some Extra Heft May Be Helpful, New Study Says.

The following chart (source: NIH) shows the ideal minimum and maximum weight range:

Height	BMI 25	BMI 30
5’0”	128	153
5’1”	132	158
5’2”	136	164
5’3”	141	169
5’4”	145	174
5’5”	150	180
5’6”	155	186
5’7”	159	191
5’8”	164	197
5’9”	169	203
5’10”	174	209
5’11”	179	215
6’0”	184	221
6’1”	189	227
6’2”	194	233
6’3”	200	240

Now I’m sure a lot of you, especially my female readers, fall below the healthy weight range, so go out there and start eating. I, for one, am going to hit McDonald’s tomorrow.

The infant mortality rate in the U.S.

Don Boudreaux posts some thoughts about why the U.S. might have higher infant mortality rates than some other developed countries. For example, Canada, Japan, the United Kingdom, France, Germany and Sweden all have lower infant mortality rates. (The reason why this is topical is because the economist/NY Times columnist Paul Krugman recently implied that our healthcare system sucks on account of our high infant mortality rate.)

Doing a little digging on the internet revealed a 1992 CBO report which sheds a lot more light on the issue. The reason why our infant mortality rate is high is because our rate of low birthweight births is high. After a low birthweight infant is born, it has “better chances of survival in the United States than elsewhere.” But the reason for why low birthweight births are more common in the U.S. than in other developed countries is a mystery.

One factor is multiple births. Compared to singleton births, low birthweight and infant mortality is many times more likely to occur in a multiple birth situation. Incidence of multiple births has been increasing significantly in the United States. Fertility treatments and older women having children are factors contributing to the increase. Some statistics can be found here.

Another factor is that black women seem to have a disproportionate amount of low birthweight births compared to whites. There’s no way of knowing if this is all environmental, or if perhaps there is some genetic difference between the races that make black women more susceptible to the problem. If the latter, then the greater percentage of blacks living in the United States contributes to our higher infant mortality compared to Western Europe and Asia.

Finally, drug and alcohol abuse by pregnant mothers contributes significantly to the problem of low birthweight births. I don’t think it’s fair to blame the healthcare system for this self-inflicted problem.

The infant mortality literature talks a lot about prenatal care. But I am not convinced that lack of prenatal care is so significant of a factor. I think it’s likely that the type of woman who is going to abuse drugs and alcohol while pregnant is also less likely to seek prenatal care. It’s the substance abuse and not the lack of prenatal care causing the problem.

In conclusion, it seems to me that the higher infant mortality rate in the U.S. compared to some other developed countries is not a direct result of inferior medical care in the U.S., but due to societal factors that are outside the scope of the medical profession. Paul Krugman, therefore, is wrong to bring this up in his op-ed pieces.

Let’s de-socialize our healthcare

Matthew Yglesias posted some healthcare statistics, and Steve Verdon responded. These are the statistics:

• United States: $5,267 on health care/ $2,364 is government spending.
• Canada: $2,931 on health care / $2,048 is government spending.
• France: $2,736 on health care / $2,080 is government spending.

So what is this supposed to imply? That if we changed to the French system of socialized medicine, we’d pay less for healthcare?

The most important point I can make here is that the United States already has socialized medicine: (1) Prices for medical procedures are set by Medicare, and most private insurance companies follow the same price schedules. (2) Hardly anyone actually pays there own way for healthcare. Whether they have Medicare, or an employer provided plan (which receives a significant tax subsidy—meaning that the government pays for part of that as well), they get to consume medical services without paying.

Prices set by the government? People get services without paying anything? That sounds close enough to socialized medicine to just call it that!

I don’t know much about the French medical system, but we might very well have better healthcare at lower cost by changing to a socialized system like the French one. It might be more efficient than our current socialized system. Who knows?

On the other hand, I am nearly certain that we’d improve our healthcare by de-socializing it. I previously wrote about pay at time of service healthcare where people pay the doctor at time of service. Doctors are able to provide health services at much lower costs when they don’t have to pay for a staff of people to bill the insurance companies. I am also convinced that quality would improve. Imagine seeing the following ad on TV: “At the Smith health center, if you wait more than ten minutes after your scheduled appointment time, your visit is free.” That kind of service sure isn’t going to happen under our current system.

I don’t understand why people are so attached to the model of all doctor visits being paid for by insurance. The healthcare system would be so much more efficient if there was free market competition between healthcare providers. High deductible insurance would still be there if you got really sick. That’s the real purpose of insurance: to pay for what you can’t afford.