Posts in: medicine

Where have all the healthcare YIMBYists gone?

Today in titles that trigger me: Where is the YIMBY movement for healthcare?.

YIMBY is too simplistic of a concept to be easily applied to healthcare. It relies on a single dimension — how easy is it to build housing — and any proposed policy can be easily placed on the NIMBY/YIMBY spectrum. And since everyone can agree on where a particular policy lies on that spectrum, creating alliances is easy.

No such luck for American healthcare, where there are many dimensions: accessibility of new procedures (clinical trial YIMBYism), accessibility of approved treatments (insurance YIMBYism), accessibility of healthcare providers (practitioner YIMBYism), accessibility of MDs in particular (doctor YIMBYism)… And even there it is not clear what the YIMBY-equivalent stance would be. Does clinical trial YIMBYism mean you want more trials, quicker trials, or just more drug approvals and doing away with trials entirely? If you are a doctor YIMBYist, do you want to increase the number of medical schools? Residency and fellowship slots? Enable more foreign medical graduates to enter practice? All of the above? But then how do you deal with practitioner YIMBYists, who want to do away with most doctors altogether and delegate most work to physician assistants, nurse practitioners and, at the end of the line, large language models?

There is not a single person in America who would say its healthcare system is working, and yet it is clear why there is no unified front on how to fix it.

To be clear, I quite like the ideas brought up in that leading article. The five sample issues it names — breakdown of the direct doctor/patient relationship, unclear fees for service, frequent insurance switching, no room for insurer creativity, too much money spent on end-of-life care — are spot on. If I had to pick one thing where I would want to be a YIMBYist, it is to remove any direct influence of the federal budget on healthcare. A large pot of money leads to hypertrophy of every other part of the system which down the line lead to many of the issues above. But is that really a YIMBY attitude?But alas the issues in question are too complex to be boiled down to a YIMBY-equivalent jingo, and to emphasize that point the article has an addendum linking to a 10,000-word report on the topic which at a glance seems to be raising the right points but I couldn’t really tell you since I have a day job that doesn’t leave much time for reading 10,000-word policy papers.

(↬Ruxandra Teslo)


Today’s FT essay on the rise of the anti-vaccine movement was a miss. Instead of asking why so many people lost trust in institutions it goes straight to politics: 10 paragraphs on Germany’s AfD, no mention of whether some of the people’s concerns were valid. With that, the movement can only grow.


A one-two punch on clinical trials from Ruxandra Teslo and Willy Chertman today: first their on-point agenda for clinical trial abundance as a guest post in Slow Boring, then Ruxandra’s longer essay which has been so thoroughly research that even yours truly gets a name-check. As I noted elsewhere, every US institution has made one bade tradeoff after another in how it conducts clinical trials to the point that it’s impossible to conduct a RECOVERY trial equivalent over here. That needs to change.


Siri, what is a "healthcare provider"?

A few sentences to make your blood boiling in this whopper from Noah Smith:

It’s mostly the providers overcharging you, not the middlemen.

[…] the Kaiser Family Foundation does detailed comparisons between U.S. health care spending and spending in other developed countries. And it has concluded that most of this excess spending comes from providers — from hospitals, pharma companies, doctors, nurses, tech suppliers, and so on.

The actual people charging you an arm and a leg for your care, and putting you at risk of medical bankruptcy, are the providers themselves.

Excessive prices charged by health care providers are overwhelmingly the reason why Americans’ health care costs so cripplingly much.

And to top it off:

Over at Tyler Cowen’s blog, a commenter argues that profit margins are not a good guide to the financial success of a business, and that instead one should look at return on equity (ROE). But if you look at the list of companies with the highest ROE, you see health care providers or suppliers like HCA Healthcare (272%), Cencora (234%), Abbvie (84%), Mckesson (84%), Novo Nordisk (72%), Eli Lilly (59%), Amgen (56%), IDEXX Laboratories (53%), Zoetis (46%), Novartis (44%), Edwards Lifesciences (43%), and so on.

Using “healthcare provider” to mean pharmaceutical companies is at best careless when the article you are writing is directly tied to a murder of a health insurance executive. But what really upsets me is that he is right: physicians, nurses, etc. have allowed themselves to be tied to these behemoths for the promise of what? A steadier paycheck that is less — for the time spent in school and at work — than what a mid-career IT professional earns? Sad. (↬Tyler Cowen)


On my way back from #ASH24 I’ll go back through the abstract book and check out how many cell therapy oral presentations were given by investigators from China. This is the first meeting I’ve attended since 2019 and the difference is striking. Kudos!


PCA maps are the new PET scan, only with zero clinical relevancy instead of at least some. Much more subjective, too! #ASH24


100% of patients developed grade ≥3 neutropenia. “The safety profile was mild” #ASH24


Seeing those PET scans after CAR-T 5–10 years ago was transformative but it has now become superfluous. Yes, yes, that was a nice anecdote, can I now please see some data? #ASH24


United Airlines IAD→SAN flight is full, the person in front of me is talking about sickle cell disease, and I know a good chunk of people on board. I should also be looking at the #ASH24 program instead of writing this but oh well.


And in even bigger news for clinical medicine:

Brian Thompson, the CEO of United Healthcare, was shot and killed by a masked man near a Midtown Manhattan hotel early Wednesday, according to police sources.

United Healthcare is, of course, the Big Bad for-profit healthcare hydra gobbling up hospitals all over the country. On an unrelated note, this seems to have been a hired hit.

Faber est suae quisque fortunae.