Category: Medical Overuse

On the Tragedy of the Commons: the Toxic Effects of Drug Co-Pay Coupons

Last week I was driving through Phoenix when I saw this sign at an intersection: It struck me that this was a perfect example of what happens when clever business folks figure out a way to short circuit the normal laws of consumer behavior.    How’s it work?  Bring your car in and the glass shop bills ...

Express Scripts Undoes Turing Pharmaceuticals: Witness the Rise of the “Activist” PBM

Everyone knows the recent story of “rapscallion” Martin Shkreli: the ethically depleted CEO of Turing Pharmaceuticals who bought the rights to Daraprim, a generic anti-parasitic medicine and marked up the price of a tablet from $13.50 to $750 overnight.   As disgusting as Shkreli’s story is–  the more important and interesting tale is how Turing was subsequently undone by ...

On Getting Burned by Population Health Thinking: (Why has a Decade of Intervention not Prevented More Deaths From Brain Aneurysms?)

In our house we take a lot of fizzy vitamin C to prevent colds in the winter. As doctors, my wife and I both know that science doesn’t support our decision… We take it anyway. We shouldn’t. After all, the well respected Cochrane group (which grades and distills multiple studies into a single “meta-analysis”) clearly ...


Medical Decisions by Gestalt. A Half-Trillion Dollar Bill and the Vexing Problem of Physician Practice Variation

It’s common that the same patient seeing two doctors for the same condition will walk away with conflicting recommendations. I recently spent time with a patient who had a bad back. One doctor had recommended a conservative approach (watch it, take ibuprofen, use ice) while another recommend an MRI and possibly an epidural steroid injection.