Policy and Ethics

We have entered dangerous times in my beloved medical profession. Non-doctor health professionals, backed by powerful lobbies, are increasingly interested in the easing of certain practice restrictions. New titles like “clinician” or “advanced practitioner” or “provider” are masking a stark reality - people will be able to practice medicine without ever having to attend medical school, perform rigorous residencies or be comprehensively and extensively trained as physicians.

This is not to diminish the powerful benefits of nurses. Far from it. But nurses are not doctors and the people most likely to get medical treatment from people who are not doctors are among the poorest that health care reform was supposed to improve. We shouldn't cave into it. From an ethics perspective...

If you know a local politician has accepted a small fortune, $300,000, from corporations with a specific agenda, would you believe:

(1) They are compartmentalizing their decisions so funding does not matter;

(2) They are simply getting donations for beliefs and work they've already done, so it does not sway them or;

(3) They are engaged in pay-for-play.

If you are at politically-motivated, dark-money-funded sites like Mother Jones or Sourcewatch, or at one of the 300 corporate marketing groups (US Right To Know et al.) that are propped up by Organic Consumers Association, the answer will always be (3) because you sell stories of conspiracies and evil corporations and scientists being bought off.

How about if I add a wrinkle? What if I note that the...


“We’re asking ... if the patient has commercial insurance, or they’re Medicaid or Medicare patients and they’re equal, that we prioritize the commercial insured patients enough so ... we can be financially strong at the end of the year to continue to advance, advance our mission,” said John Noseworthy, the CEO of the Mayo Clinic.

Given a choice, says Noseworthy [1], Mayo Clinic prefers patients with private insurance over those receiving government insurance.

When I read his statement, I was gobsmacked, mostly because this behavior is illegal, and it looks bad for a non-profit charitable trust. Those facts explain why Dr....

Will patients ever shop for health care the way consumers do for an iPhone?

Pfizer's Robert Popovian asks this question in his latest contribution for Morning Consult called "Let the ‘Buyer Beware’ for Health Care Purchases."

Policymakers have welcomed the concept of health care consumerism for many years, based on the idea that if patients could "shop" for medical services, it would set up a competition between providers (physicians, hospitals, drug companies) that would ensure that patient-consumers would receive better care for less money. Can this work?

Popovian writes, " Theoretically, the rationale sounds like a winner; however, health care is unlike most other goods or services as it is hindered by what economists refer to as “asymmetry in...

On November 8, I published an article titled, "Whoever Wins On Election Day 2016, American Science Is Still #1 In The World." That is every bit as true now as it was then.

Mr. Trump promised to be a different kind of president. So, nobody should be surprised that he is living up to his campaign pledges. However, his budget proposal for 2018 should raise some serious concerns. Cutting science funding, particularly that of the NIH, is not aligned with his goal to "Make America Great Again."

How Bad Are the Proposed Cuts?

In many ways, Mr. Trump's goal of reducing the size and scope of the federal bureaucracy is...

John Ioannidis, a professor at Stanford, has made something of a career writing about the quality of scientific reporting. His paper "Why Most Published Research Findings Are False" is among the most downloaded articles from PLoS Medicine. He has written a new essay in this month’s Social Science and Medicine. He begins with a review of a study in the same issue which demonstrated that unsolicited online reviews of medications were biased. Biased in that a drug’s effectiveness, in this case, Benecol, CholestOff, and Orlistat,

“seemed more impressive in the online reports….The difference between...

As a Californian who also lives in New York City, I am fascinated by how these two states do so many things that cost taxpayers money while producing estimates showing how much we all saved, even though taxes remain really high.

In New York, for example, we are told the state Affordable Care Act program, New York State of Health, saves us all billions, yet for some reason we get 11% of federal money while only having 6% of the enrollees. It's not really a victory for economics when you stay afloat because you get twice as much money as another state. If we were really saving money, that would mean we would instead be able to send money to poor states. 

My other coastal home, California, is saving billions of dollars by penalizing businesses, we were recently told...

Policy decisions should be based on evidence in order to provide the most benefit for the health and safety of the public. However, there are scant guidelines for making sound evidence-based policy focused on the intersection of science and society.

Making science policy requires policymakers, scientists, and the public.

Scientists don't necessarily understand policy and policymakers don't necessarily understand science, and the public, well they may or may not understand either of these two realms. But those three groups bring differing perspectives, understandings, and contexts and each has their set of values that must be integrated to create sound policy. 

The Brussels Declaration on the Ethics and Principles for Science and Society Policy-Making was published...

United Healthcare, the largest provider of Medicare Advantage (MA plans) services, is being sued by the Department of Justice (DOJ) for fraud. To give you a sense of United Healthcare’s size consider that just their third quarter revenue was $46.3 billion, up 11.6 per cent from the same period a year earlier, and the bulk of the growth was billing services and data analysis for healthcare groups, which ws up 34 percent since the beginning of 2016.

And to get a sense of the concern about the DOJ joining a whistle-blower lawsuit, consider this


I hate politics. Is that enough of a disclosure? Well, I hate erosion of the doctor-patient relationship even more, especially when predicated on politicized falsehoods. So without making a political statement, let's have a medical discussion, and you can let me know your thoughts.

A recent ruling by the 11th U.S. Circuit Court of Appeals in Atlanta, Georgia, found the Firearm Owners Privacy Act (FOPA)— enacted in 2011 in Florida— impeded the First Amendment free speech rights of medical professionals. The law sought to preserve Second Amendment rights but thought forbidding physicians to discuss gun ownership with patients was the way to do so. Fines and censure by the state medical board were threatened if doctors were found to be in violation. Ambiguous language didn’t help...