Don’t bank on the rank

October 30, 2009

The United States ranks 37th in the world in health care, according to the World Health Organization (WHO). Google the key words, and you find 3.7 million instances, with numerous mentions in recent months as the debate on health care reform heated up. What you won’t find are many articles questioning whether the statistic is true.

Enter the Wall Street Journal’s “Numbers Guy,” Carl Bialik, to deconstruct this damning statistic. First, it is based on a report released almost ten years ago. Second, this very report is based on out-of-date statistics that are incomplete and inaccurate.

The WHO ranking is composed of five criteria – life expectancy, responsiveness in providing diagnosis and treatment, inequality in health-care outcomes, inequality in responsiveness, and individual spending. The latter three proved to be the most controversial.

One huge issue was that the required data was not readily available for every nation; therefore, Bialik explains, WHO researchers would calculate the relationship between the five factors and whatever available numbers they could find. This means that literacy rates were sometimes used to approximate the quality of health care.

It is also difficult to create a ranking based on life expectancy when it is affected by a variety of factors outside of the heath-care system, such as diet and exercise habits, poverty, and homicide rate.

But wait, there’s more! According to an article from the Cato Institute, the data for each factor was collected from individual agencies and ministries. This creates inconsistencies in definition, reporting and methodology.

When individual spending is removed, the U.S. actually ranked much higher on the list. Bialik writes:

“…the WHO took the additional step of adjusting for national health expenditures per capita, to calculate each country’s health-care bang for its bucks. Because the U.S. ranked first in spending, that adjustment pushed its ranking down to 37th. Dominica, Costa Rica and Morocco ranked 42nd, 45th and 94th before adjusting for spending levels, compared to the U.S.’s No. 15 ranking. After adjustment, all three countries ranked higher than the U.S.”

Click here to see a chart from the Wall Street Journal that shows health care rankings when spending is removed.

Why Stress Makes You Fat

October 23, 2009

Originally posted on our collaborative site,

By Erika Schwartz, MD

A recent study in the American Journal of Epidemiology looked at data on 1,355 men and women who had their weight and stress levels measured in 1995 and again in 2004.

The findings showed that those who were overweight and obese packed on the pounds even more as time went by and stressors continued and increased.

Those who were thin stayed thin and according to the lead author Jason Block on faculty at Harvard, “The stress effect didn’t appear to impact normal-weight people, just those who were overweight and obese from the beginning of the study.”

The results of this study may be true but as Americans are getting fatter and sicker, we are faced with more problems than ever before.

We are suffering ever-growing rates of obesity and worsening health caused by weight problems.

Stress is a leading cause of this modern-day epidemic – brought about by our frenetic lifestyles or by financial worries from the economic recession.

Stress comes in two varieties:

Read the rest of this entry »

The CDC diagnoses swine flu by telephone

October 22, 2009

Every flu season doctors note that many people mistake having a bad cold for the flu, but that their symptoms, even if flu- like, do not mean they have the flu. So what do you think happened when the Centers for Disease Control called 10,000 people by phone and asked them if they had flu-like symptoms? Well, golly gosh, it turns out that one in five kids had “flu-like” symptoms in the past month (you know, the month when kids returned to school to give each other their germs).  The CDC claims that most of the kids probably had swine flu, which, naturally, led some people in medialand — The Los Angeles Times, MSNBC and several others who appear to have toned down their headlines during the day– to claim that they actually had swine flu.

But – cough – how could anyone possibly make an accurate diagnosis of swine flu over the phone, when so many people commonly refer to “cold-like” symptoms as having the flu? We have privileged access to our thoughts and feelings, and can tell a telephone interviewer with 100 percent accuracy whether we are happy or sad; but we cannot, alas, discern between viruses when we’re sick; we just know we’re sick with something.

Aside from the limits of self-diagnosis, a telephone survey of this kind is also prey to other kinds of bias, such as whether people were more inclined to affirm that they had flu-like symptons (rather than claim a mere cold) due to the proliferation of swine flu stories in the media.

The false certainty created by ‘guessurveying’ the  incidence of swine flu may well be designed to encourage parents to get their children vaccinated, but laudable ends are rarely well served by such obviously lame means.  It just makes the CDC look unscientific. And that’s the kind of development that can metastasize into full-blown lack of credibility, when, eventually, some news organization starts to ask awkward questions.

And despite the prevalence of stenography in the press, the CDC’s “guessurvey” comes a day after an  investigation by CBS News  found that the Centers told states to stop doing real testing for H1N1 in July — and to stop counting actual cases, decisions which the network reported left some public health experts perplexed. On top of that, CBS’s analysis of state data shows that H1N1 was less prevalent over the summer than expected  and that claims based on apparent symptoms and not actual testing — such as the alleged outbreak of swine flu at Georgetown University — were more likely to over-estimate the  incidence of disease.

Malcolm Gladwell’s advice to aspiring journalists

October 22, 2009

Author Malcolm Gladwell’s advice to future journalists is to avoid journalism programs. In an interview with TIME, he says:

“Aspiring journalists should stop going to journalism programs and go to some other kind of grad school. If I was studying today, I would go get a master’s in statistics, and maybe do a bunch of accounting courses and then write from that perspective. I think that’s the way to survive. The role of the generalist is diminishing. Journalism has to get smarter.”

You can read the full interview with Gladwell over at

Palm Beach Post accuses Erin Brockovich of fishing for law firms

October 20, 2009

Apparently, no amount of any naturally occurring substance can be tolerated in our water supply; but if you can’t sue God,  Gaia, or the Cosmos, you can sign up – for free! – to sue Pratt and Whitney…  more

Anti-vaccination – a left wing disease?

October 20, 2009

Wired has published a dazzling and timely story on the rising toll of childhood diseases in the U.S. due to the increasing numbers of parents who refuse to vaccinate their children. Author, Amy Wallace, correctly notes that this issue has bridged those on both sides of the political spectrum (we’ve observed vaccination being framed on the far right as some sort of tool of one-world health care, a division of one-world government); but the inescapable fact is that the anti-vaccination movement’s ringleaders are firmly on the liberal-left-Hollywood side of politics, which is a disaster for public health. Here’s how her article begins:

“To hear his enemies talk, you might think Paul Offit is the most hated man in America. A pediatrician in Philadelphia, he is the coinventor of a rotavirus vaccine that could save tens of thousands of lives every year. Yet environmental activist Robert F. Kennedy Jr. slams Offit as a ‘biostitute’ who whores for the pharmaceutical industry. Actor Jim Carrey calls him a profiteer and distills the doctor’s attitude toward childhood vaccination down to this chilling mantra: ‘Grab ‘em and stab ‘em.’ Recently, Carrey and his girlfriend, Jenny McCarthy, went on CNN’s Larry King Live and singled out Offit’s vaccine, RotaTeq, as one of many unnecessary vaccines, all administered, they said, for just one reason: ‘Greed.'”

It doesn’t matter that RotaTeq protects children against the Rotavirus, whose symptoms of severe diarrhoea lead to some half-a-million deaths per year, there is simply no reasoning against the anti-vax movement’s belief that big pharma is evil. So while many Democratic politicians would be appalled if asked to denounce evolution as a tool of “big science,” they appear happy to minister to the idea that vaccination is not scientific. As Wallace notes:

“There are anti-vaccine Web sites, Facebook groups, email alerts, and lobbying organizations. Politicians ignore the movement at their peril, and, unlike in the debates over creationism and global warming, Democrats have proved just as likely as Republicans to share misinformation and fuel anxiety.

US senators John Kerry of Massachusetts and Chris Dodd of Connecticut have both curried favor with constituents by trumpeting the notion that vaccines cause autism. And Robert F. Kennedy Jr., a scion of the most famous Democratic family of all, authored a deeply flawed 2005 Rolling Stone piece called “Deadly Immunity.” In it, he accused the government of protecting drug companies from litigation by concealing evidence that mercury in vaccines may have caused autism in thousands of kids. The article was roundly discredited for, among other things, overestimating the amount of mercury in childhood vaccines by more than 100-fold, causing Rolling Stone to issue not one but a prolonged series of corrections and clarifications. But that did little to unring the bell.”

Wallace and Wired, by contrast, have produced a model of science journalism – the article needs to be read for one of the best descriptions of how virulent measles is once one person is infected, and for how elegantly and economically it manages to dispel so much patent nonsense put out by the anti-vax loons. We can only hope this article gets the National Magazine Award it so richly deserves, that it shames Arianna Huffington and her friends (who have turned the Huffington Post into a venue for all manner of anti-vax vapidity), and that those on the liberal left stop patting themselves on the head for not being creationists, and realize that left-liberal irrationality might actually do more harm than Bush’s war on science ever did.

Our favorite surgeon blogger comments here

Men have potty hands

October 16, 2009

Happy belated Global Handwashing Day (it was officially October 15th, but really shouldn’t this be a holiday that is observed everyday?). And what better way to celebrate than with a new study by the London School of Hygiene & Tropical Medicine that finds only one-third of men wash their hands with soap after using the bathroom, compared to two-thirds of women.

The findings, published in the American Journal of Public Health, are based on a study of  250,000 people in Britain whose use of soap in restrooms was monitored with sensors over a period of 32 days. Also examined was the effectiveness of various handwashing reminders which were displayed on LED screens at the entrance of the lavatories.

The most effective reminder was found to be “Is the person next to you washing with soap?” When this message was displayed, the use of soap jumped 12 percent for men and 11 percent for women, suggesting that if you make people feel like they are being watched, they’ll be more likely to comply with a directive. Gross is also good, if you are a man, with messages such as “soap it off or eat it later” eliciting higher response rates; women, however, responded better to simple reminders.

The importance of handwashing should not be underestimated. The study’s authors write:

“Handwashing with soap has been ranked the most cost-effective intervention for the worldwide control of disease…It could save more than a million lives a year from diarrhoeal diseases, and prevent respiratory infections – the biggest causes of child mortality in developing countries.”

Now, as one of the tested reminders commands, please “don’t be a dirty soap dodger” and go wash your hands. Or maybe they meant you should avoid dirty soap? Either way, the Centers for Disease Control and Prevention has several helpful handwashing tips.


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