BS, what Princeton philosopher Harry Frankfurt once called a “lack of connection to a concern with truth — this indifference to how things really are,” has probably been around since the beginning of language. It’s now common in American discourse about politics (just tune in to any cable news channel), entertainment, and sports.

We’ve noticed an influx of BS in health care. You don’t have to look far to spot it. Just think of Theranos and IBM Watson. We are wondering if several new corporate “turduckens” — like the joint effort of Amazon/Berkshire Hathaway/JP Morgan, or hospitals combining with medical groups, or mergers and acquisitions creating a single company that’s an insurer, a pharmacy benefit manager, and a pharmacy — are for real or just turkeys.

While BS can be funny, it can also be sad, and worrisome. Thanks to social media, BS today can spread faster and farther than the truth.

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Health care has an acute BS problem, in part because BS can sometimes fill the bill. Suppose you are asked to address an ageless problem in health care: reduce costs while simultaneously raising quality. If you were knowledgeable to begin with or did some research, you would know there is no easy solution. You could respond with a message of failure or a discussion of inevitable trade-offs.

But you could also pick an idea with some internal plausibility and political appeal, surround it with careful but conditional language, and launch a program. It will, you note, take several years before it is successful, but you and your colleagues will argue for the idea in concept, with the details to be worked out later.

At a minimum, unqualified acceptance of such ideas, even (and especially) by apparently qualified people, will waste resources that could have been used to make the best of what we currently have, and will lead to enormous frustration for the audience of politicians and outraged critics of the current system who want answers and want them now.

The incentives to generate BS are not likely to diminish — if anything, rising spending and stagnant health outcomes strengthen them — so it is all the more important to have an accurate and fast way to detect and deter BS in health care.

In a lively 1969 speech to the National Council of Teachers of English entitled “Bullshit and the Art of Crap Detection,” educator, media theorist, and cultural critic Neil Postman said that “helping kids to activate their crap-detectors should take precedence over any other legitimate educational aim … Every day, in almost every way, people are exposed to more bullshit than is healthy for them to endure.”

We have carried Postman’s banner into academia with two reports, one in 2018 and another this year, that identify 21 different forms of BS in health care. Here are our top 10:

"Wayne's World"
Mark J. Terrill/AP

#1: Patient Engagement

Patient engagement is one of the cornerstones of the consumerism movement in health care. It means that individuals are concerned about their health status, motivated to do the right things (eat right, exercise, don’t smoke, yada yada yada), talk with their providers, and follow their recommendations. They should also be willing to seek out information about their providers, consider the cost and quality rankings of clinicians and hospitals, and make cost-effective choices regarding their care.

“It might happen. Shyeah! And monkeys might fly out of my butt,” as Wayne Campbell of Wayne’s World might have said. Most of the scenarios described above rarely happen; if they do, they occur mainly among the “worried well.” Individuals most at risk, generally those with multiple chronic conditions, are perhaps least able to act like consumers and demonstrate the engagement that advocates are looking for. Instead, they are burdened with a host of health, financial, and social problems that undermine efforts to be more proactive. Many of them don’t want to be engaged. They just want to be healed and go home.

Patient engagement is also blunted by third-party insurance coverage. Such coverage can limit an individual’s financial exposure, and efforts to promote more engagement by getting patients to have more “skin in the game” through higher deductibles and co-pays often result in deferrals of needed care. We don’t believe that is the type of consumer behavior we are looking for.

#2: Big Data

The Economist devoted its February 3, 2018, cover page to “How Data Will Transform Health Care.” The article suggests that Apple, Google, Facebook, and Microsoft are poised to disrupt (more about disruption later) the health care industry through new apps, artificial intelligence, and big data.

To be honest, we aren’t sure what “big data” look like. The term often means having more sources of information about a patient, including his or her genetic profile, diagnostic tests, sociodemographic characteristics, and use of medical resources. That’s all well and good. Yet more data is not a solution in itself. As others have argued, big data does not necessarily confer big understanding. It may, instead, just yield more noise from which to distill a signal.

To be useful, big data will require theories of what is associated with what and what causes what. It isn’t clear that the corollary to big data, “analytics,” supplies these missing ingredients. Another issue is that more observations (statistical power) are needed on the two parties closest to the delivery of health care: the doctor and the patient. If big data does not provide that, we are left with a lot of data on a small sample that may not tell us much.

#3: Call in the consultants

Many of the solutions offered to health care providers are developed by consulting firms that tend to use one-size-fits-all, off-the-shelf designs developed in other industries. Modifications for special features of the health care sector, like the need to give authority to physicians and nurses and the special risks of errors, require specialized knowledge that consultants often do not have and so aren’t made. Consultants rarely bother to consider the maxim that “health care is different” or that “all health care is local,” so why bother customizing, even though solutions imported from elsewhere are likely to fail.

GRIGOR
Adobe

#4: Transformation

Transformation is another instance of BS in health care. The term first appeared when the Commonwealth Fund created a Cartesian graph with the industry’s migration from fragmented to integrated providers on the X-axis and from fee-for-service to alternative payment models on the Y-axis. It has been more recently popularized as the movement from “volume to value.”

What’s wrong with transformation? Not all of it ends up well. Just ask Gregor Samsa who, in Franz Kafka’s classic novella, “The Metamorphosis,” wakes up to find himself changed into a monstrous bug. People forget that Samsa’s first thought upon seeing his new “form” is that he hates his job. That sounds a bit like doctors and their view of transformation. Moreover, some transformations don’t indicate progress, just a change in state. A tadpole turns into a frog, but that doesn’t make the frog superior in any way, just different.

There are more serious issues with the notion that health care is currently undergoing a transformation. First, the evidence does not support it; indeed, the pace of change along both the X-axis and Y-axis in the Commonwealth Fund’s graph is remarkably slow. Second, there is no necessary correlation between what is going on along the two axes. Third, it is not clear that this transformation is associated with improvements in quality or reductions in cost suggested by its proponents.

# 5: Synergy

One of the most frequently used (and poorly understood) terms to support new corporate strategies, the word synergy stems from the Greek word suneisis, which means “your rivers of understanding flowing together.” We are not sure corporate strategists have this in mind. Usually, they utter the simplistic phrase “1 + 1 = 3.”

The closest analogy that comes to mind is a good marriage. In such cases, there can indeed be synergy with the strengths of each party complementing the weaknesses of the other, fostering better decision-making, having to buy only one set of china, and having one good set of ears and one good set of eyes at the cinema. Of course, roughly half of all marriages end in divorce (not much synergy there), and half of the remainder are unhappy (not much synergy there, either). In other words, synergy sometimes works in marriage and in business, but often it does not.

What happens when synergy meets corporate strategy? If you are tempted here, you might want to read Alfred Chandler’s book “Scale and Scope: The Dynamics of Industrial Capitalism.” Or consider the extensive literature on corporate diversification. After roughly 50 years of research, the answer to the question of whether diversification improves company  performance is, to quote George Carlin, “definitely no yeah.” Some diversification may help, but not a lot. There is an equal amount of evidence that staying focused in one area is pretty good, too.

#6: Roll-ups

Roll-ups are a favorite strategy for forming horizontal chains of organizations. Entrepreneurs start by buying one outfit; then buy another under the promise of combined market power and efficiencies of scale; and continue on a grander scale as they form a behemoth. Entrepreneurs attract new targets and investors based on these promises (and maybe equity); they satisfy Wall Street analysts by virtue of combining the earnings of the acquired firms to show “growth.” This motivates new targets and investors to join the party. As the late Princeton economist Uwe Reinhardt once pointed out, it is akin to a Ponzi scheme.

Roll-ups have a rather ignominious origin. Wayne Huizinga (of BlockBuster fame) kicked it off by combining smaller garbage hauling companies in the late 1960s into a firm called Waste Management. Considering what followed, he got the name right. Health care companies got into the act during the 1960s and 1970s by forming hospital chains, and again during the 1980s and 1990s by forming physician practice management companies. These health care roll-ups failed to improve quality and reduce cost. They are now making a comeback; the promises of roll-ups today look eerily like the promises floated in the 1980s and 1990s. As we have written elsewhere, those responsible for the past debacles have either died or retired, leaving the current set of managers and investors to possibly repeat the mistakes of the past.

Tiny paramedics
Adobe

#7: Economies of scale

During the 1990s, Wall Street analysts justified every health care merger based on economies of scale. We liken this metric to Helen of Troy — the rationale that launched a thousand mergers.

The term economies of scale gets repeated so often that everyone assumes they must exist. This is known as the “illusory truth effect,” whereby statements heard repeatedly are more believable than statements heard just once. There is no question that small companies often have high total costs because they must pay for fixed or setup costs just to get going and to exist. Yet many people conclude from this truth that if hospital systems, physician networks, insurers, pharmaceutical companies, and the like just get big enough, efficiencies will emerge. But most health care firms are people intensive and thus lack scale economies beyond a relatively modest size.

Chandler’s book “Scale and Scope” covers this topic. We’ll try to summarize it in a sentence: Scale economies rest on running a higher volume at faster speed over a reduced infrastructure. How many multi-hospital systems have done that?

#8: Bandwagons

Every industry is prone to “collective movements” — meaning everyone jumps on the fashionable bandwagon. This behavior is often driven by fear and uncertainty, with people imitating others as a protective device. Health care has suffered from this behavior for decades. Bandwagon movements have produced waves of hospital mergers and fits of vertical integration and corporate diversification. Such movements are bred by contagion — getting the bug that has infected your competitor. No one has bothered to consider that innovations adopted for bandwagon reasons rarely improve corporate performance. Ideas do not have to be evidence based to diffuse.

#9: Disruption

Clayton Christensen popularized the term “disruptive innovation.” Such innovation involves lower-cost and lower-quality products or services that permeate an underserved (or non-served) market and then migrate upstream to take share away from incumbents who ignore the upstarts. This is a legitimate and important story of how some industries evolved. But does it really apply to health care?

Christensen himself is not even sure, even after writing about the concept for roughly two decades. In 2017, he issued a report titled, “How Disruptive Innovation Can Finally Revolutionize Health care,” (emphasis added).

Many things were supposed to have disrupted the health care industry — retail clinics, ambulatory surgery centers, single specialty hospitals, and the like — but did not. So far, no model offering “much cheaper, almost-but-not-quite-as-good quality” care has taken over in the health care sector. Narrow network health plans, meaning those that offer a limited choice of providers in exchange for lower premiums, are the most plausible current candidate, but buyers are far from satisfied and the plans themselves operate under the threat of backlash, especially for how they treat out-of-network use. Likewise, high-deductible health plans have been spreading, but not without criticism. In neither case have these innovations yet transformed the industry.

# 10: Stage models

Health care consultants, executives, and policymakers are fond of “stage models” — planned endeavors in which things build upon prior efforts in linear progression over time. During the 1990s, consultants proposed four stages through which health markets would evolve from fragmented competition to consolidated delivery systems. During the last few years, we have witnessed three stages of “meaningful use” for electronic medical records as well as four stages in the movement to value.

Proponents seem undeterred by the evidence that these models are often simplistic and wrong. Change is messy, with early results often going south into the “valley of despair.” One thing does not necessarily lead to another, it’s sometimes important to double back, and unpredictable jumps arise that bypass the planned route and require a shortcut. But how do you put all of that into a PowerPoint slide that motivates people to go along with the change?

Bologna
Joe Raedle/Getty Images

Identifying BS in health care

Astrophysicist and celebrity Carl Sagan once developed a baloney detection kit to root out bogus science. Here are some of the tools he included:

  • seek independent confirmation of the “facts”
  • encourage debate on the evidence
  • “authority” carries no weight in the argument
  • consider multiple working hypotheses
  • insist on a complete chain of evidence

That’s not a bad place to start for people trying to make sense of what’s going on in the health care space.

Lawton R. Burns, Ph.D., is professor of health care management and management at the University of Pennsylvania’s Wharton School of Business. Mark V. Pauly, Ph.D., is professor of health care management and business economics and public policy at the Wharton School.

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  • The goal of pain treatment is to relieve pain. However not only do opiates relieve pain they also result in a temporary euphoric feeling. Neurosurgical pain relief procedures to not also result in a euphoric feeling. The neurosurgical procedures are not “brain surgery”. The are primarily peripheral nervous system procedures.
    No risk of addiction. No risk of overdose.

  • If pain requires such high doses of pain medication, should neurosurgical procedures for pain management be tried?

    • Ok, so I was trying to be a little humorous, but my point stands, that noninvasive is preferable to an invasive option.

      The risks of opiates are vastly overblown by our government and our media.

      People who are prescribed high doses for pain do not experience euphoria (though even if they did, why is euphoria a bad thing? And is that a “side effect?” All side effects are a matter for the doctor and patient, not the federal government.).

      Unlike many ordinary substances & products in our homes, from iron supplements to drain cleaner, to laundry detergent, there is no reliable deadly dose known for opiates, and that is not for lack of trying. The federal government funded studies, beginning in the 1920s, to determine the deadly dose of opiates. One study, held in a hospital because the researchers expected to have to revive subjects, gave what researchers believed (based on results from mouse studies) to be a potentially deadly dose – and the subjects were not even sleepy. In 2000, Dr. Steven Karsh studied deaths of methadone patients whose deaths were either attributed to the methadone or to something that could not possibly be from methadone (say being killed in a car crash), with the expectation that the former would have higher opiate levels than the latter, but the amounts in both groups were all over the place.

      Here’s an example of the media unskeptically quoting a completely nonsensical claim about opiate death, made by Dr Robert Anderson of Glasgow University’s Forensic Toxicology Department, ‘Sometimes there is no trace of a poison in the blood because it killed the person too quickly. A heroin addict found dead with a needle sticking out of his arm is an example – sometimes there’s no trace of the drug at post-mortem. However, if the person lived long enough [after the morphine was administered] for the blood to get into circulation, it should be present.'” (https://www.theguardian.com/uk/2000/jan/31/shipman.health4)
      So a substance that didn’t even reach the blood stream reaches the brain to kill someone?

      In the 1960s, Dr. Michael Baden was a Medical Examiner in NY State, and he reported that what kills heroin users is the cutting agents (starting in the 1940s, black market sellers were stretching supplies by adding quinine. Later, other substances were used – today those include acetaminophen and lactase, among others). The added substances cause anaphylaxis, or Stevens Johnson Syndrome, either can cause the kind of rapid death that Americans have been conditioned to associate with “opiate death.”

      Actual opiate overdose takes 1-12 hours, and is basically a feedback loop that can develop in which slower breathing leads to fewer signals from the brain to the lungs, leading to lower oxygen. This process can be interrupted with the person suffering no permanent harm.

      How about comparing opiates to tobacco? Leaving lung cancer aside, tobacco can damage every organ system in body from skin to reproductive organs, to kidneys, etc…Tobacco can kill a user decades after quitting. There is no analogous situation regarding opiates.

      Here’s a link to sources that go into far more detail about opiates:
      http://www.druglibrary.org/schaffer/Library/studies/cu/cu12.htm

    • One of the symptoms most likely to drive people into the arms of charlatans is pain. By placing arbitrary limits on pain control, the CDC is making patients suffer that kind of desperation. What’s worse is that the latest pain control task force report included complaints about the fact that health insurance doesn’t cover “alternative” (i.e. unapproved) treatments such as acupuncture and yoga. Then if you look at the group who created the report, it includes practitioners of the exact unproven treatments that are not covered – with good reason. As I have heard from numerous doctors, there’s no such a thing as “alternative” medicine – if a technique or drug works, it’s Medicine, period.

  • Over the past few months, it seems that every healthcare policy “expert” (except Zeke Emanuel) has abandoned the righteous zeal that powered the Triple (Quadruple!) Aim over the past 10 years. This article exposes and articulates those “BS” talking points and ideas better than any I have read. Great job!

  • How could we get a huge reduction in healthcare costs? Easy peasy- get people to take care of themselves. Of course, this easy solution is hard since too many people just don’t and won’t.

    Then again, we could stop providing healthcare to people who don’t Got lung cancer or COPD? Are you a current or former smoker? Hope you can afford the treatment, you’re not getting it from government.

    Got Type 2 diabetes? Grossly obese? Hope you can afford the medications on your own….

    Oh, you went mountain climbing and fell off and broke a few bones? Here’s the bill for the helicopter airlift out. And another bill for the ER treatment. You’ll likely need specilaty orthopedic treatment. Hope you can afford it.

    • Easy Peasy? Obesity is indeed a BIG problem (pun intended) but the solution is not to blame people for lifestyle choices. I encourage you to watch HBO’s documentary, The Weight of the Nation at https://www.mhealthtalk.com/obesity/.

      You’ll learn that public health officials can accurately estimate obesity rates by zip code. They’ve even seen average lifespan differences of 20 years or more between affluent and poor neighborhoods on opposite sides of the same city.

      Is that because poor people lack will power? No – It’s because they live in food deserts without affordable access to healthy food. They instead rely on processed and fast food that’s cheaper and more readily available. They also don’t have safe places to play and exercise, lack access to healthcare, live with more stress and environmental pollutants, etc.

    • Unfortunately, most of the diseases suffered by humans are not under behavioral control. Birth defects, most cancers, infections, even just the deterioration that precedes our inevitable death are not far more common than the few diseases that have a behavioral component.

      Even diseases that we have been encouraged by media to believe are caused by lifestyle, such as lung cancer/smoking, heart disease/obesity are not so simple. There are people who get lung cancer who never smoked and slim people who die young of heart problems (example: famous runner Jim Fixx).

      Should we discourage sports – a very healthy collection of activities – because of the fact that numerous people get injured every year? What about the fact that inactivity is linked to problems like obesity?

      I had a recent and expensive experience with orthopedics. I tore a bursa in my shoulder trying to open my kitchen window (my kitchen is not on a mountain top and none of my care involved helicopters). I guess that’s my fault, and I should not expect my insurance to pay for the MRI, surgery and physical therapy. What about the tendonitis I got in my wrist, whose cause was never discovered? Perhaps that was because I wasn’t getting enough activity to keep a good blood supply to my tendons?

      Thanks to the media attention to those few diseases associated with lifestyle choices and the endless efforts of the sellers of panaceas, it’s easy for those who have had the great good fortune to have never suffered from illness or accident to engage in the blaming of the sick and injured.

    • Thanks, Trish. Also unfortunate is that the profit incentive is to treat symptoms, and many drugs have serious side effects that require other drugs to treat.

      “I take Metformin for diabetes caused by the Hydrochlorothiazide I take for high blood pressure, which I got from the Ambient I take for insomnia caused by Xanax I take for the anxiety that I got for chronic fatigue, which I got from the Lipitor I take because I have high cholesterol because a healthy diet and exercise with regular chiropractic care and superior nutritional supplements are just too much trouble — or expensive.”

    • We may or may not be responsible for illness. But treatment for illness is behavior under our control. We are responsible for our own behavior and free to choose our development and destiny.

  • One of the biggest portions of baloney in current-year medicine is the whole attitude about pain and especially pain treatment. Opiates are increasingly portrayed as if they are deadly poisons (and simultaneously extremely attractive for recreational use), and patients who report pain are treated as if they are unreliable observers about their own bodies, even if they have a well-documented medical condition that is known to be painful (because, of course, some criminal type might be faking pain to get a prescription for opiates).

    The situation is made worse because pain patients are increasingly being funneled into pain clinics, instead of the patient’s GP or the specialist in their condition prescribing pain treatment. Then the pain clinics are portrayed as “pill mills” because they prescribe “so many” pills compared to other doctors.

    Of course, it’s so much easier to generate jargon and patient satisfaction surveys than to stand up to the government and say that Congress should not have veto power over a doctor’s judgment of what an individual patient needs.

    • Yes, I agree. Today, the declaration, “drug epidemic” has victimized the chronic pain patient. Once they were disabled but now are stigmatized as “drug-seekers.”
      Yet this epidemic is hardly new or news, if you look at the ongoing explosion of recovery programs the past 25 years. Most doctors don’t prescribe OD doses now. They get it. They risk lives, their own licenses and livelihood. Those who envision themselves as the Robin Hood of Controlled Substances are easily tracked. Legal, prescribed medications are not the problem now. Illegal heroin and drug cocktails with fentanyl from China, smuggled across borders are.

      This distinction is often glossed over in the reporting. If you’re worried about your kids getting addicted, then you should be worried about the borders. Given the uniform media indignation about drugs, you would think some of the news stations, parents, and families of the disabled might champion some border security. If they do, I haven’t seen it. Connect the dots and you get nowhere.

      The drug epidemic is old news, but reported as if it was just discovered. What’s new is the OD drug, cocktails from outside the US. Yet doctors’ requirements for continuing education about opioids have escalated the past 5 years as if this new epidemic was about them. Even worse, those disabled by chronic pain have had their pain meds cut as if they were using.
      What has increased is the illegal immigration across the Southern border and OD deaths from smuggled illegal drugs made outside the US. How and why did these dots defy connection?

      Peggy Finston MD

    • Dr Peggy Finston, I’ve noticed what you’re saying, and I would ask why is there such pressure from our government to reduce or eliminate prescriptions of people who have used these medications responsibly for years or even decades? Even if there are no more pain prescriptions for legitimate patients, how would that affect the behavior/drug use of people who seek & use illegal black market drugs? What’s the mechanism? Sympathetic magic? Are users going to give up illegal drugs out of solidarity for pain patients?

      Also, why is the government making life so miserable for law abiding pain patients, while the same government provides funding for free needles to be used to inject illegally purchased drugs? Pain patients who have responsibly use large doses getting their prescriptions reduced to arbitrary limits like 90 mg/day- or cut off all together. Do the “needle exchange” facilities warn their clients to keep their consumption under 90 mg/day?

      It’s ridiculous!

    • I can’t imagine government rationales for many healthcare regulations. They surely don’t help patients or doctors treating them and don’t save money or time. They do provide steady jobs for those hired to do the oversight, at taxpayers expense.
      The lonely struggles of chronic pain patients to maintain some sort of life does not seem to be an issue for those who do the oversight. Rules seem to just drop down from the sky. Whoever makes them up appears clueless about how pain meds help people with chronic pain remain working. Without it, they can’t.
      Unfortunately, our healthcare culture appears committed to the “group think” of one size fits all, as judged by black and white principals. These policies are to be trusted more than the integrity of individual physicians who remain ultimately responsible for whatever happens, anyway, no matter that the insurance/government regs ultimately determine the treatment decisions.
      Peggy Finston MD

  • Congratulations for a job well done. Your article is the most comprehensive list I’ve seen of healthcare jargon, slogans, and blame-chasing solutions that have reigned and rained on the American psyche and public. We are so soaked with this make-believe rhetoric that few question whether these catchy-phrases have anything to do with reality. In fact, most people I talk to in the medical field don’t recognize they have substituted these political slogans for their own thinking. How scary is it that these highly educated professionals, the ones with boots-on-the-ground, first hand experience have abdicated and been robbed of their authority? Please spare me the “It’s a broken system.” You want broken, go to a third world country. We have much going for us here and have not earned our moans of discouragement.

    Was it 20 or 30 years ago when we choose pessimism and began to accept there was something heroic and even exceptionally moral to call out all the half-empty cups in life? Some have yet to figure out that life is far from perfect, anyway and neither are we. Instead of building on our strengths, we bask in our weaknesses. This self-indulgence has led to a voracious beast of self-improvement. We are using technology to destroy ourselves. We rationalize this with glorification, and even idolatry of our technology. “Technology is smarter and more efficient than we are.” What we call optimism in our culture is the implied or stated, “In the future, man will barely be necessary.” Rather than debate this, we ought to question why we are so hell-bent on obliterating ourselves? We are certainly using technology efficiently to destroy medicine.

    Medical professionals now recognize the burden of “time-saving” EHR. Yet I’ve yet to hear observations about how EHR perverts clinical care, obstructs the growth of clinical thinking, and more insidiously, promotes the medical paradigm that patients and doctors are robots.

    Sound outlandish? What does it mean that a doctor can only enter information that’s already provided by a drop-down menu? The more advanced the EHR, the less to no options for “free texts” or “other.” If your problem does not fit in the box, you are out of luck. It does not exist. How many sick patients go to the ER, get tested with labs and x-rays, have normal results, then sent home reassured “nothing is wrong.” There is no option to imagine our tests may be wrong, may be lacking for that person. The geniuses that brought us EHR know best.

    You want to know why healthcare does not “improve” with our “innovations?” Basically, Nature does not read our textbooks nor care about our theories. Perhaps we should care less and read Nature more. Individuals are all different and what we label a “disease” is actually the result of that individual’s constitution, psyche and environment, including energy fields with whatever we are calling “the disease.”
    We have been remiss in taking our simplifications as reality, as mentioned in the above article. In psychiatry we can name a disease schizophrenia, but those who have “it” are all different. Unlike robots, there is no one size fits all for humans.
    Our medical and general culture is predicated on “conquering” what threatens us. Our way to do this has been to give that threat a name and go on to define the rules.
    But we don’t make the rules.

    Peggy Finston MD

  • Sorry guys,
    but in light of former illustrious alumni of the Wharton School of Business, you are by definition, and regardless any other consideration, deprived of any credibility

  • I certainly agree that the task of health care reform is not easy. We must first know Why American Healthcare is So Expensive in the first place (https://mHealthTalk.com/expensive/), because there are many factors, including industry resistance.

    The potential disruption to industry revenue and profits is so great that 2020 will surely be The Most Expensive Election Ever, and by a long shot. Given what’s at stake and the proven high ROI of influence investments, expect billions to be spent on campaigns, misleading ads, and other paid propodanda from the medical industrial complex. To discover BS, follow the money.

  • One of the great missing pieces of this interesting article is no mention of the BD females have had to put up with in the medical patient community and world.
    Please have two equally educated and experienced female academics enumerate this oh so very silent aspect.

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