Saturday, April 15, 2017

How Behavioral Economics Can Produce Better Health Care - The New York Times

Consider the following.

I'm a physician at the end of more than a decade of training. I've dissected cadavers in anatomy lab. I've pored over tomes on the physiology of disease. I've treated thousands of patients with ailments as varied as hemorrhoidsand cancer.

And yet the way I care for patients often has less to do with the medical science I've spent my career absorbing than with habits, environmental cues and other subtle nudges that I think little about.

I'll sometimes prescribe a particular brand of medication not because it has proved to be better, but because it happens to be the default option in my hospital's electronic ordering system. I'm more likely to wash my hands — an activity so essential for safe medical care that it's arguably malpractice not to do so — if a poster outside your room prompts me to think of your health instead of mine. I'll more readily change my practice if I'm shown data that my colleagues do something differently than if I'm shown data that a treatment does or doesn't work.

These confessions can be explained by the field of behavioral economics, which holds that human decision-making departs frequently, significantly and predictably from what would be expected if we acted in purely "rational" ways. People don't always make decisions — even hugely important ones about physical or financial well-being — based on careful calculations of risks and benefits. Rather, our behavior is powerfully influenced by our emotions, identity and environment, as well as by how options are presented to us.

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You Draw It: Just How Bad Is the Drug Overdose Epidemic? - The New York Times

How does the surge in drug overdoses compare with other causes of death in the U.S.? Draw your guesses on the charts below.

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Friday, April 14, 2017

Brain-Altering Science and the Search for a New Normal

In 2006, Liss Murphy was in thrall to what she calls a "sepsis of the soul" — an intractable and debilitating depression. She had hardly spoken in two years. She felt almost nothing; she was barely eating; she wanted to die.
No conventional treatments had helped. So when she heard that doctors at Massachusetts General Hospital, in Boston, had developed an experimental cure for severe depression that involved permanently implanting electrodes in the brain, she didn't hesitate. The procedure seemed like no big deal. "I never read the consent form," she says. "I just didn't care." This was her last shot, she thought. She half-hoped they would make a fatal mistake during the operation.

A few months later, on June 6th, 2006, Murphy lay in an operating room in the neurosurgery wing of Mass General. She looked hardly alive — her body emaciated from eating almost nothing, her skull shaved in preparation for the surgery. A shiny, donut-shaped CT scanner surrounded her head. The doctors began their work by drilling two dime-sized openings into her skull. Then they gingerly lowered tiny electrodes, about the width of the graphite in a pencil, into a region of her cerebral cortex known as the internal capsule. Once the electrodes were in place, the doctors asked her to interact with a computer simulation, with the holes in her skull still open. Before the surgery, they had used the CT scanner and a computerized navigation system (a kind of GPS for the brain surgeon) to map her brain and determine the precise spots where they would implant the electrodes.

Together with an electrical pulse generator — a boxy rectangle, like a small external hard drive — sewn into Murphy's chest cavity, the electrode would stimulate the region of her brain that the doctors believed to be responsible for her depression. The device, known as a deep-brain stimulator (DBS), is meant to regulate neural activity and bring the brain's patterns back to normalcy. A wire from the pulse generator snakes up to the electrode, carrying electricity, which the electrode then transmits to the brain.

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Monday, April 10, 2017

Treating depression is guesswork. Psychiatrists are beginning to crack the code. - Vox

Here's a frustrating fact for anyone who has been prescribed medication or therapy for depression: Your doctor doesn't know what treatment will work for you.

"It is currently complete primitive guesswork," Leanne Maree Williams, a professor at Stanford University, says. "It's hard to imagine how you can do worse than the current situation, to be honest."

Depression means being stuck in a chronic state of sad mood or lack of enjoyment in life, to a degree where it starts to degrade quality of life. The two main treatments are cognitive behavioral therapy (CBT), a talk-centered approach that gets patients to readjust their habits, and antidepressant medications.

Both are about equally effective. Around 40 percent of patients will get better on either.

But no one treatment reliably works for everyone. And it's not just about talk therapy versus drugs. Even in the realm of medication, available drugs like Zoloft and Cymbalta will work for some but not others.

Enter "precision psychiatry." Inspired in part by "precision medicine," which changed the way doctors treat certain kinds of cancer, psychiatric researchers are hoping to bring a "precision" approach to diagnosing and treating depression using brain scans and machine learning algorithms. Too many patients are left frustrated after treatments fail. These scientists think they can do better.

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