Drs.Pamela Hartzband and Jerome Groopman offer their views on the advice of health care experts, the too often discordant answers to health care questions and the role of "mind sets" or subjectivity on what is portrayed by some as scientific and objective answers.

A subset of pneumonia patients -those considered at risk of having a multi-drug bacterial etiology-did worse if their physician complied with ATS-IDSA guidelines according to a recent study. See here for reference to the article that was published on Lancet online.

The party line (I mean the consensus of reasoned expert opinion by panels of highly educated people) has been there should not be stress tests before a person begins training for or entering a marathon because of some combination of the following reasons: low incidence of cardiac events in endurance races and shorter fun runs,large numbers of false positives noted on treadmill stress testings,and the dominant theory that the major cause of cardiac events precipitated by exercise is acute plaque rupture rather than fixed coronary artery <

Recently I blogged about data indicating that sometimes more (money spent ) is better (better outcomes in health care) as well as in most everything else even though you sometimes hear just the opposite from devotees who misinterpret and over interpret the Dartmouth Atlas data.

The hype leading up to the passage of Obama care included claims that the bill would protect the country from bankruptcy,bend the health care cost curve and boost health care quality. Now the projection for 10 years of Obamacare is for 1.76 trillion and by the time we can get a even finer tuned projection it will likely be twice what it was claimed to be. See here for the projection of OBM.

The widely quoted data from the Dartmouth Atlas has been almost as widely misunderstood to mean "more is less". How something so counter-intuitive and contrary to much everyday experience could get so much argumentative traction is a testament to a cognitive weakness that even Dr. Kahneman failed to document and explain in his book Thinking Fast and Slow. Maybe he does, it is simply gullibility or buying into data that confirm your priors.

The headline references one of the latest recommendations from the American College of Physicians (ACP).Seven members of the Clinical Guidelines Committee of the American College of Physicians have "determined" that consistent with the principle of cost conscious,high value care that "clinicians should not screen adults aged greater than equal to 75 years or those with substantial co-morbid conditions ..with a life expectancy of less than 10 years ."

Nobel prize winning economist,Milton Friedman, is quoted as saying that economics could be summed up with two principles. 1) There is no such thing as a free lunch and 2)demand curves slope downward or ( in non econo-speak) people buy more when the price is lower and less when prices are higher.

Dr Friedman did not live long enough to see that his first principle overturned.

Remember how HMOs made patients happier,doctors more satisfied with their work and also brought about better care while bending the cost curve downwards. Well, we are told that ACOs will do that only even better.

Dr. Ezekiel J. Emanuel , in this commentary, in JAMA assures physicians who might have foolishly worried that joining an ACO would lead to some loss of autonomy. He and his co-author argue that actually ACOs offer the opportunity for more ( not a typo ) autonomy.

A minor political storm emerged over the ruling of the Department of HHS regarding the mandatory inclusion of certain reproductive services in health insurance. Obamacare has made the HHS Secretary the final arbiter of many things in health care including what health insurance plans must cover so this is likely the first of many such mini-storms.