The right decision

In a democracy, the power to make the law rests with those chosen by the people. Our role is more confined—“to say what the law is.” … That is easier in some cases than in others. But in every case we must respect the role of the Legislature, and take care not to undo what it has done. A fair reading of legislation demands a fair understanding of the legislative plan.

Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter. Section 36B can fairly be read consistent with what we see as Congress’s plan, and that is the reading we adopt

I still don’t trust the Supreme Court because it’s full of blockheads like Alito, Scalia, and Thomas who actually dissented from this, even thought they like to think that they are putting laws in the correct context.  (And yes the ‘liberals’ do it too.)  But this is the right decision. Let’s hope this closes the book on ACA challenges.


I find this so depressing

Vox – Politics

via King v. Burwell won’t destroy Obamacare.

I mean, I’m glad Obamacare is here, I think it serves a real need at a reasonable cost.  Could it be a better law?  Probably.

What is depressing is that our politics is so dysfunctional that rational analysis is no longer possible.  If the plaintiffs win this suit, the only people hurt are those in their own states.  That’s just crazy.

How to Get Sued Less

A study of the program published in 2010 found that in the years after it began claims dropped 36 percent, and lawsuits dropped 65 percent. The monthly cost of total liability and patient compensation dropped 59 percent, and legal costs dropped by 61 percent.

What was the program? Tort reform? No. Admitting to errors and apologizing for them.  We’ve known this for ages.  Why do some keep insisting that we have to reform the legal system.

To Be Sued Less, Doctors Should Consider Talking to Patients More

Aaron Carroll does good work.

Epidural steroid injections compared with gabapentin for lumbosacral radicular pain: multicenter randomized double blind comparative efficacy study – BMJ 16 April 2015

Last week we had oral steroids for radiculopathy.  This week we have epidural steroids.  Still no difference.

This surprises me, maybe, a little more than the other result.  Putting the steroid right where you ‘need’ it is something we do with osteoarthritis, another ‘low inflammatory’ state, all the time.  And in OA there is definitely a short term effect on pain.  But this is a reminder that disc herniation is not OA – they are not the same and may not respond to similar treatments the same way.

Let’s quit with the steroids for low back pain now, OK?

Oral Steroids for Acute Radiculopathy Due to a Herniated Lumbar Disk – JAMA May 19, 2015

I’ve always been perplexed about why doctors would give a not-risk-free drug (steroids) for a problem that is not clearly ‘inflammatory’.  Giving steroids for acute radiculopathy – lower extremity nerve pain caused by a herniated disc – is, as far as I know, not recommended by any professional society and there is no evidence to support its use for this indication.  And yet it’s apparently very commonly done.  My own research supports this – I found a lot of prescriptions for steroids apparently for low back pain in the VA system.

So this study (behind a paywall; sorry) in JAMA is somewhat valuable.  Like many other studies of injectable and oral steroids for other indications, it suggests that there may be a tiny bit of value in relieving pain up front – though not much in this case: only a 0.3 point difference on the Oswetry Disability index, a measure of spinal function and pain, and not statistically significantly different from zero when compared to placebo – but no difference in long term pain and function.

I hope this will convince some physicians that this is a useless practice, but I’m not holding my breath.  Getting physicians to stop doing something is really hard.

I’m a baaaaaaaaad boy!

It looks my last post was approaching one year ago, and I wasn’t doing so well writing consistently before that!  All right, I’ll try to be better.  I’m not fooling myself though.  I won’t be publishing every day, and maybe not even every week.  But perhaps I can at least start churning out some posts on research again, incentivized by this site.  It’s nice to see that someone out there is making a site that can be a clearing house for good (hopefully) research blogging.

A quick personal update:  I’m now a faculty member at the UUMC, have a few decent publications under my belt, a couple of which have gotten a little attention in my narrow sphere, and am generally doing OK.  Still working on my thesis in epidemiology; just starting the real work actually, and better get a move on because there’s lot’s to be done.  I still see patients, but not all that often; most of my time is spent doing research or educating (or pretending to do one or the other while I good off).

Hope to see you again soon …

More political bullshit

This time from Rudy. has the story.

Giuliani falsely claims that only 44 percent of prostate cancer patients survive under “socialized medicine” in England.


In a new radio ad, Rudy Giuliani falsely claims that under England’s “socialized medicine” system only 44 percent of men with prostate cancer survive.

We tracked down the source of that number, which turns out to be the result of bad math by a Giuliani campaign adviser, who admits to us that his figure isn’t “technically” a survival rate at all. Furthermore, the co-author of the study on which Giuliani’s man based his calculations tells us his work is being misused, and that the 44 percent figure is both wrong and “misleading.” A spokesperson for the lead author also calls the figures “incorrect survival statistics.”

It’s true that official survival rates for prostate cancer are higher in the U.S. than in England, but the difference is not nearly as high as Giuliani claims. And even so, the higher survival rates in the U.S. may simply reflect more aggressive diagnosing of non-lethal cancers, according to the American Cancer Society.

Actually, men with prostate cancer are more likely to die sooner if they don’t have health insurance, according to a recent study published in one of the American Medical Association’s journals. Giuliani doesn’t mention that.

If there’s one thing that gets my goat, its the blatant misuse of statistics.  This isn’t even subtle, or an honest error.  It’s the deliberate twisting of facts to fit ones own pre-conceived beliefs and it is simply not acceptable.

Please folks, treat the ‘facts’ of our politicians with healthy skepticism and visit sites like to help dispel the nonsense.

I’ve Finished Harry Potter

Finished about 2 days ago. Don’t worry, I won’t give anything away – spoilers piss me off. But it was a good read. I will say, though, that there are LOTS of hints about what will happen in the other books, and if you’ve read carefully you’ll have a pretty good sense of where things are going. Reading the other 6 books just before reading the last one really helps everything to make sense too. On the other hand, Rowling once again introduces some new elements which help keep you guessing.

Oh, and my timing was perfect! I was just finishing up book VI when book VII arrived in the mail! I went from one right into the other. I think my wife will be very happy that I’m finally finished with all of them; I’ve been a little preoccupied for the last few weeks!

Anyway, if you haven’t read the Deathly Hallows yet, get moving!

Maybe one day I’ll start writing about rheumatology again …

P.S. For those of you who have finished, this site has some thoughts on the book, its good parts and its problems. Some of the writers make some very good points about a few of the latter. Lots of spoilers though, so check it out only if you’re done.