Random Acts of Medicine: The Hidden Forces That Sway Doctors, Impact Patients, and Shape Our Health - Softcover

Jena, Anupam B.; Worsham, Christopher

 
9780593468104: Random Acts of Medicine: The Hidden Forces That Sway Doctors, Impact Patients, and Shape Our Health
Softcover
ISBN 10: 0593468104 ISBN 13: 9780593468104
Verlag: Knopf Doubleday Publishing Group, 2024

Inhaltsangabe

Does timing, circumstance, or luck impact your health care? This groundbreaking book reveals the hidden side of medicine and how unexpected—but predictable—events can profoundly affect our health. • Is there ever a good time to have a heart attack? Why do kids born in the summer get diagnosed more often with A.D.H.D.? How are marathons harmful for your health, even when you're not running?

"Fantastically entertaining and deeply thought-provoking." —Emily Oster, New York Times bestselling author of The Family Firm, Cribsheet, and Expecting Better

"Random Acts of Medicine shows that the ingenious use of natural experiments can improve medicine and save lives." —Wall Street Journal

As a University of Chicago–trained economist and Harvard medical school professor and doctor, Anupam Jena is uniquely equipped to answer these questions. And as a critical care doctor at Massachusetts General who researches health care policy, Christopher Worsham confronts their impact on the hospital’s sickest patients. In this singular work of science and medicine, Jena and Worsham show us how medicine really works, and its effect on all of us.

Relying on ingeniously devised natural experiments—random events that unknowingly turn us into experimental subjects—Jena and Worsham do more than offer readers colorful stories. They help us see the way our health is shaped by forces invisible to the untrained eye. Is there ever a good time to have a heart attack? Do you choose the veteran doctor or the rookie?  Do you really need the surgery your doctor recommends? These questions are rife with significance; their impact can be life changing. Addressing them in a style that’s both animated and enlightening, Random Acts of Medicine empowers you to see past the white coat and find out what really makes medicine work—and how it could work better.

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Über die Autorin bzw. den Autor

ANUPAM B. JENA, MD, PhD, is an economist, physician, and the Joseph P. Newhouse Professor at Harvard. Jena hosts the Freakonomics, MD podcast, which explores the hidden side of health care.  CHRISTOPHER M. WORSHAM, MD, MPH, is a researcher, pulmonologist, and critical care physician at Harvard. Jena and Worsham practice medicine at Massachusetts General Hospital. Their research and writing have been published by the New England Journal of Medicine, JAMA, New York Times, Wall Street Journal, and Washington Post.

Auszug. © Genehmigter Nachdruck. Alle Rechte vorbehalten.

Chapter One

Our Lives Are Woven in a Fabric of Chance

Chance occurrences change the course of our lives all the time. Imagine the couple who meets in an airport when a blizzard cancels their flights. Or think of the entrepreneurs who happen to sit next to each other at jury duty and who hatch a business plan to start a company in the six hours it takes to be dismissed. Imagine the woman who misses the bus because a meeting ran late and who, on her walk home, happens to pass an animal shelter and adopts her new best friend.

These are unpredictable moments—­chance waltzing into our lives when we least expect it. We can all probably think of times in our lives when we were led down alternate paths, both good and bad, thanks to chance. These phenomena go by many familiar names: randomness, luck, serendipity, kismet, happenstance, accidents, or flukes.

Chance can even play a role in life and death. A retiree collapses in the supermarket from a heart attack and is rushed to the hospital as paramedics perform CPR, but the ambulance is delayed due to scheduled road closures. He dies from the heart attack two weeks later. If he had collapsed the day before when the roads were clear, might he have survived? A child doesn’t get a flu shot at his annual doctor’s visit, because the vaccine is not yet available in his doctor’s office. His parents never bring him back for a flu shot appointment. That winter, he catches influenza and spreads it to his grandmother, who ends up in the hospital. Had the flu shot been available at his annual visit, he likely would have received it. Would he and his grandmother still have gotten sick?

It’s frightening to think about how random occurrences contribute to our health, life, and death. We all like to think that if we do the right things—­eat well, wear a seat belt, quit smoking, take the medications our doctor prescribes—­we can control what happens with our bodies and our lives.

This is no less true for doctors. We too like to think that the decisions we make for our patients—­whether to prescribe them a drug, perform surgery, order a diagnostic test—­are based only on science and carefully considered data, not on simple chance. The reality, though, is that medicine can be messy, complicated, and uncertain. There are many opportunities for randomness to affect the medical care we give and receive.

Most people tend to think in terms of “good luck” and “bad luck”: the good luck of getting to the bus stop just as the bus arrives, or the bad luck of driving over a nail and getting a flat tire. But in everyday medicine, people are sent down paths of care by factors they may not think to consider—­the doctor who happened to be working in the ER the day they sprained their ankle, or the patient they happened to share a waiting room with just prior to a routine doctor’s visit. It’s not “good luck” to sprain your ankle on a Tuesday or “bad luck” to sprain it on a Wednesday—­it’s as random as a roll of the dice. Yet the day a person sprains their ankle may determine which doctor happens to treat them in the ER, and thus the likelihood they’re prescribed an opioid pain medication that could lead to long-­term use. Because opioid-­prescribing tendencies vary from doctor to doctor, as one important study demonstrated, the doctor you happen to see can have lasting repercussions. Similarly, it’s not inherently “good luck” or “bad luck” to share a doctor’s office waiting room with someone. But if that person happens to have a viral infection, a chance encounter could lead to a bout of the flu two weeks later, and especially for the very young and the elderly the flu is no laughing matter.

In this book, we’re going to explore the hidden but predictable ways in which chance affects our health—­and our health-­care system. We’re going to do it by diving into real research conducted by ourselves and others. We’ll examine what happens to patients when the doctor they expect to see in an emergency can’t be at the hospital—­and why they might be better off with a substitute. We’ll look at why meeting a surgeon just before a big birthday versus just after can affect major surgical decisions (and why this phenomenon can be explained by well-­known grocery store pricing tactics). And in an era when health care is becoming increasingly politically polarized, we’ll see whether the politics of the doctor who happens to care for you in the hospital matters for the care that you receive.

Beyond just making observations, we’re going to look at what these occurrences can teach us about what works and what doesn’t in health care today. Because while we can’t remove randomness from our lives, we can learn from it—­so we don’t become victims of chance.

—

Economists, epidemiologists, and social scientists sometimes talk about “natural experiments.” Natural experiments are “natural” because they occur without the influence of any manipulating hand. One person grows up in one zip code; another person grows up across the street, which happens to be in a different zip code. One baby is born into a season of drought; another is born during record monsoons. There is no researcher designing a study, no patients signing up to participate, no new medical intervention being intentionally tested. These are conditions for accidental experiments, science occurring in the wild.

Natural experiments run in contrast to what we might think of when we use the word “experiment.” In medicine, randomized controlled trials—­the gold standard of science, where researchers randomly assign subjects to either a treatment or a control group and then follow them into the future—­are our most powerful and preferred tool for studying cause and effect. They are our best way of knowing whether an intervention really works. These are the studies that have been used for decades to prove the efficacy of the blood pressure drugs, cancer therapies, and vaccines we use today.

But randomized controlled trials aren’t perfect. They can be logistically difficult, expensive to perform, take unreasonable amounts of time, or be flat-­out unethical. Imagine you were interested in studying the effect of air pollution on human health. A scientist couldn’t simply assign human test subjects to regions with different levels of air pollution and observe the results. Or imagine you wanted to study the long-­term effects of screen time on children. Assuming you could surmount the complicated ethics of such a controlled study, you might still have to wait dozens of years to see results, at which point your study might have ceased to be relevant.

So researchers in some fields—­economics in particular—­have come to rely on natural experiments in their work. How so? Let’s circle back to air pollution. You can’t just purposefully expose people to air pollution, but what if scientists could isolate a naturally occurring event in which some defined groups of people were exposed to higher levels of air pollution than some other groups were—­by nothing more than chance? Actionable conclusions could be drawn from those findings.

In one study, the Princeton economist Janet Currie and the UC Berkeley economist Reed Walker did precisely that. They showed that among families living near congested highway tollbooths in Pennsylvania and New Jersey, babies who happened to be born just before E-­ZPass automatic payments were introduced were more likely to be born prematurely and with low birth...

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Verlag
Knopf Doubleday Publishing Group
Erscheinungsdatum
2024
Sprache
Englisch
ISBN 10 
0593468104
ISBN 13 
9780593468104
Einband
Taschenbuch
Anzahl der Seiten
320
Kontakt zum Hersteller
Nicht verfügbar
Verantwortliche Person
preigu
mail@preigu.de

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