An umpire threw Michael Pineda out of a game Wednesday after he noticed pine tar smeared on the pitcher's neck.
Driving to a big data conference a few weeks back, Dr. Jeffrey Brenner brought his compact SUV to a full stop – in the middle of a short highway entrance ramp in downtown Philadelphia.
He shrugged, a grin playing at the corner of his mouth.
"Wait for the car in front of you to go, and then gun it," he told me.
As we picked up speed, I could only watch as we headed straight for traffic down below. Brenner laughed. And we end up merging pretty seamlessly.
"Sitting at the other end of the ramp as 50-mile-an-hour traffic goes flying by you," he said. "You can’t get on the highway. You have to try something different, right?"
Here’s what you need to know about Dr. Jeffrey Brenner: He really likes to figure out how things work. And he’s willing to go to extremes to do it – so far that he’s risking his health policy celebrity status.Jessica Kourkounis
Perhaps it’s not the smartest move from a guy who just last fall was named a MacArthur Genius, but this month, Brenner began to test his theory for treating some of the sickest and most expensive patients.
"We can actually take the sickest and most complicated patients, go to their bedside, go to their home, go with them to their appointments and help them for about 90 days and dramatically improve outcomes and reduce cost," he says.
That’s the theory anyway. Like many ideas when it comes to treating the sickest patients, there’s little data to back up that it works.
Brenner’s willing to risk his reputation precisely because he’s not positive his approach for treating folks who cycle in and out of the healthcare system -- “super-utilizers” -- actually works.
“It’s really easy for me at this point having gotten a MacArthur award to simply declare what we do works and to drive this work forward without rigorously testing it,” Brenner said. “We are not going to do that,” he said. “We don’t think that’s the right thing to do. So we are going to do a randomized controlled trial on our work and prove whether it works and how well it works.”
Helping lower costs and improve care for the super-utilizers is one of the most pressing policy questions in healthcare today. And given its importance, there is a striking lack of data in the field.
People like to call randomized controlled trials (RCTs) the gold standard of scientific testing because two groups are randomly assigned – one gets the treatment, while the other doesn’t – and researchers closely monitor differences.
But a 2012 British Medical Journal article found over the last 25 years, a total of six RCTs have focused on care delivery for super-utilizers.
“All we have are tiny pieces, when what’s needed is a full arsenal of evidence given the enormity of the challenge,” says Jon Baron, president of the Coalition for Evidence-Based Policy.
Now, to be fair, researchers admit RCTs can be tricky to set up, time-consuming and expensive. And certain situations call for different study designs.
But the bottom line, said WellPoint Chief Medical Officer Dr. Sam Nussbaum, is that most health folks agree the nation needs more rigorous studies that will lead to more reliable data.
“If we look back over the past decades, many of the results we saw were overstating the capability of the program to deliver the results that the programs believed they were achieving,” he said.
Every major health insurance company – Medicare and Medicaid, too – has spent billions on programs for super-utilizers. The absence of rigorous evidence raises the question: Is all this effort built on health policy quicksand?Jessica Kourkounis
Health worker Margarita Santiago recruits patients for RCTs. Here she is in Camden, New Jersey, talking with patient Hector Rivera.
Not being 100 percent sure can be dangerous, says Duke behavioral scientist Peter Ubel, particularly in healthcare.
Ubel said back in the 1980s and 90s doctors prescribed certain drugs for irregular heartbeats. The medication, he said, made those weird rhythms go away, leaving beautiful-looking EKGs.
“But no one had tested whether people receiving these drugs actually lived longer, and many people thought, ‘Why would you do that? We can look at their cardiogram and see that they're getting better,’" Ubel said. “Finally when somebody put that evidence to the test of a randomized trial, it turned out that these drugs killed people.”
WellPoint’s Nussbaum said he hoped Brenner’s project would inspire others to follow his lead and insert data into the discussion.
“I believe more people should be bold in challenging the status quo of our delivery system,” Nussbaum said. “The Jeff Brenners of the world should be embraced. We should be advocating for them to take on these studies.”
So why aren’t more healthcare luminaries putting their brilliance to the test? There are a couple of reasons.
Harvard economist Kate Baicker said until now there have been few personal incentives pushing people.
“If you’re focused on branding and spreading your brand, you have no incentive to say, ‘How good is my brand after all?’” she said.
And Venrock healthcare venture capitalist Bob Kocher said no one would fault Brenner if he put his brand before science, an age-old practice in this business.
“Healthcare has benefitted from the fact that you don’t understand it. It’s a bit of an art, and it hasn’t been a science,” he said. “You made money in healthcare by putting a banner outside your building saying you are a top something without having to justify whether you really are top at whatever you do.”
Duke’s Ubel said it’s too easy – and frankly, wrong – to say the main reason doctors avoid these rigorous studies is because they’re afraid to lose money and status. He said doctors aren’t immune from the very human trap of being sure their own ideas are right.
He says psychologists call it confirmation bias.
“Everything you see is filtered through your hopes, your expectations and your pre-existing beliefs,” Ubel said. “And that’s why I might look at a grilled cheese sandwich and see a grilled cheese sandwich and you might see an image of Jesus,” he says.
Even with all these hurdles, MIT economist Amy Finkelstein – who is running the RCT with Brenner – sees change coming.
“Providers have a lot more incentive now than they use to,” she said. “They have much more skin in the game.”
Finkelstein said hospital readmission penalties and new ways to pay doctors are bringing market incentives that have long been missing.
Brenner said he accepts that the truth of what he’s doing in Camden may be messier than the myth.Jessica Kourkounis
But he said he can live with that.
“I think a lot of people are afraid to be wrong,” he said. “It's kind of fun to be wrong. Because being wrong frees you up from things that are not true and lets you move on to figuring out what's true.”
If his brand does take a hit, it means more time at work and more time to figure out what works. And Brenner said he’s willing to go wherever that takes him.
This ongoing series on healthcare and data is produced in partnership with Healthy States.
Critics have blamed General Motors' delayed recall of a defective ignition switch on its dysfunctional culture. But there is already a shift underway to prioritize customers and communication.
Washington, DC is full of buildings stuffed with bureaucrats. Inside, the paper they push affects our lives in ways big and small. Two of these paper-pushing-processes are in the news this week for striking new moves that could have major impact in very different ways. They involve smoking and how we get online.
First, a look at the Food and Drug Administration’s bid to regulate e-cigarettes for the first time:
“With FDA having no authority to regulate these products, it is a bit of the wild, wild West,” says FDA commissioner Dr. Margaret Hamburg.
The agency’s new proposal would bar sales to minors and require product approval, among other measures. But it does not crack down on advertising or flavored products thought to appeal to kids.
It’s not as tough as the tobacco industry feared. That has tobacco insiders optimistic, and anti-smoking advocates furious.
Up next is a long fight between industry, anti-smoking advocates and regulators:
It could be years before anything currently proposed becomes reality. While that going may be slow, over at the FCC, they’re talking about content we want to go fast, working on rules that could determine the fate of our internet. The FCC's proposal would allow companies to pay broadband providers to allow their content to "sprint" to computers faster.
"It might behoove a company with deep pockets like Amazon or Facebook to pay extra and make sure they are promptly loaded on to your mobile device. But what about an independent media outlet?" asked Astra Taylor, an activist and author of The People's Platform: Taking Back Power and Culture in the Digital Age.
But Paul Gallant, a managing director at Guggenheim Securities, wonders if the FCC's proposals could benefit consumers by giving them more - and better - options. He suggests a scenario where ESPN pays Verizon Wireless so that customers can watch ESPN videos on their Verizon phones for free. For a lot of ESPN fans, that might look like good news.
"I think the FCC is starting to realize that having a blanket rule against any kind of traffic prioritization may wall off innovative new business models," Gallant said.
None of this is a done deal. The FCC will issue its proposal next month, and then open it up to public comment. There may not be enforceable rules until the end of this year, or later.
U.S. Postal Service workers picketed in front of Staples stores on Thursday. They were protesting USPS plans to provide mail services inside Staples stores, using nonunion Staples employees.
Hospitals in out-of-the-way places are making trade-offs as they adopt electronic medical records. Some are joining larger health systems, while others are searching for ways to go it alone.
Two growers are competing to harvest fresh figs earlier and earlier in hopes of transforming the industry for year-round production. But some fig lovers say they can hold out for summer fruit.
Google, Intel and others say they will now financially support the open-source software that encrypts much of the traffic on the Internet. The effort follows the discovery of a key security flaw.
Turkey has been roiled by street protests, a Twitter ban controversy and, most recently, a growing rivalry between the ruling party's top two figures, the president and prime minister.
Major changes are expected for the NCAA, whose board meets Thursday. Directors will consider giving the five power conferences more autonomy, as well as changing the way scholarships are administered.
The Food and Drug Administration is proposing to expand its regulatory powers to e-cigarettes and other popular products containing nicotine.
A Senate panel released a report Thursday that criticizes the inspector general of the Department of Homeland Security. It accuses him of repeatedly compromising his independence.
Early Thursday morning, the Ukrainian military moved into towns held by militants. Firefights and casualties have been reported at a number of different locations.
The Israeli government suspended peace talks with Palestinians, citing a unity agreement announced Wednesday by Palestinian leadership. The Israeli security cabinet came to the decision unanimously, angered by Palestinian President Mahmoud Abbas's decision to end a seven-year schism with the Hamas movement.
As diplomatic talks in Geneva have failed to resolve the three-year-old civil war in Syria, the U.S. is undertaking a new covert program to send weapons in support of rebel forces there.
Syria will likely meet an upcoming deadline to hand over its declared chemical weapons. But the agreement seems to have emboldened the Syrian regime to use other brutal tactics, including a chemical not covered by the deal.
The Marshall Islands, the site of 66 U.S. nuclear weapons tests between 1946 and 1958, says the Non-Proliferation Treaty requires nuclear states to disarm.
[2014-04-24 13:00:00] S.E. Hinton became a literary star while still a teenager when her novel The Outsiders was published in 1967. It’s remained a popular title over the years and has been chosen as the focus of the 2014 Big D Reads program. This hour, Hinton joins us to talk about the origins of the book and the role it’s played in her life.
[2014-04-24 12:00:00] More than 54,000 survivors of torture call Texas home. They come from Nepal, Myanmar, Iraq and other places around the world. We’ll talk this hour about how they are cared for locally with Celia VanDeGraff, executive director of the Center for Survivors of Torture.
The fashion world has always been notoriously fickle. What's hot this season may be considered passé in a few months. But one fashion accessory has had a spectacular run: the Nike Air Jordan. This is the 30th anniversary of the iconic sneaker, which has had a huge impact on the sneaker business. It spawned the era of the signature athletic shoe, and a whole generation of underground sneaker collectors known as sneakerheads, that today are not so underground.
In the early days, sneakerheads logged on to online message boards to buy and trade rare shoes. "Most of these people, they were located in the Midwest and down South and the West Coast," says Brooklyn native Joe Guerrero. Everyone calls him Sneaker Joe. He was one of the first sneakerheads who figured out how to make money buying and selling rare shoes that weren't available in big retail stores.
"I saw a demand," says Sneaker Joe. He set out to meet that demand by "hitting up all these stores in downtown Brooklyn and the Bronx, Harlem, all these mom and pop shops that had urban accounts. I just started selling on eBay."
Sneaker Joe's business grew. Soon, he had international customers. He was cutting deals with stores and buying in bulk. He sold online until 5 p.m., took a break for a couple of hours, then started his second business, hand-delivering rare sneakers to celebrities like Jay-Z and LeBron James.
"That was up until 2007," Joe says. "Then the market became oversaturated. It became harder to acquire shoes once all these blogs started reporting and hyping up stuff."
By 2007, sneaker collecting had reached new heights. Camping outside a store for a new shoe release was common. "What changed the way sneakers are looked at is information, the internet," says DJ Clark Kent. "If you didn't know that a new Jordan was coming out, you wouldn't be hyped up to get it."
He was one of the people Sneaker Joe used to deliver to. Kent is a record producer and a sneaker aficionado who has designed several shoes for Nike, and hosts an online talk show about shoes. He says sneaker companies have mastered the art of hype. The limited edition special release is now a standard marketing strategy. "Everybody is hyped for what's coming out on Saturday," he says. "Saturday comes. Whoever gets it, gets it, and then next Saturday there's something else, and then they are hyped all over again."
For Sneaker Joe, camping out overnight for a shoe was never something he was willing to do. Today there are sneaker conferences and brick and mortar stores that have taken the place of entrepreneurs like him. So he has evolved with the times and altered his business model. He invented the Sneaker Pimp tournament, where sneakerheads compete for who has the coolest kicks.