"So basically,when it comes to saving lives, docs are three times more likely to recommend a screening test based on irrelevant data than they are to recommend it based on relevant data. I’m bracing myself for the hate mail, but this is part of the reason why I’m skeptical that just providing docs with more evidence will change the way they practice. Most docs just aren’t trained to understand this stuff."

"The other key thing to pay attention to is who this marketing campaign was targeted at: key decisionmakers at providers and insurance companies. Those are the people who decide whether medical procedures get ordered. It’s not patients. Patients aren’t going to experience a loss of freedom or satisfaction because an expert reviewer at the Independant Payment Advisory Board makes the call as to whether a procedure is medically beneficial, rather than the corresponding bureaucrat at their insurance provider or at the for-profit clinic they’re attending."

"I think there's at least one more possibility:

3. Sodium's isn't a causal agent of disease but instead given that processed foods are phenomenally high in sodium, is a useful biomarker for the degree of processed foods a person's consuming, and that it's the huge volumes of sugar and pulverized flour (that's more often than not packaged with gobs of sodium) that's actually causal for cardiovascular disease and death."

"…But this is America. If you want to have the procedure, so be it. You get to choose. That’s the way we roll.

My question is, did your doctor recommend it? Did your doctor tell you about this study? Do you think that those who recommend and perform this procedure don’t know about this study, and that if only they had this evidence they’d stop?

Or, do you think physicians are influenced by biases and their personal beliefs? Me? I think they’re human."

"When I walked into the offices of Dr. Ken Cirka, I was looking for cleaner teeth, not material for an Ars Technica story. I needed a new dentist, and Yelp says Dr. Cirka is one of the best in the Philadelphia area. The receptionist handed me a clipboard with forms to fill out. After the usual patient information form, there was a “mutual privacy agreement” that asked me to transfer ownership of any public commentary I might write in the future to Dr. Cirka. Surprised and a little outraged by this, I got into a lengthy discussion with Dr. Cirka’s office manager that ended in me refusing to sign and her showing me the door."

With respect to the DSM-5, I am agnostic about the diagnostic criteria for individual conditions, such as panic disorder or generalized anxiety disorder; in the end, I am not certain that either of these categories capture nature or will even appear in the DSM-6. When it comes to individual diagnostic categories, I would recommend that the DSM-5 take a conservative approach, leaving criteria unchanged unless compelling new evidence suggests that a change would be beneficial. Whatever the ultimate approach to the DSM-5, it is critical that the scientific community escape the artificial diagnostic silos that control so much research, ultimately to our detriment.

"I strongly suspect these patterns are driven mostly by customers, i.e., that more accurate professionals would be less successful in inspiring confidence by others in them. If you are a successful professional, that is probably in part because of your unjustified arrogance."

"…Being on fire, you would probably apply powerful pails of water to put it out, and send off your man for the engines? You would do very wrong.…"

"Hospital-based chaplains and pastoral counselors come up against a fairly brutal form of scientism all the time. In many health care institutions, these people are barely tolerated. They are pointedly not invited to participate in rounds or in patient evaluation sessions. I recall how, as a first-year seminary student doing what is called “supervised ministry” at a New Haven mental health hospital, I was somewhat shocked to see how patients’ behavior was interpreted purely in terms of reactions to their medications, whereas I could see plainly that many of these same patients were responding to the presence or absence of human connection—visits and phone calls from loved ones either made or not made, friendships with other patients either formed or broken."

"But health care is not zero-sum villainy. This post is not arguing that insurers are better than you think and providers worse. This post is arguing that nature of both groups is beside the point. They work within the market the government constructs. And both the market for insurance and the market for health care need reform. But we're comfortable reforming only the market for insurance, and so we are leaving half -- or maybe more than half -- the job undone."

"Pot does not kill anyone, and he would have been content to make that his substitute for the mood-altering he seemed to have to have. But he was compelled to give it up, and now he is dead.

This fine man was 49 years old and leaves behind a young widow, mother and hundreds of grieving friends. He was loved by many for his gentleness and many charitable endeavors."

"This isn't as simple as cutting out waste. The real project here is getting the medical system to define waste the same way consumers define waste: treatments that don't help people, and in fact hurt the bottom line. As it is, those treatments currently help the bottom line, and so are no more wasteful for the institution than a Best Buy salesman persuading you to buy an expensive HDMI cable you don't need."

"I suspect Frank is right on the pay issue, but for the wrong reasons. I am always staggered when I hear of law school and business school graduates being in debt to the tune of $100,000, even $200,000. I have no idea what the level for MDs is, but I imagine it is even worse.

And you cannot discharge student debt in a bankruptcy. You have no choice but to pay it (or I suppose flee the US or go underground, there are always extreme options). So the fee for service model may remain intact despite the fact that it produces poor outcomes for society as a whole because the current generation of doctors needs high incomes to so they can service their debts."