Archive for September, 2007

Debating the Science of Dead Pop Stars

September 19, 2007
 If there’s a rock and roll heaven, sang the Righteous Brothers, you know they’ve got a hell of a band. Maybe — but the real question is, do they have a health plan? According to one study, “famous” pop stars are far more likely to die prematurely than the general population — often from either drug use or depression. That finding is objectionable to some rock fans, but their protests raise a different set of problems. Numbers can be misused or twisted, but they hold wisdom. In this case, they may have more to teach us than even the study’s authors realize.

The article, published in the Journal of Epidemiology and Community Health, is entitled “Elvis to Eminem: Quantifying the price of fame through early mortality of European and North American rock and pop stars.” It’s analytically sound. They define “fame” as having been “a solo performer or group member with a listed album” in Virgin’s list of “All Time Top 1000 Albums.” Maybe that’s not a perfect definition — but, in the words of economist and systems theorist Herbert Simon, it “satisfices.”

The authors give this reason for conducting the study: “While qualitative reviews support rock and pop stars suffering high levels of stress depression, and substance use, quantitative studies of mortality amongst such individuals are almost completely absent.” The piece goes on to describe their methodology in detail, and it looks reasonable.

Their findings are interesting, although they may seem obvious (or, as analysts prefer to say, “intuitive.”). American and European pop stars (including rock, rap, and R&B) are more likely to die young than their peers, when compared to populations with similar backgrounds. The authors use valid sample sizes, and their results are statistically significant.

Statistical validity is important, whether we’re discussing dead pop stars, cancer victims, or the frequency and size of hurricanes. Any one event — a death, a storm, an accident — can be caused by many things. But when the numbers reveal a pattern, there is an underlying story to be told.

Ideologues and industry spokespeople often challenge the idea of statistical significance, using the general public’s innumeracy to cast doubt on everything from global warming to carcinogens in the environment. But the “Elvis to Eminem” study brought objections from a different quarter. Music blogger Brad Laidman wrote a critical post called “I Want My Rock Stars Dead.” It was then distributed to the email list for Rock and Rap Confidential, Dave Marsh’s music magazine.

What were their objections to the study? First, Laidman goes after the methodology with a classic anti-science line of attack: “Their study sample is too small and 75 percent of it hasn’t managed to die yet.” That’s wrong, and here’s a simple response: Even if all of a sample group hasn’t died yet, some percentage of it has. If that percentage is greater than it is for the general population, in a statistically meaningful way, then something significant is taking place.

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Medical Justice League of America

September 4, 2007

justice-league-whos-in.jpg

A new company is helping doctors write “gag order” forms for patients who might want to post about them on one of those health information sites. It turns out they’re also doing some other interesting, if provocative, things.

This entry in the Wall Street Journal’s Health Blog was intriguing:

Next time you go to the doctor, look for a new form buried in the stack of insurance and health-history paperwork you’re asked to complete. You might find a contract that would require you ask your doctor for permission to grade him or her online.

A new company called “Medical Justice” is selling services to doctors.  Among their offerings is a form that doctors can insist patients sign before providing treatment. The form forbids the patient from rating or reviewing the physician on any website or online forum.

“The whole notion of your reputation on the line and not having control makes physicians feel vulnerable,” Medical Justice CEO Jeffrey Segal told the Health Blog. “The goal is to regain control of the flow of information.”

We’re not proponents of anecdotal information to make medical decisions, whether it’s in the choice of physician or in determining a course of treatment. There is a lot of unsubstantiated information on the web, and it’s a health problem. And we’re sympathetic to beleaguered doctors.

Still, Dr. Segal’s solution sounds harsh, defensive, and insecure. All of us need to accept the fact that the Internet is here to stay, and that brute-force attempts to resist it aren’t as likely to be effective as more accommodating approaches. Handing yet another form to an anxious patient, with the implication that treatment will be withheld if its not signed, sounds heavy-handed.

The strident tone is borne out by a visit to Medical Justice’s website, where the slogan is “Relentlessly Protecting Physicians From Frivolous Lawsuits.” The subheading reads “Deterrence, Early Intervention, and Countersuit Protection.”

The website reads like a attempt to intimidate would-be litigants. Medical Justice promises to help organize and pay for counterclaims against people who sue physicians –  and to pursue suits against expert witnesses who testify for claimants, provide free expert witnesses for the defense, and “warn perpetrators with a strategic Early Intervention Program” intended to discourage the filing of claims.

“Medical Justice has been the driving force in getting numerous cases dropped,” the website boasts, “and has deterred many plaintiffs from filing frivolous suits.”

There is no question that frivolous lawsuits are a genuine problem, and that med mal premiums represent a crisis for many physicians. Physicians deserve to be protected from specious claims.

But the dominant tone at the Medical Justice site is rage – and therein lies the danger. The website comes perilously close to suggesting that the organization will discourage lawsuits through browbeating and intimidation, rather than a reasonable mustering of the facts.

The plan, and the concept itself, deserves further scrutiny. For example, the website claims under “Deterrence” that “In Florida, physicians are sued at a rate of 15% per year. (FPIC 2004 Q1 statistics, Crittenden). Matched by specialty, the overall suit rate for Medical Justice Plan Members practicing in Florida is less than 2%.” It continues:

A recent actuarial study of the Medical Justice track record by SG Risk, Inc. (Lyndhurst, New Jersey), concluded that the medical malpractice claim count against our plan members in Florida is statistically lower than those without protection (95% confidence level). Put a different way, Medical Justice plan members in Florida are sued much less frequently than their unprotected cohort.

Notice that it doesn’t say the study concluded that claim rates were reduced from 15% to less than 2%, or that the study concluded plan members are “sued much less frequently” – only that the plan’s members are sued at a “statistically lower” rate. Obvious question #1: Is that self-selection, because plan members are more cautious people in general? We can’t know.

A better risk management approach to medical malpractice is clearly warranted. And Dr. Segal et al. may have some interesting ideas. But their rhetoric borders on disturbing. and might even be used against their members at some point.

Conclusion: Real problem, genuine need, strident approach, questionable tactics – but worthy of more investigation and fine-tuning, either by this organization or another, more judicious one.

(WSJ link courtesy iHealthbeat)