What Surgeons Get Paid, and What Patients Think Surgeons Get Paid

Jared Foran, an orthopedic surgeon in Denver, is a co-author of a new study called "Patient Perception of Physician Reimbursement in Elective Total Hip and Knee Arthroplasty" (PDF here). The authors surveyed 1,200 patients to see how much they thought orthopedic surgeons should make and what Medicare actually pays for a hip or knee replacement.

In an e-mail, Foran describes their results:

On average, patients thought that surgeons should receive $18,501 for total hip replacements,  and $16,822 for total knee replacements. Patients estimated actual Medicare reimbursement to be $11,151 for total hip replacements and $8,902 for total knee replacements.  Seventy per cent of patients stated that Medicare reimbursement was “much lower” than what it should be, and only 1% felt that it was higher than it should be.

End of Illness Author David Agus Answers Your Questions

We recently solicited your questions for David Agus, the oncologist author of The End of Illness. Now he's back with answers, including: the numbers on taking aspirin, how to get the most from a doctor visit, and the top 10 actions to reduce your cancer risk. I can guarantee you that his answers will enlighten and thrill some people and enrage and confound others. Thanks to everyone for their participation, and especially to Agus for the thorough answers. 

Q. I’m a 4th year medical student, and I watched your interview on The Daily Show when it first aired and really took issue with the way you presented many of these things. It seemed that you simplified your “solutions” to the point that it may actually be dangerous for people to listen to what you suggested. For example, you implied that everyone should be taking aspirin.

Bring Your Questions for End of Illness Author David Agus

Here's an obvious but sobering thought: every one of us will someday get sick and die. And here's a happier thought: with ever-advancing medical technology and research, we can now avoid many kinds of illnesses and add more years to our lifespan.

The oncologist David Agus lives halfway between those two thoughts. He is a professor at USC, the founder of Oncology.com, a co-founder of Navigenics, and now the author of The End of Illness. Most impressively, perhaps, he was recently a guest on The Daily Show

The End of Illness is Agus's take on how the body works and why it fails. Along the way, he challenges a lot of conventional wisdom about health with academic studies and his own medical experience. Arguments in the book include: that taking vitamins may increase the risk of cancer; that sitting at a desk all day may be as damaging as smoking; and that you can tell something about a patient's health based on whether she wears high-heel shoes. One review of the book reads: "A ‘rock star’ doctor says throw away the vitamins, load up on baby aspirin, and keep moving."

How to Make Tough Medical Decisions? Bring Your Questions for the Authors of Your Medical Mind

What do you do when the medical experts disagree? Should you have that PSA screening, or mammogram? Should you really be taking statins -- and what about vitamins? On these and many other medical issues, consensus is hard to come by; individuals end up weighing the benefits and risks.

Jerome Groopman (more here) and Pamela Hartzband have written a book to address this conundrum, called Your Medical Mind: How to Decide What Is Right For You. The authors are both Harvard physicians, and they are also married to each other. To write the book, they interviewed a variety of patients with different medical problems, including those from various socioeconomic, religious, and cultural backgrounds. Along the way, the authors identified all sorts of different mindsets -- proactive vs. passive, "believers" vs. "doubters," and so on. They synthesize what they learned into a framework meant to help any one person try to figure out what's the optimal treatment. Along the way, the authors ask a variety of tricky, compelling questions: how much autonomy do people really want in making treatment choices?

Aspirin and Cancer: A Seriously Cost-Effective Measure

At Freakonomics, we're all about finding cheap, easy solutions to life's big problems. And judging by the results of a new study published in The Lancet, a rather large one just came down the pike. Turns out that aspirin may be one of the most effective measures to combat colon cancer. The study found that taking two aspirin pills a day for two years reduced the risk of colorectal cancer by 63 percent in a group of 861 people who have Lynch syndrome, and are therefore at a high risk for the disease.

Though there have been previous studies that suggest aspirin may effectively reduce the risk of cancer (like this one from 2010), according to the BBC, this most recent study was the first randomized control trial specifically for aspirin and cancer to prove it. So, while we've spent what probably amounts to tens of billions of dollars in pharmaceutical R&D trying to come up with an effective cancer drug, one of the best methods may have been already sitting in our medicine cabinet, at just a few bucks a bottle.

The Power of the FDA

What exactly happens when the Food and Drug Administration (FDA) issues one of those ominous Public Health Advisories (PHAs) about a pharmaceutical product? A new paper by Rena M. Conti, Haiden A. Huskamp and Ernst R. Berndt investigates.

 

From the abstract:

We find firms targeted by an advisory have average stock price declines of 3% in three days and 11% in five days following the advisory release, and in turn appear to decrease total physician-directed promotion spending, journals ads and detailing visits significantly six months following the advisory release; the provision of free samples is unaffected. We find no changes among therapeutic substitutes unaffected by the advisory.

Do Results of Oregon's Medicaid Lottery Boost the Case for Obamacare?

One of the many debates over the new health care law is whether increased access to health insurance really improves the public's overall health and financial security. Even though there are hundreds of studies comparing insured and uninsured groups of people, there's nothing definitive so far that answers the question one way or the other. The problem is getting clean data which clearly demonstrates behavior before and after people have had access to health care, rather than comparing two separate groups of people.

But a new study by a group of economists and health care researchers may provide the first empirical evidence that shows expanding health care coverage to low-income individuals does result in better reported health, more preventative care, and improved financial well-being.

Another Batch of Poop-Loving Doctors

In this week's Freakonomics Radio podcast, "The Power of Poop" (subscribe to iTunes here), we meet Alex Khoruts, an immunologist and gastroenterologist at the University of Minnesota whose research concerns the human gut. It turns out that human waste, which for centuries has been regarded with fear and wariness, is now being redefined as the largest organ in your body -- and, more important, as a potential source for new ways to treat ailments ranging from constipation to obesity to Parkinson's disease.

The Unintended Consequences of "Polio Eradication" in India?

A reader named Ed Woodcock writes to tell us of ...: "[A] conversation I had with a WHO (World Health Org.) official I bumped into while touring the Taj Mahal for the first time about 5 or 6 years ago. We introduced ourselves and she told me that she was a "polio advocate," which obviously led to the question, "What the heck does that mean?" She basically spent her time lobbying organizations for donations to help eradicate polio. Obviously a very worthy cause!"

The Real Cost of Unnecessary Breast Biopsies

Articles on the health-care industry are a fertile source of large numbers and, sometimes, large errors. It is estimated that nationally 300,000 women a year may be getting unnecessary surgery at a cost of "hundreds of millions of dollars." I was happy to believe the figure of 300,000 women a year. However, the cost set off my number-sense alarm.