Dylan Thomas: Do not go gentle into that good night
http://www.poets.org/poetsorg/poem/do-not-go-gentle-good-night
Do not go gentle into that good night
Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.
Though wise men at their end know dark is right,
Because their words had forked no lightning they
Do not go gentle into that good night.
Good men, the last wave by, crying how bright
Their frail deeds might have danced in a green bay,
Rage, rage against the dying of the light.
Wild men who caught and sang the sun in flight,
And learn, too late, they grieved it on its way,
Do not go gentle into that good night.
Grave men, near death, who see with blinding sight
Blind eyes could blaze like meteors and be gay,
Rage, rage against the dying of the light.
And you, my father, there on the sad height,
Curse, bless, me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.
From The Poems of Dylan Thomas, published by New Directions. Copyright © 1952, 1953 Dylan Thomas. Copyright © 1937, 1945, 1955, 1962, 1966, 1967 the Trustees for the Copyrights of Dylan Thomas. Copyright © 1938, 1939, 1943, 1946, 1971 New Directions Publishing Corp. Used with permission.
Andrew Lo (MIT) – financial engineering a “cancer megafund”
Via Felix.
http://video.mit.edu/watch/professor-andrew-lo-can-financial-engineering-cure-cancer-11949/
https://lgo.mit.edu/news/articles/lo-cancer-megafund/lo-cancer-megafund.html
In LGO webinar, Andrew Lo discusses “cancer megafund”
By Josh Jacobs, LGO Director of Operations and Partner Integration
Andrew Lo
In a recent MIT Leaders for Global Operations webinar titled “Can Financial Engineering Cure Cancer?” MIT SloanProfessor Andrew Lo described how the same tools that were used to catastrophically inflate U.S. mortgage debt markets could be used to fuel a “cancer megafund” to distribute the risks and rewards of breakthrough research across the vast global bond market.
Lo, who directs MIT’s Laboratory for Financial Engineering and also leads a hedge fund he created in 2003, is noted for applying tools from various disciplines to provide new insights on key issues in finance. In recent years, driven by the impact of cancer on friends and family members, he wondered if the resources of global capital markets could be used to accelerate progress toward solving pressing global challenges in health and energy.
Working from his expertise in financial markets, Lo described his concept for how the greed and financial engineering that drove a six-fold increase in U.S. mortgage debt in the 2000s might be focused to more altruistic aims. Recognizing that a huge global bond market—vastly bigger than the venture capital market—is looking for ways to secure reasonable returns, Lo proposed a $30 billion cancer megafund that would invest in more than 150 promising drug development projects. He discussed his cancer proposal recently with both the Economist and the Boston Globe.
In his March 1 presentation, Lo demonstrated that spreading the typical cost, risk and return on cancer drugs across such a broad range of potential successes would present very attractive potential rates of return to bond investors. This potential fund would address the current negative trend for investment in biotech, driven by very long development timelines as well as dry cancer-drug development pipelines.
While $30 billion is not a very large target in the context of global bond and sovereign wealth investment resources, it’s equal to the current overall budget for the National Institutes of Health—and, more importantly, it would provide a longer-term horizon than venture capital investors now offer for drug development efforts.
In response to a question by an LGO student about the governance procedures that would be needed to prevent a “cancer bubble” along the lines of the housing bubble, Lo said that despite the lessons learned from the housing finance crisis, “the price of innovation may be some false positives.” However, he added, with proper oversight and financial structuring, the net impact of the cancer megafund would be overwhelmingly positive, particularly in light of declining governmental support for such research.
Lo, who was recognized by Time as one of the World’s 100 Most Influential People, is convening a conference this June at MIT on the cancer megafund project with key stakeholders from the biotech industry, government, the investment community, and cancer researchers. More details will be forthcoming soon on his website.
Jeff Brenner – final meeting
Met with Jeff Brenner, Medical Director at Camden Coalition of Healthcare Providers.
Learned about him after listening to these freakonomics podcasts:
An eloquent, thoughtful keen student of the history of epidemiology, public health’s political success and a tireless advocate for the underserved communities of Camden, NJ.
Holds a strong, long-term, systems view of change in public health and healthcare.
Currently engaged in a loss-avoidance play as an ACO demonstration site – geographically defined, shared savings project, which has protection from federal anti-trust laws to allow providers to collaborate.
Doubts the claims of most preventive health organisations, on basis of the Medicare Chronic Care Demonstration Project in the 80s where only 3 of 15 corporate participants survived a randomised control trial of preventive interventions after a year.
The game changer in many examples of public health shift are the troubling personal experiences of decision makers.
Emotional, visceral, aesthetic impact.
Tapped into Grenny’s observation about Don Berwick needing to get hospital CEOs to run the analysis of patient harm personally rather than to delegate in order to experience first hand the damage their institutions were doing to their patients.
Examples of AU Health Minister’s personal experience of the harms of tobacco driving the change to plain packaging.
Complex systems are kept in place by:
- goodwill
- money
- tax dollars
- positive media
- These foundations need to be eroded one by one to effect change.
For a venture capitalist, they’ll need a pitch that appeals to their outrage at the lack of evidence or transparency around the way that healthcare works.
For someone on the left, the conversation will need to be nuanced around the human tragedy of chronic disease, and the need for humanity to do better.
Don’t get wedded to the strategy, just the outcome.
There is a 100 year gulf between the way corporations collect and use data, and the way that government uses the same resource.
Analytics allow us to surveil, segment, target and measure interventions, then tell a good story of why things happen.
Dual System Utilizers – healthcare and law enforcement
On the way to the meeting, came up with a name for the concept – the QALYBOND – will grab the domain name.
References
http://www.macfound.org/fellows/886/
- “Bury the Chains” – end of slavery
- “The Children” – civils rights movement
- The fight to roll out covered sewers, welfare reform (fixed by the right)
- Adverse Childhood Event Study – Vince Felitti, KP
RWJF: Starting Early to Teach Healthy Habits
Washington Post: Thiel on anti-aging
http://www.washingtonpost.com/business/on-leadership/peter-thiels-life-goal-to-extend-our-time-on-this-earth/2015/04/03/b7a1779c-4814-11e4-891d-713f052086a0_story.html
Peter Thiel’s quest to find the key to eternal life
By Ariana Eunjung Cha April 3
Peter Thiel, 47, revels in being a contrarian. The billionaire co-founder of PayPal and investor in Facebook has set up a fellowship program that encourages kids to drop out of college, has given millions of dollars to Ron Paul’s PAC and has started an organization dedicated to the world’s first floating city out of reach of any government on Earth. But the idea he’s most passionate about is using technology to extend human life far beyond what it is now and all the biological, societal and philosophical changes that come with that.
He’s funding dozens of scientists through his nonprofit, Breakout Labs, which aims to support early-stage companies that push the boundaries of what’s possible, and directly through personal donations to institutions and individuals.
This interview, one in a series of conversations with Silicon Valley figures who are shaking up philanthropy, has been edited for length and clarity.
Why aging?
I’ve always had this really strong sense that death was a terrible, terrible thing. I think that’s somewhat unusual. Most people end up compartmentalizing, and they are in some weird mode of denial and acceptance about death, but they both have the result of making you very passive.
I prefer to fight it.
Almost every major disease is linked to aging. One in a thousand get cancer after age 30. Nixon declared war on cancer in 1971, and there has been frustratingly slow progress. One-third of people age 85 and older have Alzheimer’s or dementia, and we’re not even motivated to start a war on Alzheimer’s. At the end of the day, we need to do more.
All your philanthropic projects are founded on the idea that there’s something wrong with the way the current system works. What are the challenges you see in biomedical research?
I worry the FDA is too restrictive. Pharmaceutical companies are way too bureaucratic. A tiny fraction of a fraction of a fraction of NIH [National Institutes of Health] spending goes to genuine anti-aging research. The whole thing gets treated like a lottery ticket. Part of the problem is that aging research doesn’t always lend itself to being a great for-profit business, but it’s a very important area for a philanthropic investment.
How is your approach different?
NIH grant-making decisions end up being consensus-oriented, focused on doing things that a peer review committee thinks makes sense. So you end up with a very conservative bias in terms of what gets done.
[On the other hand,] the original DARPA [Defense Advanced Research Projects Agency] was phenomenally successful. You had a guy running it, and he just gave out the money. It was more focused on substance and less on the grant-writing process. That’s the direction we should go. I worry that right now, we have people who are very nimble in the art of writing grants who have squeezed out the more creative.
You’re currently funding Cynthia Kenyon, Aubrey de Grey and a number of other researchers on anti-aging. What was it about these individuals and their work that got your attention?
They think far outside the conventional wisdom and are far more optimistic about what can be done. I think that’s important to motivate the research.
Leon Kass — the physician who was head of the President’s Council on Bioethics from 2001 to 2005 — as well as a number of other prominent historians, philosophers and ethicists have spoken out against radical life extension. Kass, for instance, has argued that it’s just not natural, that we’ll end up losing some of our humanity in the process. What do you think of their concerns?
I believe that evolution is a true account of nature, but I think we should try to escape it or transcend it in our society. What’s true of evolution, I would argue, is true of all of nature. Even basic dental hygiene. If it’s natural for your teeth to start falling out, then you shouldn’t get cavities replaced? In the 19th century, people made the argument that it was natural for childbirth to be painful for women and therefore you shouldn’t have pain medication. I think the nature argument tends to go very wrong. . . . I think it is against human nature not to fight death.
What about the possibility of innovation stagnation? Some argue that if you live forever, you won’t be as motivated to invent new ways of doing this.
That’s the Steve-Jobs-commencement-speech-in-2005 argument — that he was working so hard because he knew he was going to die. I don’t believe that’s true. There are many people who stop trying because they think they don’t have enough time. Because they are 85. But that 85-year-old could have gotten four PhDs from 65 to 85, but he didn’t do it because he didn’t think he had enough time. I think these arguments can go both ways. I think some people could be less motivated. I think a lot of people would be more motivated because they would have more time to accomplish something meaningful and significant.
How long is long enough? Is there an optimal human life span?
I believe if we could enable people to live forever, we should do that. I think this is absolute.
You’re currently funding researchers who are working on a lot of different ways to slow down or even stop aging — a treatment that would work on the cellular or molecular level, regenerative technologies to replace body parts, cybernetics. If scientists are able to come up with a way to extend human life, how do think it will work?
It will be very multi-pronged. I don’t think the answer will be a single pill. I think there will be a series of regenerative technologies and a series of cures for various diseases. I think it’s probably a combination of those two that will be the most critical. Then there are a few problems that will probably require a different approach — like how do you avoid decay of the brain over time.
What does the future look like if everyone lives to be, say, 150?
Certainly if we could just live to all be 100, that would be quite a transformation. There is good news and bad news. The bad news is: If you don’t believe in the good news, you’re not saving enough for retirement and likely to spend much of your old age in poverty. I suspect if people live a lot longer they would be retired for a somewhat longer period of time. Just the financial planning takes on a very different character.
I think you have far more generations in a family. People would have great-great-great-grandchildren in ways I think quite rare today. I think if you had a much longer life span, I do think the question of the future becomes more important. What would the 22nd-century world look like?
[In terms of careers,] I think you could, for example, become a teacher and then you could become a writer, and then you could become a doctor. Those are completely different professional lives. If someone tries to do all these things now, that is generally seen as kind of a really confused person who doesn’t know what they are doing. But in the future, there is a way in which you might be able to have these really divergent careers. Or maybe you could have something new — a combination of those three.
So would you say you have an optimistic view of the future? Are there particular books, TV shows or other things that influenced your outlook?
There is a sort of genre of optimistic science fiction that I like, and I don’t think there is enough of. One of my favorites is a relatively short story by Arthur C. Clarke, “The City and the Stars.” It’s set in this far future on Earth in this somewhat static society and trying to break out. There is a sense we are just at the beginning of this infinite journey. . . . I was a fan of the original “Battlestar Galactica” and watched a few of the remake ones, and it was so much more negative than the original. The Cylons were the enemies, and it was generally a bad tech experience. I much prefer the original.
What about you? What would you do with the rest of your life if you knew you would live that long? Would you want to be a rock star or take up professional golf or something like that?
I’m not sure . . . but I would be tempted to go back into some specific technical research area where I would just work on really understanding some area of science. I always have the sense that I don’t have enough time to learn about all the things I want to learn about.
Assuming the breakthrough in eternal life doesn’t come in our lifetime, what do you hope to have achieved through your philanthropy before you die? What would you like to be remembered for?
I think if we made some real progress on the aging thing, I think that would be an incredible legacy to have. I have been fortunate with my business successes, so I would like to encourage, coordinate and help finance the many great scientists and entrepreneurs that will help bring about the technological future. It’s sort of not important for me to get credit for the specific discoveries, but if I can act as a supporter, mentor and financier, I think that feels like the right thing.
NYT: Out of pocket cost tool to be mandated by HHS
http://www.nytimes.com/2015/05/09/us/politics/health-care-law-consumer-complaints-to-get-addressed-by-white-house.html
WASHINGTON — The White House is moving to address two of the most common consumer complaints about the sale of health insurance under the Affordable Care Act: thatdoctor directories are inaccurate, and that patients are hit with unexpected bills for costs not covered by insurance.
Federal health officials said this week that they would require insurers to update and correct “provider directories” at least once a month, with financial penalties for insurers that failed to do so. In addition, they hope to provide an “out-of-pocket cost calculator” to estimate the total annual cost under a given health insurance plan. The calculator would take account of premiums, subsidies, co-payments, deductibles and other out-of-pocket costs, as well as a person’s age and medical needs.
Since insurers began selling coverage through public marketplaces 19 months ago, many consumers and doctors have complained that the physician directories are full of inaccuracies. “These directories are almost out of date as soon as they are printed,” said Kevin J. Counihan, the chief executive of the federal insurance marketplace.
Medicare and Medicaid officials have found similar problems in the directories of insurance companies that manage care for beneficiaries of those programs. In December, federal investigators said that more than a third of doctors listed as participating in Medicaid plans could not be found at the locations listed.
The Obama administration recently adopted stricter standards stating that each insurer in the federal marketplace “must publish an up-to-date, accurate and complete provider directory, including information on which providers are accepting new patients, the provider’s location, contact information, specialty, medical group and any institutional affiliations.”
In addition, Mr. Counihan said, the administration will require insurers to provide physician information in a format that software developers can use to create tools to help consumers find health plans in which their doctors participate. Consumer advocates like Robert M. Krughoff, the president of the Center for the Study of Services, also known as Consumers’ Checkbook, said such tools could be a boon to consumers.
The new standards significantly strengthen an earlier rule, which required insurers to publish directories online and to make paper copies available on request. In the federal exchange, violations are subject to civil penalties of up to $100 a day for each person adversely affected.
Federal officials said that inaccurate provider directories could be a sign of larger problems. If doctors listed in a directory are not available or are not taking new patients, consumers may not have access to covered services, and the insurers may not meet federal standards for “network adequacy,” the officials said. Consumers must often pay extra when they use doctors outside the network of their health plan, so an inaccurate directory could also lead to higher costs for patients.
Moreover, doctors said that they too need accurate directories so they can refer patients to physicians in the network when specialized treatment is required.
“The impact of inaccurate provider directories on consumers can be devastating, especially on those consumers who need to carefully examine networks for specific subspecialists, cancer centers or children’s hospitals,” the American Medical Association told state insurance officials in a recent letter endorsed by dozens of health care provider and patient groups.
But insurers say that the problems might not be easy to fix, and that doctors are partly to blame for the directory errors. Insurers “are unable to guarantee the accuracy of the provider’s status” in a directory because doctors often “stop accepting particular health plans’ members off and on throughout the year and fail to notify the plan in a timely manner,” America’s Health Insurance Plans, the chief lobby for the industry, said in a letter to the Obama administration.
In its online doctor directory, Blue Cross and Blue Shield of Texas says that it makes every effort to provide correct information, but that it “cannot be responsible for omissions or errors in the provider details.” Aetna says that data in its directory is “subject to change at any time.” UnitedHealth tells Medicare beneficiaries, “A doctor listed in the directory when you enroll in a plan may not be available when your benefits become effective.”
The problems that consumers face with unexpected costs may result, in part, from the way plans are listed on HealthCare.gov, the website for the federal marketplace. More than 8.5 million people are in private health plans selected through the site, and the plans are listed in order of their premiums, from lowest to highest.
This encourages consumers to focus on premiums rather than total costs, said Mr. Krughoff, the Consumers’ Checkbook president, and they often spend hundreds or thousands of dollars more than they need to.
Mr. Krughoff’s group has been publishing a guide to health plans for federal employees for more than 30 years, and a version of its online toolfor comparing health plans is available on the website of the federal marketplace in Illinois. “It’s been a great tool,” said Jose M. Muñoz, a spokesman for Get Covered Illinois, the state agency that promotes enrollment.
The tool can perform searches tailored to a person’s needs and priorities. It asks consumers to describe their health status, offering five levels from excellent to poor, and to list “expected medical procedures” like childbirth,knee replacement or prostate removal. It also provides an estimate of total yearly costs for the user.
Federal officials said that they might link HealthCare.gov to an out-of-pocket cost calculator later this year, and that they hoped to make such comparisons a standard part of the shopping experience at the site in later years.
“We know that we have work to do to make it easier for consumers to find plans that meet their needs,” said Lori Lodes, a spokeswoman at the Centers for Medicare and Medicaid Services, which runs the federal marketplace serving more than 30 states.
A few state-run exchanges are developing similar tools. Peter Nichol, the information technology director for the state insurance exchange in Connecticut, said it would add a “cost calculator” to its website this summer.
The Obama administration is also taking steps to increase the accuracy of doctor directories in Medicare. About 30 percent of the 55 million beneficiaries are in private Medicare Advantage plans that typically use networks of doctors to care for patients.
The Medicare agency said it had received complaints about insurance company directories that included doctors who “have retired from practice, have moved locations or are deceased.” New federal rules will require insurers to update their Medicare directories each month, “with specific notations to highlight those providers who are closed or not accepting new patients.”
Disney breaks with Happy Meals in 2006 – an abberation
I was told at dinner last night that the Institute for the Future had recently persuaded Disney to dissociate itself from McDonalds on account of the downstream legal exposure they would incur due to McDonald’s targeting of children (an initiative that will cost Disney $800M p.a. and 5000 jobs), with Disney now searching for a more upstanding dining partner. I haven’t been able to corroborate the information and it doesn’t seem public, but did sound like it was heading in the right direction.
http://articles.latimes.com/print/2006/may/08/entertainment/et-mcdonalds8
ProPublica – US Medicare Part D Pharmaceutical Prescribing Data Release
http://linkis.com/www.propublica.org/a/mxEES
Government Releases Massive Trove of Data on Doctors’ Prescribing Patterns
The move follows a ProPublica investigation showing that Medicare did little to find dangerous prescribing by doctors to seniors and the disabled. It is also part of the government’s new push to bring transparency to taxpayer-supported medical care.
This story has been updated to include a statement from the American Medical Association.
The federal government released detailed data today on nearly 1.4 billion prescriptions dispensed to seniors and disabled people in the Medicare program in 2013, bringing more openness to the medication choices of doctors nationwide.
The data release comes two years after ProPublica reported that the Centers for Medicare and Medicaid Services had done little to detect or deter hazardous prescribing in its drug program, known as Medicare Part D. ProPublica analyzed several years’ worth of prescription data, obtained under the Freedom of Information Act, and created a tool called Prescriber Checkup that lets users compare individual physicians to others in the same specialty and state.
But Medicare itself hadn’t made this information easily accessible—until now.
“This transparency will give patients, researchers, and providers access to information that will help shape the future of our nation’s health for the better,” said acting CMS Administrator Andy Slavitt in a statement accompanying the data’s release.
The information released by CMS is part of the agency’s data transparency initiative. In recent years, CMS has released data on hospital charges, geographic variations in the way health care is delivered, and Medicare’s payments to doctors. The payment data, first released last year, came after the Wall Street Journal and its parent company challenged a long-standing legal injunction that had kept the information private.
Medicare changed its approach to overseeing Part D after the ProPublica reports.
Before, agency officials insisted that monitoring problem prescription patterns fell to the private health plans that administer the program, not the government itself. Congress never intended for CMS to second-guess doctors – and didn’t give it that authority, officials said.
Doctors didn’t even have to be enrolled in Medicare to prescribe to patients in Part D, making it impossible for the program to know basic facts about whether the prescriptions these doctors wrote were appropriate.
Since our reports, CMS has moved to fix Part D’s excesses and blind spots. In May 2014,the agency gave itself the authority to expel physicians from Medicare if they are found to prescribe drugs in abusive ways. Beginning next month, the agency also will compel health providers to enroll in Medicare to order medications for patients in Part D, closing the loophole that has allowed some practitioners to operate with little or no oversight.
Medicare Part D is popular among seniors for helping to lower their drug costs. But experts have complained that since Part D began in 2006, Medicare has placed a higher priority on getting prescriptions into patients’ hands than on targeting problem prescribers. The U.S. Department of Health and Human Services’ inspector general has repeatedly called for tighter controls.
Among ProPublica’s findings:
- Medicare had failed to use its own records to flag doctors who prescribed thousands of dangerous, inappropriate or unnecessary medications.One Miami psychiatrist, for example, wrote 8,900 prescriptions in 2010 for powerful antipsychotics to patients older than 65, including many with dementia. A black-box warning on the drugs says they should not be used by such patients because it increases their risk of death. The doctor said he’d never been contacted by Medicare.
ProPublica also found that many of the top prescribers of the most abused painkillers had been charged with crimes, convicted, disciplined by their state medical boards or terminated from Medicaid. Nearly all remained eligible to prescribe in Medicare.
- Medicare wasted hundreds of millions of dollars a year by failing to rein in doctors who routinely give patients pricey name-brand drugs when cheaper generic alternatives are available.
- The top prescribers of some drugs received speaking payments from the companies that made them.
- Medicare’s process of flagging fraud was so convoluted and ineffective that the program was losing millions of dollars to schemes. Though the number of prescriptions attributed to Florida kidney specialist Carmen Ortiz-Butcher more than quadrupled in a year and the cost of her drugs to Medicare spiked from $282,000 to $4 million, Medicare didn’t ask any questions until Ortiz-Butcher realized that her prescription pads had been stolen and falsified.
The data released by Medicare today includes summary information, such as the total number of prescriptions written by each doctor in 2013, as well as more detailed information about each drug a doctor prescribed. It covers prescriptions worth more than $103 billion, not including rebates that lower the cost by an undisclosed amount.
The top prescribed drug in the program in 2013 was the blood pressure drug Lisinopril, prescribed 36.9 million times, including refills. Medicare spent the most on Nexium, $2.5 billion, not including rebates. The drug taken by the most Part D patients was the narcotic hydrocodone-acetaminophen. More than 8 million users filled at least one prescription for it.
Eric Hammelman, a vice president at the consulting firm Avalere Health, said the prescribing data could unlock clues about differences in how doctors practice medicine. Take, for instance, antibiotics, he said, which are often prescribed for inappropriate reasons. While the new data won’t show which prescriptions are inappropriate, it may flag providers who should be asked questions because they prescribe the drugs to a high proportion of their patients.
Beyond that, if consumers compare the prescribing data to data on the payments drug companies have made to doctors, they can see how often doctors prescribe products sold by companies with whom they have financial relationships.
“Knock on wood, these files are coming out on a regular basis. I think some of the doctors and manufacturers would prefer this goes away,” Hammelman said.
Robert M. Wah, president of the American Medical Association, said in a statement that the data “is much more complex than initially meets the eye. The limitations of it should be more comprehensively listed and highlighted more prominently so that patients can clearly understand them.”
ProPublica will be analyzing the information in coming weeks and incorporating the data into our Prescriber Checkup tool.
WIRED: IHME
Decent story about IHME, the development of DALY’s, WHO’s reluctance to return to politically sensitive measures and how Australia apparently used the measures to improve its health system.
http://www.wired.com/2015/04/epic-measures
ONE DOCTOR’S QUEST TO SAVE THE WORLD WITH DATA
Click to Open Overlay GalleryIN RWANDA, PEOPLE have to deal with all kinds of threats to their health: malaria, HIV/AIDS, severe diarrhea. But in late 2012, Agnes Binagwaho, Rwanda’s Minister of Health, realized her country’s key health enemy was something far more innocuous. The thing causing the most harm to her people, the leading risk factor for premature death and disability, was inside their own homes: Dirty indoor air, from cooking food over burning dung and vegetation in poorly ventilated huts. Within weeks, Binagwaho announced a program to distribute one million clean cookstoves to the poorest households in the young, mostly rural country.
Binagwaho was able to improve millions of lives thanks to a new kind of medical record-keeping, only possible in this era of big data. Just as Billy Beane, general manager of the Oakland Athletics, used sabermetrics to maximize wins, epidemiologists can crunch data to determine the so-called global burden of disease—information that can be used to optimize the health of a neighborhood, nation, or the entire globe. Call it Moneyball for public health.
You might think that policymakers and health czars would jump at the chance to save the maximum number of lives with a minimum of investment. But it hasn’t always been easy going for Christopher Murray, the godfather of the approach, who today directs the Institute for Health Metrics and Evaluation at the University of Washington. In Epic Measures, published earlier this month, health journalist Jeremy Smith recounts Murray’s struggle to index the global burden of disease—and the political obstacles he encountered in publishing and distributing his findings.
A Precocious Pharmacist
The roots of the global burden of disease stretch back to Murray’s childhood. At 10 years old, his family traveled to Niger to help run a rural hospital. After traveling more than a month through the Saharan desert to get there, they found no power, no water, no medical supplies and no other staff. At 10 years old, Murray was promoted to role of hospital pharmacist. In his role, he saw children sick with malaria and suffering from malnourishment, along with a fair share of donkey bite victims.
Those experiences shaped the rest of his life: “It gave me my primary question, which I continue to try to get the answer to,” Murray says. “What are people’s main problems and what can you do to fix them in a way that transcends individual clinical practice?”
More than 20 years later, as a leader at the World Health Organization (the United Nation’s health arm), Murray noticed that official reports and analyses of those main problems didn’t quite reflect medical reality. In fact, the numbers—many of which came from advocacy groups, seeking money and attention for specific causes—didn’t make sense. “If you added things up,” he says, “people were dying three times over.”
So Murray took a different approach. He and his collaborators—not advocacy groups—calculated disease impacts, double checking to ensure they matched the total number of people who had died. And he revised a strategy he and medical demographer Alan Lopez had pioneered in the early 1990s at the Harvard School of Public Health, where they created a new metric for quality of life and health loss (disability-adjusted life years, or DALYs). Using DALYs as a quality of life measure makes it possible to compare one disease to another, giving a complete view of the global burden of disease.
“It’s a study of everything wrong with everyone everywhere, in all countries for all time,” says Smith. “I mean everything that makes people sick, everything that kills people, everything that causes pain and suffering and the risk factors for those things.” That can include anything from whether you live with an abusive partner to how much lunch meat you consume.
Explosive Results
In 2000 Murray’s team released a new version of the global burden of disease data, analyzing world health between 1990 and 2000 and adding new insights. Rankings of national health systems performance were among those additions—including the famous statistic that the United States has the 37th best health system, despite spending the most per capita.
Controversy erupted. “That generated much greater reaction than anything else,” Murray says. “When you start talking about performance of health systems, you get very close to the job description of the minister of health in a country.”
Some politicians and ministers felt the ranking was a direct threat, an evaluation of how well they did their jobs. (Murray says the clever ones used the results to push for more money.) José Serra was the health minister of Brazil at the time, running a presidential election campaign. “He really went after us at the WHO at the time,” says Murray, “saying that this was not appropriate for the UN to do this. I think the WHO still shows the scars.” Since the conflict, Murray says, the WHO has been enormously reluctant to venture near health care system performance.
A Third Life for GBD
But Murray’s quest still lives. The study’s current iteration, housed at the Institute for Health Metrics and Evaluation in Seattle, analyzes global health data up to 2013. A super-computing cluster is busily whirring away at the University of Washington—supported by more than $100 million in funding from the Gates Foundation—crunching information from sources like hospital and police records to output more than a billion data points.
That data and the approach it drives will go on to accomplish grand things, Murray hopes. Already it’s racking up success stories. Australia used the data to re-map their health systems: In 1970 the life expectancy of the average Australian man was about the same as a man in the United States (about 71). Now, Australia is neck and neck with Japan (80 years).
The same approach worked in Colombia, where Rodrigo Guerrero, mayor of Cali, analyzed data to understand patterns of violence. Deaths were concentrated on weekends, he found, particularly near paydays. Drugs and gangs weren’t the sole cause of gun violence and murders—the devil, in this case, was the dangerous combination of young men, alcohol, and an already violent culture. Guerrero changed where and when booze could be sold and instituted gun bans, cutting shootings and murders nearly by half.
The information Murray and his more than 500 collaborators have gathered is designed to help you lead a better life, too. One of best health interventions for Americans, turns out, is simply to eat more fruit, helping to prevent heart disease and stroke. That’s the beauty of the DALY: It works to identify the root cause of the greatest health threats, whether it’s a dung-filled fire, alcohol-fueled violence, or in the case of American men in their late 30s, processed meat. Sorry, guys: The data doesn’t lie.