Category Archives: global health

September 5, 2009 · 12:39 am

Holiday reading

Whoops, I got busy again and didn’t have time to make new pictures of TFR vs HDI for Rif and Tanja, let alone fix the Bayes factor estimation code or implement the nested sampling version (which I think will be the cool way to estimate evidence). But coming soon: How MCMC is tying my new work in Health Metrics to my education in Operations Research. That will be in two weeks, at best.

Until then, here is some light reading to get ready for a big week of US healthcare reform debate: Get Sick, Get Out, a survey conducted by lawyers interested in catastrophic medical payments and their connection to housing forclosures. It’s 40 pages long, but it’s in legal-journal format, where they have like 10 words per page if you skip the footnotes. From the abstract:

Half of all respondents (49%) indicated that their foreclosure was caused in part by a medical problem, including illness or injuries (32%), unmanageable medical bills (23%), lost work due to a medical problem (27%), or caring for sick family members (14%).

I’m excited for the next week of healthcare reform debates. When my most jaded friends are forwarding me Moveon.org videos (and I’m listening to 4 minutes of recent REM), I know something unusual is going on.

Happy labor day weekend!

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June 25, 2009 · 8:04 pm

ID Modeling Summer School

I’ve been spending the week at the Infectious Disease Modeling Summer School here at UW. It’s very interesting, and good for me to learn more about how people in my new field think (especially people in my new field, outside of my little institute…)

I’ve discovered a pet peeve during this week of presentations, though. I’ve seen a lot of numerical examples where the numbers work out perfectly… a little too perfectly. If you split 1000 people into an experimental and control group by choosing a random subset of 500, fine. But if you look within that group to see how many have a trait that occurs independently with probability 0.2, you do not often find exactly 100 in group A and 100 in group B. I think a little more complexity in the numbers makes the example easier to understand.

I’m sure that you, my loyal reader, can generate random numbers from a multitude of distributions, if you wanted to spend the time. But if you’re busy, busy, busy, then you can have wolfram alpha do all the work. It actually comes through for that one: “sample Binomial(500, .2)“.

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June 24, 2009 · 2:52 am

US Health Care Costs, cont.

I wrote two months ago about the mysterious differences in health care costs that I found so intriguing in a talk by Jonathan Skinner. (That was two months ago? Really?) Since then, the surgeon/author Atul Gawande has brought the mystery to the national stage. In a long story for the New Yorker, he gave the non-technical version of Skinner’s talk, and today he addressed some of the feedback that this article has received over the last month.

His short answer to the mystery is this:

Analysis of Medicare data by the Dartmouth Atlas project shows the difference is due to marked differences in the amount of care ordered for patients—patients in McAllen receive vastly more diagnostic tests, hospital admissions, operations, specialist visits, and home nursing care than in El Paso.

But that is not the end of the story. It only takes a sentence to explain the “proximal” cause of these cost differences, but it takes the whole article for Gawande to do justice to his theory on the underlying cause, and his is certainly not the only theory.

Since his theory of the root cause of this inequality is centered on physicians putting profit over patients, it has made some doctors uneasy. Greg Roth, a physician that I work with hadn’t had time to read the article when we last chatted, but he did attend Skinner’s talk with me two months ago. Greg told me about a detail that has emerged as doctors put Gawande’s article under their microscopes: we might be making a mountain out of molehill-sized mystery.

Look at this plot, which shows the complementary cumulative distribution function for the primary quantity in Gawande’s article, Total Medicare reimbursements per enrollee for 2006.

Investigative reporter have to get the story, and raking the muck way out in the tail of this distribution turned out to be a good bet this time. But McAllen is 6 standard deviations above the mean (not to imply that this distribution is normal… should it be?) How much impact would it have, for the whole population, if the outliers were greatly improved?

If through anti-fraud policing, better culture, and general hard work, the top 10% of hospitals reduced their cost per patient to the national average, that would reduce the average cost by 3.6%. Outliers show what is possible, but making a big change involves more than outliers.

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June 18, 2009 · 4:13 pm

Population Health in Iran

The political situation in Iran has been in the news and on the nets a lot this week. I hope that the friends and families of all my Iranian colleagues are safe. I’m thinking of you.

Continue reading →

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May 24, 2009 · 9:17 pm

Anatomy of a Django-driven Data Server

I haven’t had time to write anything this week because I am up to my neck in this Seven-Samurai-style software engineering project. You know, where a bunch of untrained villagers (that’s me) need to defend themselves against marauding bandits (that’s the Global Burden of Disease 2005 Study), so they have to learn everything about being a samurai (that’s writing an actual application that people other than this one villager can use) as quickly as possible.

I guess this analogy is stretching so thin that you could chop it with Toshirō Mifune’s wooden sword. But, if anyone knows how a mild-mannered theoretical computer scientist can get a web-app built in two weeks, holler. If you prefer to explain in terms of wild-west gunslingers, that is fine.

Here’s my game plan so far: I’m going to make the lightest of light-weight Python/Django apps to hold all the Global Disease Data, and then try to get my epidemologist doctors to interact with it on the command-line via an interactive python session.

The rest of this post is basically a repeat of the Django tutorial, but specialized for building a data server for global population data. As far as interesting theoretical math stuff, hidden somewhere towards the end, I’ll do some interpolation with PyMC’s Gaussian Processes using the exotic (to me) Matérn covariance function. Continue reading →

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April 29, 2009 · 10:03 pm

Computers and the Flu

I was reluctant to enter this media frenzy about H1N1 flu (or whatever we end up calling it…), but only 8% of telephone respondents are “not concerned at all” about these events, so I thought I’d say something more than nothing.

Information technology’s main contribution so far has been the rapid spread of misinformation: for example, eating pork is no less safe than usual, despite rumors to the contrary twittering around the globe.

But there is an opportunity for IT to shine a little bit, too. I’m optimistic about Ushihidi’s web2.0 approach to “crowdsourcing crisis information”. Definitely something I can spend too much time looking at.

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April 20, 2009 · 2:37 pm

California foreclosures, mosquitoes, and skate punks

Do you remember last summer’s health scare around the housing market collapse? There was a theory that all the swimming pools in all the foreclosed houses in California would become major mosquito breeding grounds, leading to major crops of mosquitoes, leading to West Nile virus or maybe even the reintroduction of malaria in the US.

There have been some fun ideas for tackling this potential problem, like filling the foreclosed pools with exotic fish. But I woke up today to learn about my new all-time favorite approach: let skateboarder to drain the pools and skate in them. (thx @omarkhalifa)

Bonus points opportunity for my influential readers: WSJ reports that local disease control agencies are doing aerial surveillance for abandoned pools. Can you convince them to release their aerial photos of abandoned pool locations to the local skaters?

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April 18, 2009 · 12:36 am

Mysterious Question: Differences in Health Care Costs

Health Economist Jonathan Skinner gave a talk at IHME about a week and a half ago. He told us about his work on the Dartmouth Atlas of Healthcare, and showed us some of the numbers he’s crunched on the variation of Medicare costs by region. He has found this mysterious, 2.5x variation between the cost of care between expensive regions (like Miami) and inexpensive regions (like Seattle). It seems like a great mystery, and I’ve been puzzling over it for a week now. Any theories? I’m partial to network effects.

Here’s his paper on the subject.

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April 6, 2009 · 2:44 pm

Welcome to National Public Health Week

Since 1995, presidential decree has designated the first full week of April to be National Public Health Week in the United States. The American Public Health Association is kicking things off with an online “viral video” campaign. Public health has much more experience trying to stop the spread of viruses, so this campaign has some underdog appeal. It’s also got nice motion graphics, but definitely not my first choice for inspirational music.

(Hey, this soundtrack would be so easy to remix, if only it had an appropriate Creative Commons license. APHA could probably get a bit of notice from folks who wouldn’t otherwise see a public health video by changing the license today and send CC and friends a nice press release. Hint hint.)

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March 26, 2009 · 6:35 pm

Numbers from World TB Day + Maps of Malaria

Twice as many people were diagnosed with both HIV and tuberculosis in 2007 than were in 2006. (Science Mag, BMJ)

Quote about global health data in the article that is quite consistent with what I’ve seen comes from Richard Chaisson:

“They’re working with the best stuff they have, and the best stuff they have is not good.”

PLoS Med today has an article with some beautiful maps, co-authored by PyMC super-hacker Anand Patil. A World Malaria Map: Plasmodium falciparum Endemicity in 2007.

And, to make it a triple-crown news day for infectious disease, the Pope claims that condoms exacerbate HIV and AIDS problem. (I guess this was the big news a week ago, but it just crossed my desk today.)

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