This episode explores the long history of energy use as told by Vaclav Smil in Energy and Civilization: A History⁠, starting with the basic power of human and animal muscles and moving toward the harnessing of wind and water.

We will look at how these traditional power sources were essential for early agriculture, transportation, and manufacturing.

The episode also examines the transition to the use of fossil fuels like coal, which greatly expanded the availability of energy and enabled the Industrial Revolution.

We will see how innovations like the steam engine and the development of electricity transformed societies, and also look at the human cost of these developments, for example in coal mining.

Finally, we will consider how the concentration of power in modern technologies requires new safety precautions and how energy use continues to evolve and impact our civilization.

Source: Energy and Civilization: A History by Vaclav Smil

This Week in Healthcare, Jan 10, 2024

In this week’s episode of The Intersect, we dive into the latest headlines reshaping the healthcare industry.

From CVS’s bold move to "cost plus" pharmacy pricing to Transcarent’s $621 million acquisition of Accolade, strategic shifts in healthcare delivery and benefits are taking center stage.

We also explore the FDA’s efforts to tackle bias in AI-powered medical devices, a new rule wiping medical debt from credit reports, and updates on UnitedHealth’s delayed $3.3 billion merger.

Plus, we break down the VA’s timeline to resume its electronic health record rollout and what’s next in the ongoing reassessment of state Certificate of Need laws.

Tune in for insightful analysis and discussions on the stories that matter most in This Week in Healthcare!

This episode is adapted from a transcript of The Storytelling Expert: Hidden Triggers That Make People Act | Matthew Dicks on September 4, 2024 by The Knowledge Project Podcast from Farnam Street.

Master storyteller Matthew Dicks reveals the hidden blueprint behind stories that win million-dollar deals, transform resistant teams, and turn skeptical investors into champions.

Learn why most leaders tell stories that fail, and discover the counterintuitive techniques that make audiences lean in, remember, and act. From high-stakes boardrooms to viral TED talks, Dicks unveils the psychological triggers that turn everyday moments into weapons of mass persuasion.

Dicks emphasizes that a story is about change, usually a shift in mindset or transformation. He highlights that the fundamental rule for great storytelling is understanding that no one is obligated to listen unless given a reason. Skilled storytellers acknowledge that they must “entertain relentlessly” regardless of the format.

Dicks discusses how much preparation goes into making a story appear spontaneous. The best storytellers find a middle ground, where they "remember" stories rather than memorize them verbatim, allowing for flexibility in delivery based on the audience's engagement.

He describes carrying “five anecdotes in his pocket” to re-engage an audience if needed. The art is in knowing the beats, the key moments, without locking into precise phrasing.

He also notes that a story should stay with you for days, weeks, or even a lifetime, unlike anecdotes which are easily forgotten. A well-told story creates a connection with the listener’s life experiences, eliciting shared emotions and reflections.

Dicks uses "The Spoon of Power" story to illustrate his points. He explains that he organizes his stories around scenes, each tied to a location: the playground, the classroom, the math test, the bus ride, the principal’s office, the hallway, the last day of school, and the pandemic year.

Dicks outlines the "Mount Rushmore" of storytelling elements: stakes, suspense, surprise, and humor and introduces six key storytelling techniques.

Did you know that your doctor might be encouraged to diagnose you with conditions you don't actually have?

This episode dives deep into the practices of UnitedHealth Group, the nation's largest health insurer, and their impact on Medicare Advantage payments.

We explore how UnitedHealth's system of employing doctors and providing them with checklists of potential diagnoses has led to significant increases in patient sickness scores and, consequently, billions in extra government payments.

● We’ll discuss how doctors working for UnitedHealth were sometimes presented with lists of diagnoses before they even saw the patient, and how the company’s software required them to weigh in on each one before moving on to the next patient.

●We'll delve into the details of how these diagnoses affected patients' sickness scores. For example, analysis showed that sickness scores for UnitedHealth patients increased 55% on average in their first year in the plans.

●We'll hear from doctors who worked for UnitedHealth, like Nicholas Jones, who described how the diagnoses suggested were often "irrelevant or wrong", and who sometimes had to look up obscure conditions suggested by the company’s software.

●We will also examine specific conditions, such as senile purpura, a benign bruising condition, that were diagnosed much more frequently in UnitedHealth Medicare Advantage patients than in traditional Medicare patients.

●The episode will also investigate how financial incentives such as bonus payments were offered to doctors who confirmed or ruled out a high percentage of the suggested diagnoses.

●We’ll also explore how some patients began to suspect that their doctors had a financial incentive to portray them as higher risk1011, for example, a patient who was diagnosed as morbidly obese despite being an athletic weightlifter.

●We will also examine how the design of the diagnostic system could lead to errors that ultimately resulted in more money from taxpayers.

●The podcast will also discuss the company's response and the government's reaction to the findings.

This episode raises crucial questions about the integrity of the Medicare Advantage system, the pressure doctors face to prioritize payments over patient care, and the potential consequences for patients and taxpayers. Join us as we uncover the truth behind UnitedHealth’s diagnosis dilemma.

Source: UnitedHealth’s Army of Doctors Helped It Collect Billions More From Medicare

This podcast discussion explores the hidden motivations behind patients' healthcare choices. It argues that people seek medical care not primarily for medical outcomes, but for social validation and reassurance.

The discussion uses examples like the popularity of likeable but potentially ineffective doctors and patients' low interest in objective medical data to support this claim.

Experts highlight the significant role of patient experience and service quality in overall satisfaction, even at the cost of medical efficacy.

The conversation also touches upon the NHS and its efforts to balance patient experience with clinical standards, and the inherent inefficiencies driven by patients' desire for the best care.

Book Source

Hacking the Unconscious (Rory Sutherland)

This episode explores the concept of "nudging," using insights from behavioral science to influence decision-making for the better.

We delve into how individuals and organizations can design choices that promote positive outcomes, from health and finance to environmental sustainability.

We examine real-world examples of effective nudges, as well as potential pitfalls, including the misuse of nudges for self-serving purposes and the dangers of “sludge,” which makes it harder for people to make good decisions.

We discuss the ethics of nudging and the importance of transparency and respect for individual choice, and consider how the principles of libertarian paternalism can be applied to improve society while preserving individual freedoms.

Learn how seemingly small changes in our environment can lead to big differences in behavior and how to harness the power of nudges for good.

Key points covered:

● The definition of nudges and their roots in behavioral science.

● The concept of choice architecture and how it can be used to improve decision-making.

● Examples of successful nudges in various fields, including health, finance, and the environment.

● The potential for misuse of nudges, and the concept of "sludge".

● The importance of transparency and the "publicity principle" in nudging.

● The idea of libertarian paternalism and its implications for policy.

● Real-world cases of nudging, such as organ donation policies, and the ways in which language can impact these policies.

● The need to apply rigorous tests to determine the effectiveness of nudges.

Book Links

Nudge: Improving Decisions About Health, Wealth and Happiness

Misbehaving: The Making of Behavioral Economics

This episode dives into the world of Direct Primary Care (DPC), a healthcare model where patients pay a monthly fee directly to their doctor, similar to a gym membership.

We explore a research paper that analyzes the financials of DPC and its potential to reshape the U.S. healthcare landscape.

The study compares a hypothetical DPC practice to a traditional fee-for-service (FFS) practice.

We discuss how DPC practices, despite not receiving large insurance payments, can actually be more profitable due to lower administrative costs.

The episode also explores the potential benefits for patients, such as more personalized care and longer appointment times, as well as the potential drawbacks, such as the possibility of "cherry-picking" healthier patients.

The analysis suggests DPC could lead to significant cost savings, better patient outcomes, and reduced physician burnout.

However, it's important to note that DPC does not replace the need for insurance.

Source: Direct Primary Care: Financial Analysis and Potential to Reshape the U.S. Healthcare Landscape

What are the most critical topics in health, science, and medicine?

From AI advancements in cell biology to the hurdles of finding therapies for rare diseases, we delve into the latest research and the personal stories driving progress.

We analyze the effects of healthcare policy, the fight against misinformation, and the efforts to achieve fairness in medicine.

We also investigate the connections between politics and healthcare, with perspectives from various political leaders.

Join us as we break down key discoveries, explore controversies, and hold organizations responsible, providing you with an in-depth look at the revolution in human health.

Source: STAT Summit 2024 - Uncovering Solutions to Health and Medicine's Greatest Challenges