27 de novembre 2021

Choosing how to choose (2)

 The elements of choice: why the way we decide matters 

A book on choice architecture. In the last chapter:

Having looked, throughout this book and in this chapter, at choice architecture, both good and bad, there are three things that we should consider going forward:

Choosers are unaware of the effects of choice architecture and do not respond to warning.

Designers can underestimate the effects of choice architecture.

Choice architecture has a larger effect on the most vulnerable.

If these three statements are true, what should we do? One place to start is educating designers and choosers. The education I have in mind is not just pointing out choice architecture and its effects, but also providing an understanding how it works.


 

26 de novembre 2021

Mental health challenges

 Fitter Minds, Fitter Jobs

From Awareness to Change in Integrated Mental Health, Skills and Work Policies

1 What does a mental health-in-all-policies approach look like? 

2 What are current social and labour market outcomes for persons with mental health conditions? 

3 How far have we come in implementing integrated mental health, skills and work policies?

4 What are the implications and lessons of the COVID-19 pandemic for integrated mental health, skills and work policy?

A timely OECD report 5 years after the approval of the Recommendation on Integrated Mental Health, Skills and Work Policy. Unfortunately many countries still have to apply them...



25 de novembre 2021

AI everywhere (8)

 AI Assistants

A useful introductory book with this contents:

1 What Is a Virtual Assistant?

2 AI and Machine Learning

3 Speech Recognition

4 Natural Language Understanding

5 Natural Language and Speech Generation

6 The Dialog Manager

7 Interacting with an Assistant

8 Conclusions

 




 

24 de novembre 2021

The urgent answer to the coming black box medicine

Black box medicine and transparency

 The series of reports Black Box Medicine and Transparency examines the human interpretability of machine learning in healthcare and research:

1. Machine learning landscape considers the broad question of where machine learning is being (and will be) used in healthcare and research for health 

2. Interpretable machine learning outlines how machine learning can be or may be rendered human interpretable

3. Ethics of transparency and explanation asks why machine learning should be made transparent or be explained, drawing upon the many lessons that the philosophical literature provides

4. Regulating transparency considers if (and to what extent) does the General Data Protection Regulation (GDPR) require machine learning in the context of healthcare and research to be transparent, human interpretable, or explainable

5. Interpretability by design framework distils the findings of the previous reports, providing a framework to think through human interpretability of machine learning in the context of healthcare and health research

6. Roundtables and interviews summarises the three roundtables and eleven interviews that provided the qualitative underpinning of preceding reports 

Each report interlocks, building on the conclusions of preceding reports.

Meanwhile you can start with the executive summary. Does anybody care about it





23 de novembre 2021

Payment systems during the pandemic

 Balancing financial incentives during COVID-19: A comparison of provider payment adjustments across 20 countries

Key messages:

•Públic payers assumed most of the COVID-19-related financial risk.

•Income loss was not a problem when providers were paid by salary, capitation or budgets.

•Providers paid based on activity were compensated through budgets or higher fees.

•New FFS payments were introduced to incentivize remote services.

•Payments for COVID-19 related costs included new fees, per-diem and DRG tariffs.


 Paolo Gasparini at KBR

22 de novembre 2021

Beyond supply and demand economics

 What Students Learn in Economics 101: Time for a Change

On the need for a new perspective in economics education: 

The question thus arises: how do we want students to use the supply and demand apparatus when there may be excess demand or supply in equilibrium—as in the labor or credit markets when lending and hiring is analyzed using a principal–agent model? A Bowles and Carlin: What Students Learn in Economics 101 related question arises in other markets if the out- of-equilibrium rent- seeking behavior of firms and individuals generates significant excursions away from the intersection of the supply and  demand curves determined by economic fundamentals.

Our response is that in many settings “where the supply and demand curves cross” is not the correct answer. Importantly, this does not amount to an abrogation of the “laws of supply and demand” or a reduction in their force. It requires instead that we break away from the benchmark of the intersection of the two curves, either because that intersection may not exist, or may not be where the market is heading as occurs, for example, during a bubble.

I absolutely agree. 


 Currently at KBR


21 de novembre 2021

The Dahlgren and Whitehead model 30 years after

 The Dahlgren-Whitehead model of health determinants: 30 years on and still chasing rainbows


From the authors review:

Reflection on the past 30 years has helped us identify where to go from here, to develop the model so that it is adapted to the burning issues of the day. First, we need to find ways to better illustrate the vertical links between the social, economic and cultural determinants of health and those of lifestyle. This is needed to reinforce the point that many lifestyles are structurally determined. There is a  common, flawed assumption that the lifestyles of different socio-economic groups are freely chosen, ignoring the reality that lifestyles are shaped in important ways by the social and economic  environments in which people live.

Second, there is a current debate about the importance of the commercial determinants of health and whether they have been neglected by the public health community, including a critique of these not being given sufficient prominence in the Dahlgren and Whitehead model (Maani et al., 202015). By ‘commercial determinants’, Maani and colleagues refer to factors that adversely influence health, which stems from the profit motive; the examples they give concentrate on the strategies of tobacco, alcohol and food and beverage producers to promote their products. While we acknowledge that the impact of commercial interests should always be analysed, we deliberately do not define ‘commercial interests’ as a determinant in its own right to be included in the  rainbow model. In a rebuttal to Maani and colleagues, we explain how we consider profit-driven commercial interests as ‘driving forces’ that are related to almost all determinants of health except genetic factors.

 

20 de novembre 2021

This did not have to be a global pandemic

 spike. THE VIRUS vs THE PEOPLE THE INSIDE STORY

The title of chapter 9 of this book is: "This did not have to be a global pandemic". 

And says,

WHAT IF THE TAPE had run differently? What if those six miners who developed pneumonia after clearing droppings from bat caves in southern China† had been properly investigated? Imagine what could have happened if doctors had traced their infections back to a novel SARS-related corona-virus most commonly seen in bats. What if there had been a global system not only to pick that up, but also to raise an alert that humanity had no immunity against the virus, to immediately share virus samples globally with scientists and to trigger research into putative vaccines and treatments?

None of this is easy: it is a struggle to identify clusters and unmask a completely new pathogen at work. But, equally, none of it is beyond the capability of science.

This is what we desperately need: surveillance in the shadowlands where humans and animals overlap, and specifically when those exchanges are leading to illness. We need to be asking: which viruses in wild and domestic animals are crossing back and forth between humans and animals? How can we spot these perilous cross-species breaches and how should we respond?

The pathogens that keep me awake at night are those against which humanity is defenceless. So, in the next five years, we need to document these gaps in the global human immune landscape. For a decade now, I have been wondering whether seasonal influenza, or winter flu, may not be the viral enemy we think it is, because the world has a degree of protection against many of the strains in the flu family.

A crucial book to understand the origins of the pandemic and what should be done for the next one.

 


18 de novembre 2021

Against body commercialism (2)

 Banking on the Body: The Market in Blood, Milk, and Sperm in Modern America

Kara Swanson traces the history of body banks from the nineteenth-century experiments that discovered therapeutic uses for body products to twenty-first-century websites that facilitate a thriving global exchange.

El llibre "Banking on the Body: The Market in Blood, Milk, and Sperm in Modern America" de Kara W. Swanson explora detalladament la història de la mercantilització dels fluids corporals humans als Estats Units moderns [referència a tot el text]. Swanson argumenta que la dicotomia tradicional entre "regal" i "mercaderia" és imprecisa i limitant per entendre les complexes dinàmiques d'intercanvi que involucren sang, llet materna i esperma. Aquesta dicotomia dificulta apreciar els aspectes superposats de venda i donació presents en molts intercanvis i assumeix una separació completa entre els interessos privats i l'interès públic en la distribució d'aquests productes corporals.

El llibre analitza com la metàfora del "banc" ha influït en la discussió pública sobre aquests productes corporals. Per exemple, la prohibició de la compensació per la donació d'òrgans a la National Organ Transplant Act es basa en la idea que els interessos privats i públics són necessàriament oposats, i que els tractaments mèdics vitals haurien d'anar als més malalts i no als més rics. No obstant això, l'autora il·lustra com organitzacions com moremarrowdonors.org intentaven crear un intercanvi on els incentius privats podien coexistir i fins i tot promoure l'interès públic en l'assignació de productes corporals, augmentant l'accés a teràpies que salven vides per a grups socioeconòmicament desavantatjats.

Swanson dedica una part important del llibre a la història dels bancs de sang. Explora els orígens d'aquesta pràctica, començant amb els intents de Bernard Fantus a l'Hospital del Comtat de Cook de Chicago, que va publicar un article titulat "Cook County's Blood Bank". Fantus va treballar per augmentar l'accés a la sang per a transfusions. El llibre examina la transició de la donació remunerada a la donació voluntària durant la Segona Guerra Mundial, impulsada pel patriotisme. També es discuteix la segregació racial de la sang que van practicar alguns bancs, com el del Johns Hopkins Hospital, que separava la sang per evitar controvèrsia, tot i que no hi havia objeccions biològiques o fisiològiques vàlides. En contrast, el Irwin Memorial Blood Bank de San Francisco no separava la sang per raça. El llibre també aborda la importància de la informació detallada del donant per garantir la seguretat de la sang emmagatzemada.

La història dels bancs de llet materna és un altre focus important del llibre. Swanson examina els esforços inicials per organitzar el subministrament de llet materna, com el Directory for Wet Nurses creat per Talbot a Boston el 1910. Aquest directori era una oficina que posava en contacte mares lactants que buscaven feina amb empleadors, cobrant una petita tarifa. Talbot fins i tot va establir una casa on les dones podien viure amb els seus nadons mentre esperaven ser contractades. Aquestes cases també funcionaven com a llocs de disciplina on es monitorava la dieta, la vestimenta i el comportament de les futures dides, i se les examinava per malalties. El llibre descriu la transició gradual de les dides als bancs de llet materna, influenciada per factors com la professionalització de la medicina i la demanda de llet humana per a nadons prematurs [vegeu notes relacionades amb l'evolució de la llet materna]. Swanson també explora el paper de les organitzacions de dones, com la Junior League, en l'establiment i el suport dels bancs de llet materna. El llibre examina l'evolució de les directrius dels bancs de llet, incloent la importància de la història detallada de cada donant i el debat sobre la llet fresca versus la congelada. Finalment, el llibre considera l'aparició de bancs de llet amb ànim de lucre com Prolacta.

La tercera part del llibre se centra en la història dels bancs d'esperma i la inseminació artificial. Swanson traça l'evolució d'aquesta pràctica des dels seus inicis fins a la creació de bancs d'esperma comercials com Idant i Chartered International Cryobank. Aquests bancs oferien serveis com l'emmagatzematge d'esperma abans de la vasectomia. El llibre també examina la influència de l'eugenèsia en els primers bancs d'esperma, com el Repository for Germinal Choice, que tenia l'objectiu explícit de promoure la reproducció utilitzant esperma d'homes "d'elit". La transició cap a les vendes directes als pacients es discuteix, així com la creixent demanda per part de les dones de tenir més control sobre la selecció del donant. El llibre també aborda les qüestions legals i ètiques relacionades amb la inseminació artificial i la paternitat [vegeu notes sobre aspectes legals].

En conclusió, "Banking on the Body" ofereix una anàlisi exhaustiva de la història del mercat de fluids corporals als Estats Units. L'autora demostra com la dicotomia entre regal i mercaderia és insuficient per comprendre les motivacions i les conseqüències d'aquests intercanvis. El llibre revela la complexa interacció entre interessos privats, interès públic, avenços mèdics i canvis socials que han donat forma a aquest mercat en evolució constant. Swanson destaca com les "banques" de sang, llet i esperma no només han facilitat l'accés a recursos mèdics importants, sinó que també han plantejat qüestions ètiques i socials fonamentals sobre la propietat del cos i la distribució de substàncies vitals [referència a conclusions generals del llibre].





10 de novembre 2021

Nudging and public policy

 Psychology and Behavioral Economics. Applications for Public Policy

This is a textbook on applied behavioral economics for public policy issues. In chapter 5 you'll find the health section and this is the summary:

Where people live, what they eat, how careful they are about taking their medications, and even what they do in their spare time are very much related to the quality of their lives and their health-related outcomes. While our genetic makeup accounts for a signifcant portion of our health outcomes, we know that health is also heavily infuenced by what are known as social determinants: education, wealth, neighborhood safety, housing, and health literacy, among many others. Throughout the day, we face many decisions that have a direct or indirect impact on our health and quality of life. Many of these choices can be infuenced toward healthier options by behavioral interventions.

This chapter presents behavioral insights and interventions that have a high potential to impact the health of community members, reduce disparities, and improve their overall quality of life. These insights and interventions range from increased medical adherence to improved nutritional choices using nudges, regulations, provision of information, or rewards for positive behaviors