As is often the case when flying I was rewarded for offering a greeting to my row mate on the plane with a bit of insight and knowledge I’d have missed had I not simply reached out a hand and said, “Hi, I’m Darrell.” My momentary companion (we each moved to more spacious seats) had been a schoolmate of the recently deceased Kate Spade. He confirmed her years-long struggle with ...

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My wife Beth and I had a rather spirited discussion about how we in the U.S. might be able to pay for the health care of our citizens. Being ever practical, and also owning the job of writing the checks that pay for the health insurance our company offers its associates (including us), Beth in effect is arguing for a national consensus on something we might describe as a baseline ...

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"I’m sorry, Doctor, but we can’t have you give that talk; you have a conflict of interest since you’ve been paid to do research on that medicine." "Well, Senator, it’s a conflict of interest for a doctor to sell those crutches in his office." "It is the opinion of this newspaper that physicians should declare to each patient any ownership interest they might have in a surgery center so that the ...

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It’s become one of those trendy phrases, "unnecessary care." When you hear it on television or talkshow radio it’s usually said with a sneer. Indeed, the speakers almost spit the phrase out -- "unnecessary care" -- like it tastes bad.  It’s almost always accompanied by "fraud and abuse," or a not so subtle accusation that some doctor is profiting off this unnecessary care at the expense of some poor ...

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Someone has gone and rained the facts down on what is generally considered a feel–good story in American medicine, the dramatic increase in female doctors in America. In response to Dr. Herbert Parde’s "The Coming Doctor Shortage" article in the Wall Street Journal, Dr. Curtis Markel pointed out that there is a difference between the raw, gross number of physicians in America, and the effective number of practicing physicians.  Not only ...

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I don’t feel so hot. No, that’s not quite right. I feel really lousy. That’s more accurate. I’m really not much of a complainer. I go to work unless I simply can’t rise from bed and crawl to the shower. The entire staff, my family, and every patient who walks into my office, all feed off my mood. No matter how I feel, how up or down I might be, on the ...

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I’m a big game theory guy. I think you can explain the actions of the participants in any structured activity or enterprise by looking at the rules of the game. When you look backwards in time you discover that the "players" almost always made choices that represented rational self-interest. This is especially true in games played using zero sum rules: someone wins only if someone else loses. How the game is ...

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