Fiscal FactCheck: payroll tax = income tax!

Fiscal FactCheck.

Astonishing fact is buried here: Payroll taxes (social security, medicare etc) have almost caught up with federal income tax. Payroll taxes are 40% of federal receipts in 2010, while personal income tax was 41.5%.

Payroll taxes tend to be quite regressive — they start at about 10% of ALL payroll income for your first dollar, and fall to about 2.3% above $100,000 or so. So this means we have a bizarre combination of progressive and regressive tax rates. And it’s more evidence of how high health care costs are dragging everything down (in this case, via Medicare costs).

By the way, many “conservatives” have suggested a “flat income tax”  e.g. 17%. As far as I can tell, this does NOT include payroll taxes. So it would not be flat at all – it would be highly regressive. Another factor is that richer people earn more from capital gains and other sources not counted as income. I’d love to see someone lay out the numbers carefully on this. Some information is in this report by Congressional Research Services. 

JAMA — Ensuring Integrity in Industry-Sponsored Research: Primum Non Nocere, Revisited, March 24/31, 2010, DeAngelis and Fontanarosa 303 12: 1196

The evidence on false conclusions from drug trials, and their publications, is mounting. I am forced to the conclusion that, most likely,

1) This has been going on for a long time; the big change is that it’s occasionally getting noticed now, and

2) The results of this over many years must be that  doctors are prescribing based on incorrect evidence. Specifically, lots of drugs are getting prescribed when they shouldn’t be.

According to the article by Nissen,1 the report of the Senate investigation,2 and published media accounts,8-9 the manufacturer of rosiglitazone exerted inappropriate influence during the conduct of a pivotal safety study of this drug, the RECORD Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycaemia in Diabetes clinical trial,10-11 which included undertaking nonprespecified unblinding of study data; attempting to undermine the authority and responsibilities of the study steering committee; expediting publication of an unscheduled interim analysis,10 specifically to counter2 the publication of a meta-analysis by Nissen and Wolski12 that suggested increased cardiovascular risk associated with rosiglitazone; having employees extensively involved in statistical analysis,11 and preparation of the manuscript10 reporting the results of the trial; and reportedly2 failing to fully acknowledge the significant cardiovascular risk associated with this drug.

via JAMA — Ensuring Integrity in Industry-Sponsored Research: Primum Non Nocere, Revisited, March 24/31, 2010, DeAngelis and Fontanarosa 303 12: 1196.

Your Brain on Computers – NYTimes.com

Article yesterday on the brain-altering effects of constant computer use. It’s a complex topic and I think a lot more research is needed, but there is certainly something going on. The reporter, Matt Richtel, won a Pulitzer last year for his series on distracted driving while using cellphones. (I’m quoted in the article, but not by name.)

Scientists say juggling e-mail, phone calls and other incoming information can change how people think and behave. They say our ability to focus is being undermined by bursts of information.These play to a primitive impulse to respond to immediate opportunities and threats. The stimulation provokes excitement — a dopamine squirt — that researchers say can be addictive.

Continue reading

How American Health Care Killed My Father – Magazine – The Atlantic

The problems with the US Health care system are at their root not so complicated. This author seems to have done a pretty good assessment, with a year of research. The “system” is very good at delivering elaborate procedures and medications; there are few incentives for anything else. And it turns out that elaborate procedures are a gamble.  The old joke was “The surgery was a success, but the patient died!” But it’s no longer a joke.

Like every grieving family member, I looked for someone to blame for my father’s death. But my dad’s doctors weren’t incompetent—on the contrary, his hospital physicians were smart, thoughtful, and hard-working. Continue reading

Latest development in the battle over vaccinations

The Lancet retracts paper linking MMR vaccines and autism By Matt Ford | Last updated February 3, 2010 9:27 AM

This week, after receiving the conclusions of a multiyear ethics investigation of UK doctor Andrew Wakefield performed by the General Medical Counsel GMC, the editors of British medical journal The Lancet formally retracted a study which purported to find a link between the childhood MMR vaccine, gastrointestinal disease, and autism. It was published in 1998 and has been a source of controversy ever since.

via The Lancet retracts paper linking MMR vaccines and autism.

This article is tale of greed and incompetence.  But the harm it did lives on. Here’s a site that claims to present “all sides,” but clearly thinks Wakefield is a hero. There are many like it – conspiracy theories flourish better than scientific analysis on the web. (More fun  and much easier to write, after all.)  For a good article on these hysterias, see an article by Amy Wallace in Wired.  As best I can tell, some  parents cannot handle the concepts of bad luck or Acts of God. If their child gets sick, someone is responsible! And it’s part of a widespread plot!

A second problem, much more widespread than the vaccine phobias, is that people have trouble dealing with small probabilities. (This observation goes back at least to research by Kahneman and Tversky on how humans have systematic cognitive biases.) So you can find nonsensical statements like “If screening for disease X [breast cancer screening under age 50 is the current example] saves even a single life, than not doing it is manslaughter.” What’s the problem? Screening itself causes difficulties, such as unnecessary biopsies. Not to mention that more lives might be saved by spending the same amount of money on something else. So deciding whether/when to get screened is a balancing act; it’s not all one way or the other.

One interesting bit of sociology (which to me is further proof that these health-scare controversies almost never have factual basis): most countries have phobias about vaccines and medicines, but the specific phobia varies by country. For example, the smallpox-eradication effort fell apart at the last moment when smallpox vaccine was rumored to cause infertility. (I’m looking for more specifics on the nation-specific fears of vaccines – I’ve forgotten where I came across it.)

Yet,  there are a LOT of problems with modern medicine, and with drugs in particular. But in an environment where any half-baked theory gets taken seriously, it’s very hard to separate the fear-mongering from the real problems.

The Lancet retracts paper linking MMR vaccines and autism

The Lancet retracts paper linking MMR vaccines and autism By Matt Ford | Last updated February 3, 2010 9:27 AM

This week, after receiving the conclusions of a multiyear ethics investigation of UK doctor Andrew Wakefield performed by the General Medical Counsel GMC, the editors of British medical journal The Lancet formally retracted a study which purported to find a link between the childhood MMR vaccine, gastrointestinal disease, and autism. It was published in 1998 and has been a source of controversy ever since.

via The Lancet retracts paper linking MMR vaccines and autism.

This article is tale of greed and incompetence.  But the harm it did lives on. Here’s a site that claims to present “all sides,” but clearly thinks Wakefield is a hero. There are many like it – conspiracy theories flourish better than scientific analysis on the web. (More fun  and much easier to write, after all.)  For a good article on these hysterias, see an article by Amy Wallace in Wired.  As best I can tell, some  parents cannot handle the concepts of bad luck or Acts of God. If their child gets sick, someone is responsible! And it’s part of a widespread plot!

A second problem, much more widespread than the vaccine phobias, is that people have trouble dealing with small probabilities. (This observation goes back at least to research by Kahneman and Tversky on how humans have systematic cognitive biases.) So you can find nonsensical statements like “If screening for disease X [breast cancer screening under age 50 is the current example] saves even a single life, than not doing it is manslaughter.” What’s the problem? Screening itself causes difficulties, such as unnecessary biopsies. Not to mention that more lives might be saved by spending the same amount of money on something else. So deciding whether/when to get screened is a balancing act; it’s not all one way or the other.

One interesting bit of sociology (which to me is further proof that these health-scare controversies almost never have factual basis): most countries have phobias about vaccines and medicines, but the specific phobia varies by country. For example, the smallpox-eradication effort fell apart at the last moment when smallpox vaccine was rumored to cause infertility. (I’m looking for more specifics on the nation-specific fears of vaccines – I’ve forgotten where I came across it.)

Yet,  there are a LOT of problems with modern medicine, and with drugs in particular. But in an environment where any half-baked theory gets taken seriously, it’s very hard to separate the fear-mongering from the real problems.

Small is Beautiful for global health tech? A good theme for project proposals

(This presentation discusses the “car-parts neonatal incubator” in more detail, which  the NY Times profiled recently.  This is an example of appropriate technology. It would make a good takeoff point for projects in several of my courses.)

Many multinational companies manufacturing medical devices for developing countries focus their efforts on high-end products too expensive to be used in most healthcare settings. Unable to afford their own equipment, healthcare providers in areas with few resources often receive donated equipment from international organizations. Unfortunately, while this donated equipment is usually state-of-the-art, it often ends up falling into disrepair and eventually disuse. Donors with the best of intentions fall into the trap of donating equipment that the recipient cannot afford to maintain. Just as most of us would like to own a Ferrari but would be unable to pay for its upkeep, most clinics in resource-poor areas cannot afford to maintain expensive devices, such as incubators, designed for use in developed countries.

via CIMIT Forum: Medical Devices in Global Health: Idea to Implementation, Successes and Challenges.