"Numbers have an important story to tell. They rely on you to give them a voice"--Stephen Few
Better healthcare decisions, supported by data.
data & donuts uses a blend of proprietary and non-proprietary data to integrate disease state knowledge, social correlates of health, economics, and policy to the complexity of decisions at the point of care. Focused insights inform better decisions and informed context in a dynamic and evolving healthcare marketplace.
What are your goals?
Be ready with the right data...
Data delivered as Excel exports, interactive data visualizations, or a wide variety of additional formats
I am a writer and a data analyst — not by choice but by necessity. The digital exhaust of big data, machine learning algorithms, and our quantified lives is choking all of us. If you lack the skill to curate or evaluate the evidence — it is at your own peril.
Economic theories in healthcare and in the world in general are expansive and quite complex.
But there are a few truths needed for the right level of context. Conversations of free market economics for example, are fundamental to emerging value frameworks being debated within healthcare but existing in the context of capitalistic forces.
Listening to political posturing about the role of government and unknown 3rd party political ideologies I often blink in disbelief. So you hate government and want to minimize the oversight and intervention? Okay then, go smash your iphone.
Go ahead. I’ll wait. All the innovation you see shattered all over your desk?
None of it would exist without wholly subsidized government grants. These are tax payer investments — with Apple receiving the spoils.
How do you tease out the role of government when the social economics of the vulnerable are less important than the interests of the wealthy and powerful? The resulting “small government” mentality is rebranded as fiscal responsibility and shifts the tax burden to the middle class. I share these thoughts because it is important to be clear about the benefactors of a policy or yes, even an effort to create alternative payment models within fee-for-value frameworks.
I’ve been privileged to see developing in government-subsidized laboratories for decades. MIT, where I’ve been since the 1950s, is one of the institutions where the government, the funnel in the early days was the Pentagon, was pouring in money to create the basis for the high-tech economy of the future and the profitmaking of the institutions that are regarded as private enterprises. It was decades of work under public funding with a very anticapitalist ideology. So according to capitalist principles, if someone invests in a risky enterprise over a long period and thirty years later it makes some profit, they’re supposed to get part of the profit, but it doesn’t work like that here. It was the taxpayer who invested for decades. The profit goes to Apple and Microsoft, not to the taxpayer. — Noam Chomsky
I listen to healthcare stakeholders discuss incentives where the provider or payer has the opportunity to gain bonuses for value-based care. Again, the end-user is left out of the cost savings.
Where is the patient in discussions of value and incentives?
The power of economic theory is derived from a belief in universal truths proven by mathematical models. This is only partially true. In order to apply mathematical theory we have to make a few non-trivial assumptions.
The rise of behavioral economics highlights the demise of what was historically described as the ultimate rationality of humans, organizations, and markets.
We also primarily neglect the role of time and space in economic theory. If we don’t close off these aspects of the model there would be a system of equations that would extend to infinity thus being unsolvable.
Why are we talking about the dismal science? I wanted to close the loop by observing the similar assumptions we make in clinical trials.
Attempts are made to homogenize a treatment population to isolate any detected signals as dependent solely on the intervention or therapy. The inclusion and exclusion criteria for a clinical trial population yield a highly selected population not specifically relevant in the real world where the majority of patients seek care.
Post-market analyses continue to measure adverse events accumulating in patients prescribed therapies exposed to boundless timelines only evaluated in the short-term.
The evolving real world evidence is how we evaluate the efficacy and safety of drugs once they are FDA approved.
We need to heed good economic theory — don’t assume the model is relevant and applicable under all conditions.
Uninformed consumerism will make irrational choices against their own best interests.
Before You Get Your Ducks in a Row, You Need to Figure Out What to Do with the Duck
Fallacy Fallacy in Medical Literature (around 22 minute mark)
What inspires me lately? You!
"I just want to acknowledge how much I appreciate what you share here. And I find your comments insightful as well.Thank you for infusing some intelligence and sanity into the conversation."
"Your insight/intellect has been a breathe of fresh air for me. Keep up the great work."
"Just read your latest email. Could you please become Secretary of Health and Human Services?"