By Jennifer Jang, ASTRO Communications
Tuesday morning, Anupam Bapu Jena, MD, PhD, led an interactive session to show how health is shaped by forces outside of our typical scope of thinking. Dr. Jena’s perspective is shaped by multiple illustrious roles, including the Joseph P. Newhouse Professor of Health Care Policy at Harvard Medical School, author of “Random Acts of Medicine” and previous host of the Freakonomics M.D. podcast. Fellow colleague Jason Efstathiou, MD, PhD, FASTRO, introduced Dr. Jena, noting his additional roles as internist at Massachusetts General, Faculty Research Fellow at the National Bureau of Economic Research, and one of a small group of physician economists in the world.
To warm up, Dr. Jena shared findings from several studies. To start, a few years ago, the New England Journal of Medicine shared a study that firearm-related injuries decreased during the annual NRA convention. In Florida, data on policing behavior indicated that when a person pulled over for a ticket shared the officer’s name, the person was less likely to receive a ticket. Dr. Jena extrapolated this finding to medicine. If he finds out a potential patient is from his hometown, he is more likely to spend extra minutes with him, leading to deeper trust and greater engagement.
Each connection or question requires some cleverness or creativity to discover, and the hardest part sometimes is generating the idea. Teamwork and brainstorming are critical, and a priority for Dr. Jena that he practices several times a week. To demonstrate in real time, Dr. Jena brought in the assistance of attendees James Bates, MD, Jean Moran, PhD, Hari Menon, MD, and Chelsea Pinnix, MD, PhD.
Dr. Jena launched into a series of images to depict the role that chance plays in our health. He began with the Boston Marathon, where the volunteers considered the number of muscular injuries or cardiac events that might occur during the event. The group then discussed ambulances on marathon days, facing multiple roadblocks that increase time to reach a hospital. A study released in 2017 using Medicare data from multiple marathons over a decade, indicated that mortality rates were higher on marathon days.
Closer to home, Dr. Jena tapped into the audience’s general sentiments about Joint Commission visits. The audience stirred to convey the negative connotation these events carry, and that nervousness, running through checklists, and a desire for the visit to be over, dominate. Interestingly, patients do better during the days of these events, which could be attributed to the Hawthorn Effect: greater awareness that you are being observed and thus act the way you believe you ought to be acting. What can be learned from this effect and replicated and scalable in a way where benefits outweigh the costs?
Dr. Jena described the health impact influenced by the cutoff age for kindergarten. In Massachusetts, a child must be five years old by September 1 to enter kindergarten. The impact on ADHD diagnoses is that 30% more of August-born children are likely to be diagnosed than September-born children, with a larger effect in boys. And, the probability of ADHD diagnosis is higher on Halloween than any other day.
Equity issues emerged, with Dr. Jena noting the troubling practice that female physicians are more frequently referred to by first name, while male physicians are referred to as “Dr.” Male authors of journal articles are also more likely to use words such as “unique,” “novel,” “ground-breaking,” and “assuring” compared to female authors.
Dr. Jena concluded with other examples of bias, such as left-digit bias, where items cost $4.99 rather than $5. Similarly, in medicine, a creatinine level of 1.9 versus 2.0 is not substantively different to alter treatment but does. Differences in care are evident regarding age, where an 80-year-old patient is 20% less likely than a 79-year-old patient to be offered cardiac bypass surgery, even if they might be mere weeks apart.
Final examples included kids with summer birthdays are 15% less likely to receive the flu shot and thus more likely to get the flu; when a surgeon operates on their birthday, the patient’s risk of mortality is higher. Finally, people drive faster soon after a movie from the “Fast and Furious” franchise is released.
Dr. Jena closed with appreciative remarks to the audience for doing their important work. In turn, we appreciated the refreshing approach he offered to look at existing problems in new ways, that we might be equipped to generate richer solutions.
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