The myth that mental illness causes mass shootings – Tage Rai

MIT Sloan Research Associate and Lecturer, Tage Rai

From Behavioral Science

“A sick, demented man.” That was Donald Trump’s assessment of Stephen Paddock, who shot nearly 600 people, leaving 58 dead, during a concert in Las Vegas on Sunday. Echoing Trump’s rhetoric, House Speaker Paul Ryan said that “one of the things we’ve learned from these shootings is often underneath this is a diagnosis of mental illness.” Most Americans agree that there is a strong link between mental illness and mass shooting, and shifting the national conversation to mental health reform carries the advantage of avoiding the more politically divisive gun-control debate. But what if Stephen Paddock had no diagnosable mental illness? And what if his mental state was the rule, not the exception?

In the aftermath of a mass shooting, we naturally seek to understand the killer’s motives. Our first instinct is to assume that the killer must be mentally deranged somehow. He must be a sadist who takes pleasure in the suffering of innocents, or a psychopath who feels no empathy for his victims, or a schizophrenic haunted by paranoid delusions. How else could someone commit such an awful atrocity? Yet, there is no evidence that Stephen Paddock was any of those things. He had no history of mental illness. He had no criminal record. He was a successful businessman. Relatives and people who know him are in disbelief. Paddock’s father was a notorious bank robber, but the two men never met, and if Paddock inherited violent tendencies from his father genetically, they never manifested until now. Read More »

Why home care costs too much – Paul Osterman

MIT Sloan Prof. Paul Osterman

MIT Sloan Prof. Paul Osterman

From the Wall Street Journal

As baby boomers age into long-term care facilities, Medicaid costs will go through the roof. Americans already spend – counting both public and private money – more than $310 billion a year on long-term support services, excluding medical care, for the elderly and the disabled. Medicaid accounts for about 50% of that, according to a 2015 report from the Kaiser Commission on Medicaid and the Uninsured. Other public programs cover an additional 20%.

Yet in another decade or so these figures may look small. In 2015 around 14 million Americans needed long-term care. That number is expected to hit 22 million by 2030. There’s an urgent need to find ways of providing good long-term care at a lower cost. One fix would be to deregulate important aspects of home care.

There are two million home health aides in the U.S. They spend more time with the elderly and disabled than anyone else, and their skills are essential to their clients’ quality of life. Yet these aides are poorly trained, and their national median wage is only a smidgen more than $10 an hour.

The reason? State regulations – in particular, Nurse Practice Acts – require registered nurses to perform even routine home-care tasks like administering eyedrops. That duty might not require a nursing degree, but defenders of the current system say aides lack the proper training. “What if they put in the cat’s eyedrops instead?’ a healthcare consultant asked me. In another conversation, the CEO of a managed-care insurance company wrote off home-care aides as “minimum wage people.”

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MBA diary: tackling the diabetes epidemic – Stefany Shaheen

Stefany Shaheen, EMBA ’18

From The Economist

My entrepreneurial journey began on a chilly January morning in 2008, not long after my daughter, Elle, was diagnosed with type-1 diabetes. She and I were in the kitchen of our New Hampshire home getting ready for breakfast. Elle, who was eight at the time and the eldest of four children, reached into the cupboard and picked out a box of Cheerios and a bowl. I handed her a measuring cup, calculator and notepad.

The realities of living with type-1 diabetes—a chronic, autoimmune disease that destroys the body’s ability to make insulin—were just starting to sink in. Fixing a bowl of cereal was no longer a simple process; it was maths problem. Together, we needed to figure out the amount of carbohydrates in the cereal and milk and then determine how much insulin Elle would need to inject to turn that food into fuel. We also needed to keep track of the food she was eating along with her physical activity and blood sugar levels to avoid dangerous high and low blood sugars. Having blood sugar that is either too high or too low can cause serious complications and could lead to death.

Elle and I got to work but she soon became frustrated. She threw the cereal box across the room; Cheerios flew everywhere. “Why does this have to be so hard?” she asked me through muffled tears.

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As You Were Saying … MGH needs checkup for possible ER bottlenecks — Steven J. Spear

MIT Sloan Senior Lecturer Steven Spear

MIT Sloan Senior Lecturer Steven Spear

From The Boston Herald

Five years after a $500 million expansion, Massachusetts General Hospital’s emergency department is again overburdened, in the words of hospital President Peter Slavin with “delays, dissatisfaction, and sometimes even concerns about quality and safety.”

Before the public, payers, policymakers and donors get on the hook — again — for more staff and more extraordinarily expensive capital expenditures, let’s ask these questions first.

• What’s the mix and volume of patients presenting at the emergency department?

• What portion of discharges occur on time, and of the rest, how long are they delayed?

• From when a patient first presents in the ED, what’s the lag until that patient is examined and treatment begins, the time from “door to doc?”

As to the first question, there are certainly patients with conditions that truly are life- or limb-threatening and arise unexpectedly. Think stroke, heart attack, or aneurysm.

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Reimagining Chile’s healthcare system: Harnessing the power of strategic analytics and Big Data to keep patients healthier for less money – Rafael Epstein, Marcelo Larraguibel, Lee Ullman

Lee Ullmann, Director of the MIT Sloan Latin America Office

Lee Ullmann, Director of the MIT Sloan Latin America Office

From El Mercurio

Economic growth, urbanization, and rising affluence are having a profound impact on the health of Latin Americans. Very little of it is positive, especially in Chile.

While life expectancy has increased faster in Chile than in most OECD countries and income per person has quadrupled over the last quarter-century, great disparities continue to exist between the country’s public and private healthcare systems. Healthcare costs are skyrocketing and many of the country’s public hospitals—especially those in rural areas—face a shortage of general practitioners and family physicians.

The modern Chilean diet—comprised largely of ultra-processed foods and sugary drinks—is taking a toll. One third of Chilean children are overweight or obese; one quarter of Chilean adults are in those categories. Chronic diseases, like diabetes, are increasingly prevalent. Stress-related disorders and mental illnesses are also on the rise, as are rates of alcoholism, tobacco use, and certain types of cancer. Over the last decade suicide has been one of the top 10 causes of death in Chilean men.

Today’s statistics are bleak, but we have hope for the tomorrow. Technological innovations and discoveries, powered by Big Data, hold enormous opportunities for Chile and Latin America overall. To explore this further, we are hosting a conference next month in Santiago—“Strategic Analytics: Changing the Future of Healthcare”—that aims to highlight the many ways in which data and analytics promise to transform the provision of healthcare. The conference is expected to draw hundreds of researchers and leaders from academia, health care, government, and industry.

Our agenda is ambitious. By combining MIT’s expertise in analyzing massive amounts of data and optimizing complex systems with Universidad de Chile’s path-breaking medical research and Virtus Partners’ strategic and operational insights, we aim to unravel the complicated underlying problems that plague the healthcare system.

Of course many countries—including the US—face healthcare challenges. Our hope is that this conference inspires engineers, medical professionals, economists, and technologists from all over the world to see the benefits of working together to improve human health. Our goal is simple: to keep patients healthier for less money.

Progress is afoot. At MIT, researchers have devised algorithms that boost treatment for certain diseases, including diabetes, using a combination of machine learning and electronic medical records. At a time when 1.7 million Chileans, or about 12.3% of the population, have diabetes, this research has important implications.

The dawn of telemedicine—which enables doctors to monitor patients from afar—also holds promise, particularly for patients who live in remote areas. (Chile is a long and skinny country, and about 10% of the population lives in rural areas.) Researchers at the Universidad de Chile’s Medical Informatics and Telemedicine Center are using sensors and other devices to monitor patients’ blood pressure, heart rate, weight, and blood sugar levels from great distances. Technologists at the MIT Media Lab are finding new ways to apply emotion technology and wearable devices to help sufferers with autism, anxiety, and epilepsy manage their symptoms.

Researchers are also finding new ways to contain medical costs. Using Big Data to measure returns of healthcare spending, economists are able to help hospitals uncover best practices and align incentives to improve the quality of the care they provide. This has special relevance to Chile. The country’s Fondo Nacional de Salud (FONASA) struggles with overwhelming management challenges and increasing costs. Meanwhile, access to high-quality technology and healthcare services is still limited to the wealthy.

The promise of Big Data is immense, but so, too, are its perils. Many questions remain: How do we ensure that patient data stays both confidential and secure? How do we safeguard against Big Data applications creating even more disparities between the rich and poor, and instead use it to build a more equitable healthcare system for all? And how should governments cope with managing the high costs of aging populations?

These are big challenges and nothing will be solved overnight. Our hope is that the conference will point to new ideas and solutions that improve patient health for generations to come.

Read the original blog post at El Mercurio.

Lee Ullmann is the Director of the MIT Sloan Latin America Office.

Rafael Epstein is the Provost of Universidad de Chile.

Marcelo Larraguibel is the Founder of Virtus Partners, the management consultancy, and an Advisory Council Member of the MIT Sloan Latin America Office (MSLAO).