Category: Regulations

Our Brains Learn in a Process of Continuous Bayesian Updating

(p. A13) First articulated in the 18th century by a hobbyist-mathematician seeking to reason backward from effects to cause, Bayes’ theorem spent the better part of two centuries struggling for recognition and respect. Yet today, argues Tom Chivers in “Everything Is Predictable,” it can be seen as “perhaps the most important single equation in history.” It drives the logic of spam filters, artificial intelligence and possibly our own brains. . . .

At its core, the theorem provides a quantitative method for getting incrementally wiser by continuously updating what you think you know—your prior beliefs, which initially might be subjective—with new information. Your refined belief becomes the new prior, and the process repeats.

. . .

At times Mr. Chivers, a London-based science journalist who now writes for Semafor, seems overwhelmed by an admittedly complex subject, and his presentation lacks the clarity of Sharon Bertsch McGrayne’s “The Theory That Would Not Die” (2011). Yet he is onto something, since Bayes’ moment has clearly arrived. He notes that Bayesian reasoning is popular among “people who come from the new schools of data science—machine learning, Silicon Valley tech folks.” The mathematician Aubrey Clayton tells him that, in the cutting-edge realms of software engineering, “Bayesian methods are what you’d use.”

. . .

It’s notoriously difficult for most people to grasp problems in a structured Bayesian fashion. Suppose there is a test for a rare disease that is 99% accurate. You’d think that, if you tested positive, you’d probably have the disease. But when you figure in the prior—the fact that, for the average person (without specific risk factors), the chance of having a rare disease is incredibly low—then even a positive test means you’re still unlikely to have it. When quizzed by researchers, doctors consistently fail to consider prevalence—the relevant prior—in their interpretation of test results. Even so, Mr. Chivers insists, “our instinctive decision-making, from a Bayesian perspective, isn’t that bad.” And indeed, in practice, doctors quickly learn to favor common diagnoses over exotic possibilities.

. . .

Our brains work by making models of the world, Mr. Chivers reminds us, assessing how our expectations match what we earn from our senses, and then updating our perceptions accordingly. Deep down, it seems, we are all Bayesians.

For the full review, see:

David A. Shaywitz. “Thinking Prior to Thought.” The Wall Street Journal (Thursday, May 15, 2024): A15.

(Note: the online version of the review has the date May 14, 2024, and has the title “‘Everything Is Predictable’ Review: The Secret of Bayes.” In the last quoted sentence I have replaced the word “earn” that appears in both the online and print versions, with the word “learn.”)

The book under review is:

Chivers, Tom. Everything Is Predictable: How Bayesian Statistics Explain Our World. New York: Atria/One Signal Publishers, 2024.

Patient-Reported Health Information Deserves Respect

Patients may have more accurate knowledge of their health than the information found in doctors’ blood tests, as reported in the study summarized below. The credibility of patient self-knowledge provides an added reason, besides respect for freedom, why government should not mandate an individual’s food and drug decisions.

(p. D4) . . . a . . . study . . . suggests that how patients say they feel may be a better predictor of health than objective measures like a blood test. The study, published in Psychoneuroendocrinology, used data from 1,500 people who took part in the Texas City Stress and Health Study, which tracked the stress and health levels of people living near Houston.

. . .

The study found that when people said they felt poorly, they had high virus and inflammation levels. People who reported feeling well had low virus and inflammation levels.

“I think the take-home message is that self-reported health matters,” said Christopher P. Fagundes, an assistant psychology professor at Rice University and a co-author of the study. “Physicians should pay close to attention to their patients. There are likely biological mechanisms underlying why they feel their health is poor.”

For the full story see:

Tara Parker-Pope. “Doctors, Listen to Patients.” The New York Times (Tuesday, July 19, 2016 [sic]): D4.

(Note: ellipses added.)

(Note: the online version of the story has the date July 15, 2016 [sic], and has the title “Doctors Should Listen to Patient Instincts.”)

The academic paper co-authored by Fagundes and mentioned above is:

Murdock, Kyle W., Christopher P. Fagundes, M. Kristen Peek, Vansh Vohra, and Raymond P. Stowe. “The Effect of Self-Reported Health on Latent Herpesvirus Reactivation and Inflammation in an Ethnically Diverse Sample.” Psychoneuroendocrinology 72 (Oct. 2016): 113-18.

Ending the “License Raj” in India Allowed Economic Growth and the Creation of Earned Entrepreneurial Wealth

(p. A8) The younger son of Mukesh Ambani, India’s richest man, is set to wed his fiancée in Mumbai on Friday, the finale of a monthslong extravaganza that signaled the arrival of the unapologetic Indian billionaire on the global stage — and introduced the world to the country’s Gilded Age.

. . .

Kavil Ramachandran, a professor of entrepreneurship at the Indian School of Business, said there were more billionaires with fatter wallets because India has sustained a high growth rate for more than two decades. That’s created a deep domestic market for goods and services, and pushed Indian companies to pursue new businesses, pairing opportunity with ambition.

“It’s a consequence of rapid growth and entrepreneurialism,” Mr. Ramachandran said.

. . .

India has come a long way from its socialist origins. Until 1990, the country operated under strict government supervision and protectionist policies. Companies could only run after procuring multiple permits and licenses from the government, leading to the name “License Raj” — a play on the term British Raj, which referred to colonial rule.

Once India opened up its economy after a series of reforms, some domestic companies embraced the logic of free markets while remaining family-run and tightly controlled, diversifying into new businesses.

. . .

Many Indians see in Mr. Ambani’s staggering rise in stature and wealth a version of the India they want: a country that doesn’t make a play for attention but demands it. Some even feel pride that his son’s wedding has attracted such global attention. To them, India’s poverty is a predictable fact, such opulence is not.

“Based on the level of the Ambanis’ wealth, the wedding is perfect,” said Mani Mohan Parmar, a 64-year-old resident from Mumbai.

“Even the common man here in India spends more than his capacity on a wedding,” Ms. Parmar said. “So it’s nothing too much if we talk about Ambani. He has so much money due to God’s grace, so why shouldn’t he spend it by his choice?”

For the full story see:

Anupreeta Das. “India’s New Gilded Age on Display at a Wedding.” The New York Times (Monday, June 15, 2024): A8.

(Note: ellipses added.)

(Note: the online version of the story has the date July 12, 2023, and has the title “A Wedding Puts India’s Gilded Age on Lavish Display.”)

Following Salt Consumption Guidelines Increases Risk of Death

Official experts often turn out to be wrong, as in the salt consumption guidelines discussed below. The fallibility of expert knowledge provides an added reason, besides respect for freedom, why government should not mandate an individual’s food and drug decisions.

(p. D4) People with high blood pressure are often told to eat a low-sodium diet. But a diet that’s too low in sodium may actually increase the risk for cardiovascular disease, a review of studies has found.

Current guidelines recommend a daily maximum of 2.3 grams of sodium a day — the amount found in a teaspoon of salt — for most people, and less for the elderly or people with hypertension.

Researchers reviewed four observational studies that included 133,118 people who were followed for an average of four years. The scientists took blood pressure readings, and estimated sodium consumption by urinalysis. The review is in The Lancet.

Among 69,559 people without hypertension, consuming more than seven grams of sodium daily did not increase the risk for disease or death, but those who ate less than three grams had a 26 percent increased risk for death or for cardiovascular events like heart disease and stroke, compared with those who consumed four to five grams a day.

In people with high blood pressure, consuming more than seven grams a day increased the risk by 23 percent, but consuming less than three grams increased the risk by 34 percent, compared with those who ate four to five grams a day.

For the full story see:

Nicholas Bakalar. “Low-Salt Diet as a Heart Risk.” The New York Times (Tuesday, Oct. 11, 2016 [sic]): D4.

(Note: ellipses added.)

(Note: the online version of the story has the date May 25, 2016 [sic], and has the title “A Low-Salt Diet May Be Bad for the Heart.”)

The academic paper reporting the results summarized above is:

Mente, Andrew, Martin O’Donnell, Sumathy Rangarajan, Gilles Dagenais, Scott Lear, Matthew McQueen, Rafael Diaz, Alvaro Avezum, Patricio Lopez-Jaramillo, Fernando Lanas, Wei Li, Yin Lu, Sun Yi, Lei Rensheng, Romaina Iqbal, Prem Mony, Rita Yusuf, Khalid Yusoff, Andrzej Szuba, Aytekin Oguz, Annika Rosengren, Ahmad Bahonar, Afzalhussein Yusufali, Aletta Elisabeth Schutte, Jephat Chifamba, Johannes F. E. Mann, Sonia S. Anand, Koon Teo, and S. Yusuf. “Associations of Urinary Sodium Excretion with Cardiovascular Events in Individuals with and without Hypertension: A Pooled Analysis of Data from Four Studies.” The Lancet 388, no. 10043 (2016): 465-75.

Copper Hospital Fixtures Would Reduce Bacterial Infections

If healthcare was unregulated, nimble entrepreneurs could make quick use of the findings summarized below. In our sclerotic hyper-regulated healthcare system, healthcare workers have neither the incentives nor the decision rights to make use of them.

(p. D6) Researchers equipped nine rooms in a small rural hospital with copper faucet handles, toilet flush levers, door handles, light switches and other commonly touched equipment. They left nine other rooms with traditional plastic, porcelain and metal surfaces.

. . .

. . . on average, fixtures in copper-equipped rooms had concentrations of bacteria about 98 percent lower than in rooms furnished with traditional equipment, whether the rooms were occupied or not. On half of the copper components, the researchers were unable to grow any bacteria at all.

“Copper in hospital rooms is not yet common,” said the lead author, Shannon M. Hinsa-Leasure, an associate professor of biology at Grinnell College in Iowa.

For the full story see:

Nicholas Bakalar. “Copper May Stem Infections.” The New York Times (Tuesday, Oct. 11, 2016 [sic]): D6.

(Note: ellipses added.)

(Note: the online version of the story has the date Oct. 4, 2016 [sic], and has the title “Copper Sinks and Faucets May Stem Hospital Infections.”)

The academic paper reporting the results summarized above is:

Hinsa-Leasure, Shannon M., Queenster Nartey, Justin Vaverka, and Michael G. Schmidt. “Copper Alloy Surfaces Sustain Terminal Cleaning Levels in a Rural Hospital.” American Journal of Infection Control 44, no. 11 (Nov. 2016): e195-e203.

Perfusion Eases the Scarcity of Organs for Transplantation

(p. A1) Surgeons are experimenting with organs from genetically modified animals, hinting at a future when they could be a source for transplants. But the field is already undergoing a paradigm shift, driven by technologies in widespread use that allow clinicians to temporarily store organs outside the body.

Perfusion, as its called, is changing every aspect of the organ transplant process, from the way surgeons operate, to the types of patients who can donate organs, to the outcomes for recipients.

. . .

(p. A12) Scientists have long experimented with techniques for keeping organs in more dynamic conditions, at a warmer temperature and perfused with blood or another oxygenated solution. After years of development, the first device for preserving lungs via perfusion won approval from the Food and Drug Administration in 2019. Devices for perfusing hearts and livers were approved in late 2021.

. . .

Now surgical teams can recover an organ, perfuse it overnight while they sleep and complete the transplant in the morning without fear that the delay will have damaged the organ.

Perhaps most important, perfusion has further opened the door to organ donation by comatose patients whose families have withdrawn life support, allowing their hearts to eventually stop. Each year, tens of thousands of people die this way, after the cessation of circulation, but they were rarely donor candidates because the dying process deprived their organs of oxygen.

. . .

By tapping this new cadre of donors, transplant centers said they could find organs more quickly for the excess of patients in urgent need. Dr. Shimul Shah said the organ transplant program he directs at the University of Cincinnati had essentially wiped out its waiting list for livers. “I never thought, in my career, I would ever say that,” he said.

. . .

Dr. Shaf Keshavjee, a surgeon at the University of Toronto whose lab was at the forefront of developing technologies to preserve lungs outside the body, said the devices could eventually allow doctors to remove, repair and return lungs to sick patients rather than replace them. “I think we can make organs that will outlive the recipient you put them in,” he said.

Dr. Ashish Shah, the chairman of cardiac surgery at Vanderbilt University, one of the busiest heart transplant programs in the country, agreed, calling that “the holy grail.”

“Your heart sucks,” he said. “I take it out. I put it on my apparatus. While you don’t have a heart, I can support you with an artificial heart for a little while. I then take your heart and fix it — cells, mitochondria, gene therapy, whatever — and then I sew it back in. Your own heart. That’s what we’re really working for.”

For the full story see:

Ted Alcorn. “Keeping Organs For Transplants Alive for Longer.” The New York Times (Wednesday, April 3, 2024): A1 & A12.

(Note: ellipses added.)

(Note: the online version of the story has the date April 2, 2024, and has the title “The Organ Is Still Working. But It’s Not in a Body Anymore.”)

The Absence of a Randomized Double-Blind Clinical Trial Is Used as an Excuse to Ignore an Emergency Procedure That Saves Lives

In an urgent emergency the son and wife of a man with a stopped heart, improvised the use of a toilet plunger to get his heart to start pumping again. In his wonderful account of the sources of insight, Gary Klein told a different example of urgent emergency improvisation: “Wag” Dodge saved himself from a massive wildfire racing toward him by lighting a match to the grass at his feet to pre-burn a patch he could lie down in. When the wildfire reached him, it passed on both sides, avoiding the patch that now had no fuel. Neither the son-and-mother, nor Wag Dodge, got their insight from collaboration or a randomized double-blind controlled trial.

(p. D5) In 1988, a 65-year-old man’s heart stopped at home. His wife and son didn’t know CPR, so in desperation they grabbed a toilet plunger to get his heart going until an ambulance showed up.

Later, after the man recovered at San Francisco General Hospital, his son gave the doctors there some advice: Put toilet plungers next to all of the beds in the coronary unit.

The hospital didn’t do that, but the idea got the doctors thinking about better ways to do CPR, or cardiopulmonary resuscitation, the conventional method for chest compressions after cardiac arrest. More than three decades later, at a meeting of emergency medical services directors this week in Hollywood, Fla., researchers presented data showing that using a plunger-like setup leads to remarkably better outcomes for reviving patients.

. . .

The new procedure, known as neuroprotective CPR, has three components. First, a silicone plunger forces the chest up and down, not only pushing blood out to the body, but drawing it back in to refill the heart. A plastic valve fits over a face mask or breathing tube to control pressure in the lungs.

The third piece is a body-positioning device sold by AdvancedCPR Solutions, a firm in Edina, Minn., that was founded by Dr. Lurie. A hinged support slowly elevates a supine patient into a partial sitting position. This allows oxygen-starved blood in the brain to drain more effectively and to be replenished more quickly with oxygenated blood.

. . .

. . ., a study carried out in four states found . . . [p]atients who received neuroprotective CPR within 11 minutes of a 911 call were about three times as likely to survive with good brain function as those who received conventional CPR.

. . .

Dr. Karen Hirsch, a neurologist at Stanford University and a member of the CPR standards committee for the American Heart Association, said that the new approach was interesting and made physiological sense, but that the committee needed to see more research on patients before it could formally recommend it as a treatment option.

“We’re limited to the available data,” she said, adding that the committee would like to see a clinical trial in which people undergoing cardiac arrests are randomly assigned to conventional CPR or neuroprotective CPR. No such trials are happening in the United States.

Dr. Joe Holley, the medical director for the emergency medical service that serves Memphis and several surrounding communities, isn’t waiting for a larger trial. Two of his teams, he said, were getting neurologically intact survival rates of about 7 percent with conventional CPR. With neuroprotective CPR, the rates rose to around 23 percent.

His crews are coming back from emergency calls much happier these days, too, and patients are even showing up at fire stations to thank them for their help.

“That was a rare occurrence,” Dr. Holley said. “Now it’s almost a regular thing.”

For the full story see:

Joanne Silberner. “How a Plunger Improved CPR.” The New York Times (Tuesday, June 27, 2023 [sic]): D5.

(Note: ellipses added.)

(Note: the online version of the story has the date June 15, 2023 [sic], and has the title “How a Toilet Plunger Improved CPR.”)

The Gary Klein book that I praised above is:

Klein, Gary. Seeing What Others Don’t: The Remarkable Ways We Gain Insights. Philadelphia, PA: PublicAffairs, 2013.

The “study carried out in four states,” and mentioned above, is:

Moore, Johanna C., Paul E. Pepe, Kenneth A. Scheppke, Charles Lick, Sue Duval, Joseph Holley, Bayert Salverda, Michael Jacobs, Paul Nystrom, Ryan Quinn, Paul J. Adams, Mack Hutchison, Charles Mason, Eduardo Martinez, Steven Mason, Armando Clift, Peter M. Antevy, Charles Coyle, Eric Grizzard, Sebastian Garay, Remle P. Crowe, Keith G. Lurie, Guillaume P. Debaty, and José Labarère. “Head and Thorax Elevation During Cardiopulmonary Resuscitation Using Circulatory Adjuncts Is Associated with Improved Survival.” Resuscitation 179 (2022): 9-17.

“People Will Die” from Blackouts Caused by Walz’s Net-Zero Climate Policies

(p. A13) Minnesota Gov. Tim Walz last year signed one of America’s most aggressive climate laws, mandating that 100% of the state’s electricity come from carbon-free sources by 2040. Even if he doesn’t ascend to national office, he may end up leaving not only Minnesota but other states in the dark. As we show in a new paper, politicians like Mr. Walz are destroying the electricity markets that are essential to economic success and even individual survival.

We analyzed seven Great Lakes states with connected electricity grids—Illinois, Indiana, Minnesota, Michigan, Ohio, Pennsylvania and Wisconsin. For decades, these states have bought and sold electricity in regional markets, benefiting from the abundance of reliable power generated from sources like coal, natural gas and nuclear. But through a combination of state mandates and utility company decisions, all of them are moving away from those reliable sources toward unreliable wind and solar power, in pursuit of net-zero greenhouse gas emissions.

. . .

When subzero temperatures sweep across the Great Lakes every January, states will increasingly ask each other for power that doesn’t exist. Ditto when heat waves crest in July and August. Factories will lose power—a death knell for competitiveness—while families will lose air conditioning or heat. In Michigan, we estimate that a wind-, solar- and battery-based grid will cause blackouts lasting as long as three days during extreme winter weather. People will die.

For the full commentary see:

Joshua Antonini and Jason Hayes. “Cross Country; Walz’s Climate Policies Could Leave the Midwest in the Dark.” The Wall Street Journal (Saturday, Aug. 10, 2024): A13.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date August 9, 2024, and has the same title as the print version.)

The “new paper” by Antonini and Hayes mentioned above is:

Antonini, Joshua, and Jason Hayes. “Shorting the Great Lakes Grid: How Net Zero Plans Risk Energy Reliability.” The Mackinac Center for Public Policy, 2024.

Governments Often Deliver “Horrible Ideas Executed Terribly”

(p. A15) After the $320 million floating fiasco ran aground, Ohio Sen. J.D. Vance tweeted: “The Gaza pier is a symbol of the Biden administration. A horrible idea executed terribly.”

. . .

Government is bad for your health. Whose idea was it to pay for gain-of-function research in Wuhan? Remember when the Food and Drug Administration delayed the rollout of Covid tests by, among other things, requiring applications on CD-ROMs? In 2020! The FDA interference, according to a Yale Law Journal 2020 Forum, was “possibly the deadliest regulatory overreach in U.S. history.”

. . .

Between the Covid-19 Economic Injury Disaster Loan, the Paycheck Protection Program and the Federal Pandemic Unemployment Compensation program, the FBI reports almost $300 billion in fraud. It was so easy, tens of thousands reportedly filed applications from jail.

. . .

Why are governments so bad at execution? Accountability and incentives. There are no prices or profits, just elusive cost benefits estimated in simple spreadsheets any first-year investment banker could fudge.

But these public-works projects are well intentioned, right? Hardly. Good luck finding all the hidden agendas, political back scratching and paid-off donors. Or, in the case of student loans, bribes to voters. Getting re-elected is how politicians measure the success of government work vs. private-sector profits.

Those profits from each private-sector project or product provide capital that pays for the next important project. In perpetuity. Profits also provide guidance to markets that fund great ideas and kill off bad ones. It’s Darwinism vs. kleptocracy. Sadly, politicians and industrial policy will always fund dumb things like electric-vehicle chargers, high-speed rail and Neom—horrible ideas executed terribly.

For the full commentary see:

Andy Kessler. “Your Government at Work.” The Wall Street Journal (Monday, June 10, 2024): A15.

(Note: ellipses added.)

(Note: the online version of the commentary has the date June 9, 2024, and has the same title as the print version.)

In “An Entrenched Echo Chamber” the Highly Credentialed Slow Progress Toward an Alzheimer’s Cure

Centralized research funding (often centralized by government agencies) reduces the pluralism of ideas and methods that often lead to breakthrough innovations. The story of Alzheimer’s research, quoted below, is a dramatic case-in-point.

A secondary related lesson from the story quoted below is that Dr. Thambisetty, one of the outsiders struggling to make a difference, is trying to evade the enormous costs of mandated phase 3 clinical trials, by only investigating drugs that already have been approved by the FDA for use against other conditions. With his severely limited funding, and the huge costs of mandated phase 3 clinical trials, this may be a shrewd strategy for Thambisetty, but notice that by following it, he will never explore all the as-yet-unapproved chemicals that might include the best magic bullet against Alzheimer’s.)

(p. A25) What if a preposterous failed treatment for Covid-19 — the arthritis drug hydroxychloroquine — could successfully treat another dreaded disease, Alzheimer’s?

Dr. Madhav Thambisetty, a neurologist at the National Institute on Aging, thinks the drug’s suppression of inflammation, commonly associated with neurodegenerative disorders, might provide surprising benefits for dementia.

It’s an intriguing idea. Unfortunately, we won’t know for quite a while, if ever, whether Dr. Thambisetty is right. That’s because unconventional ideas that do not offer fealty to the dominant approach to study and treat Alzheimer’s — what’s known as the amyloid hypothesis — often find themselves starved for funds and scientific mind share.

Such shortsighted rigidity may have slowed progress toward a cure — a tragedy for a disease projected to affect more than 11 million people in the United States by 2040.

. . .

. . ., in 2006, an animal experiment published in the journal Nature identified a specific type of amyloid protein as the first substance found in brain tissue to directly cause symptoms associated with Alzheimer’s. Top scientists called it a breakthrough that provided a key target for treatments. The paper became one of the most cited in the field, and funds to explore similar proteins skyrocketed.

. . .

In 2022, my investigation in Science showed evidence that the famous 2006 experiment that helped push forward the amyloid hypothesis used falsified data. On June 24 [2024], after most of its authors conceded technical images were doctored, the paper was finally retracted.

. . .

In reporting for my forthcoming book about the disturbing state of play in Alzheimer’s research, I’ve spoken to many scientists pursuing alternatives. Dr. Thambisetty, for example, compares brain tissues from people who died in their 30s or 40s with and without genetic risk factors for Alzheimer’s. He then compares these findings to tissues from deceased Alzheimer’s patients and people who didn’t have the disease. Where changes overlap, drug targets might emerge. Rather than develop new drugs through lab and animal testing, followed by clinical trials that cost vast sums — a process that can take decades — he examines treatments already approved as reasonably safe and effective for other conditions. Patent protections have lapsed for many, making them inexpensive.

Experiments have also begun to test the weight-loss drug semaglutide (sold as Wegovy, among other brands). Researchers hope that results due in 2026 will show that its anti-inflammatory effects — like Dr. Thambisetty’s idea about hydroxychloroquine — slow cognitive decline.

Ruth Itzhaki, a research scientist at the University of Oxford, stirred curiosity in the 1990s when she shared evidence tying Alzheimer’s to herpesvirus — a scourge spread by oral or genital contact and often resulting in painful infections. For years, powerful promoters of the amyloid hypothesis ignored or dismissed the infection hypothesis for Alzheimer’s, effectively rendering it invisible, Dr. Itzhaki said with exasperation. Research suggests that viruses may hide undetected in organs, including the brain, for years, causing symptoms divergent from the original infection.

. . .

Sometimes a disease stems from a single clear-cut origin, such as genetic mutations that cause deadly sickle cell disease. “But very few diseases of aging have just one cause. It’s just not logical,” said Dr. Matthew Schrag, a neurologist at Vanderbilt University Medical Center. Working independently of his university, he discovered the 2006 research image manipulations.

. . .

“There is an entrenched echo chamber that involves a lot of big names,” Dr. Schrag said. “It’s time for the field to move on.”

For the full commentary see:

Charles Piller. “All the Alzheimer’s Research We Didn’t Do.” The New York Times (Friday, July 12, 2024): A25.

(Note: ellipses, and bracketed year, added.)

(Note: the online version of the commentary has the date July 7, 2024, and has the same title as the print version. Where there are a couple of small differences in wording, the passages quoted above follow the online version.)

Piller’s paper in Science, mentioned above, is:

Piller, Charles. “Blots on a Field?” Science 377, no. 6604 (July 2022): 358-63.

Piller’s commentary is related to his forthcoming book:

Piller, Charles. Doctored: Fraud, Arrogance, and Tragedy in the Quest to Cure Alzheimer’s. New York: Atria/One Signal Publishers, Forthcoming on February 4, 2025.

A Dollar Spent on Medicaid Yields (at Most) 40 Cents of Value to Recipients

(p. C3) A . . . National Bureau of Economic Research study estimated the value of Medicaid to its recipients at between 20¢ and 40¢ per dollar of expenditure, with the majority of the value going to health-care providers like doctors and hospitals. By comparison, the Earned Income Tax Credit—a cash transfer program designed to enhance the incomes of the working poor—delivers around 90¢ of value to its recipients per dollar of expenditure. Given that more than half of Obamacare’s reduction in the numbers of the uninsured has been from its expansion of Medicaid, this makes the law look more like welfare for the medical-industrial complex than support for the needy.

For the full commentary see:

Daniel P. Kessler. “The Health of Obamacare.” The Wall Street Journal (Saturday, Dec. 12, 2015 [sic]): C3.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date Dec. 11, 2015 [sic], and has the same title as the print version.)

The NBER working paper mentioned above was later published in:

Finkelstein, Amy, Nathaniel Hendren, and Erzo F. P. Luttmer. “The Value of Medicaid: Interpreting Results from the Oregon Health Insurance Experiment.” Journal of Political Economy 127, no. 6 (Dec. 2019): 2836-74.

(Note: my title for this blog entry continues to be supported in the 2019 published version of the earlier NBER working paper.)