Peter Ubel, MD

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel. He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together.

Sun exposure makes people both more and less likely to die of melanoma. How can that be?

Peter Ubel, MD

Conditions

January 8, 2019

Quick quiz question: two people are diagnosed with melanoma — Sarah Sunburn, an adamant sun-worshipper, and Paula Pale-All-The-Time, a fanatical sun-avoider. Who is more likely to die of the disease?

The answer is pale-faced Paula. Surprised? Let me unpack this mystery and explain why sun exposure simultaneously kills people, while making the cancers they are diagnosed with appear to be less life-threatening.

I will start with what you probably know already. Melanoma …

The insanity of American health care prices played out in this one, real oncology appointment

Peter Ubel, MD

Meds

December 3, 2018

The oncologist had prescribed Xgeva hoping it would strengthen her bones while also delaying the progression of Angela Kahn’s breast cancer. But Kahn (a pseudonym) couldn’t get over the price of the drug. Before the oncologist had a chance to ask how she was feeling, she blurted out that the medication cost “$15,000 a shot.” “That’s crazy,” the oncologist replied, continuing by saying the price “fits right in with the …

A CT scan for kidney cancer? It may depend on where you live.

Peter Ubel, MD

Conditions

November 8, 2018

About one in fifty people reading this essay will be diagnosed with kidney cancer at some time in their life. In fact, one out of one people writing this essay has already been diagnosed with kidney cancer. (I had a small tumor removed from my left kidney not long after I turned 50.) But how many people diagnosed with kidney cancer have been overdiagnosed with the condition? And what does moving to Florida have …

The conservative appeal of Medicare for all

Peter Ubel, MD

Policy

November 6, 2018

Everyone thinks of “Medicare for all” as a liberal idea, an extremely liberal one embraced by the socialist wing of the Democratic Party. It’s an idea Democrats were hesitant to embrace in the Obama era, for being too far out of mainstream political thought. It was thought of as an idea that was too easy to demonize as socialism.

What everyone seems to be forgetting is that “Medicare for …

Medical bankruptcies happen less frequently than you think

Peter Ubel, MD

Policy

October 15, 2018

Elizabeth Warren describes medical bills as “the leading cause of personal bankruptcy” in the United States. She bases that opinion in part on her own research, in which she and her collaborators surveyed people who had experienced personal bankruptcy, asked them whether they’d experienced health-related financial distress, and concluded that 60 percent of all bankruptcies in the U.S. result from illness …

Do uninsured patients receive more unnecessary care?

Peter Ubel, MD

Policy

August 17, 2018

American physicians dole out lots of unnecessary medical care to their patients. They prescribe things like antibiotics for people with viral infections, order expensive CT scans for patients with transitory back pain, and obtain screening EKGs for people with no signs or symptoms of heart disease. Some critics even accuse physicians of ordering such services to bolster their revenue.

So what happens when uninsured patients make it to the doctor’s office …

Don’t blame doctors for outrageous emergency department prices

Peter Ubel, MD

Policy

June 12, 2018

Recently I posted a piece, describing research out of Johns Hopkins, showing that when patients come to ERs — either with no insurance or insurance that is out-of-network — they often face charges that are four, six, or even ten-fold greater than what Medicare would pay for the same services.

After the post, I was inundated with angry tweets and emails, mainly from emergency medicine …

How high-deductible plans are a bait and switch

Peter Ubel, MD

Policy

March 14, 2018

If you get health insurance through your job, beware: you might be picking up more of the cost of your medical care than you realize. With increasing frequency, employers are directing their workers to the kind of high deductible, high out-of-pocket insurance plans that leave workers financially responsible for a surprising portion of their health care expenses.

Not long ago, having insurance coverage meant your costs were largely …

Obamacare prices are rising. But not for the reasons you think.

Peter Ubel, MD

Policy

March 12, 2018

It has been well publicized that premiums for Obamacare insurance plans have been rising at a disturbing rate. Local news is filled with reports of 21.5%, 36.3% and even higher price hikes. President Trump complained in February that Obamacare premiums “have increased by double and triple digits,” even remarking that premiums in Arizona “went up 116% last year alone.”

If the cost of buying insurance were really …

How to tell seniors they’re too old for cancer screening

Peter Ubel, MD

Conditions

January 26, 2018

Cancer screening can save lives. Mammographies reduce the chance women will die of breast cancer; and colonoscopies reduce the chance people will die of colon cancer.

But should my 93-year-old father receive a screening colonoscopy? The test is uncomfortable, carries risks, and costs money. Even more importantly, my dad probably won’t live long enough to benefit from the test. That’s why most medical experts think people like my dad—people unlikely to …

Relative risk reduction is a troublesome way to convey the benefits of treatments

Peter Ubel, MD

Meds

January 1, 2018

How excited would you be about a medication that lowered your risk of cardiovascular death, heart attack or stroke by 1.5%? Excited enough to spend a few thousand dollars a year on the drug? I expect not.

What if, instead, the drug reduced those same terrible outcomes by 20%? That’s probably enough benefit to interest some in the drug.

Well, those statistics come from the same clinical trial, evaluating the same drug. …

Surprise! Doctors spend more time with computers than with patients

Peter Ubel, MD

Physician

December 8, 2017

Medical appointments are getting shorter by the year. Sometimes it feels like doctors have no time to spend with their patients.

What’s to blame for these brief clinical interactions? It could be the electronic health record, or EHR. Because of changes in how insurance companies and the government pay for medical care, doctors increasingly need to document their care on the computer, causing many physicians to spend more time with their …

Who’s really to blame for the obesity epidemic?

Peter Ubel, MD

Policy

November 21, 2017

Growing up Republican, I have long believed in personal responsibility. In junior high school, when I observed close relatives who struggled with obesity, I vowed to never let myself get out of shape. (“Junior high” is what we called middle school back in the day.) When hip surgery gone wrong dramatically reduced my level of physical activity two and a half years ago, I cut back on what I ate …

Are behavioral economic interventions the key to health system improvement?

Peter Ubel, MD

Policy

November 12, 2017

It has become trendy in health policy circles to believe that behavioral economic interventions are the key to health system improvement. After all, traditional economic interventions like pay per performance have generated underwhelming results, with little or no change in physician behavior. Why not try a non-financial, psychological intervention: like performance feedback!

Well, a study conducted in the last couple years in Switzerland raises questions about the effectiveness of …

Direct-to-consumer advertising: Who’s really to blame?

Peter Ubel, MD

Physician

October 27, 2017

There are some sad truths about being an aging male. Your muscle mass usually declines. You start feeling tired more easily. And there’s a good chance either you start losing interest in sex or start experiencing a decline in sexual performance.

Here’s another truth: Your testosterone level probably ain’t what it used to be. Which raises a question: Would testosterone supplementation restore some of your youthful vitality?

That is certainly what manufactures …

When it comes to consumer choice, more is not always better

Peter Ubel, MD

Policy

October 18, 2017

Mark Letterman’s rheumatoid arthritis had been progressing unrelentingly despite popping dozens of pills each week — eight methotrexate pills on Mondays alone. Letterman felt like he was 63 going on 93.

If rheumatoid arthritis progresses unchecked, it is as debilitating of a disease as can be imagined. Don’t think garden variety arthritis that only interferes with activities like, um, gardening. Think: finger and wrist joints so inflamed it feels like your …

Doctors should be paid well. But how much is enough?

Peter Ubel, MD

Physician

October 2, 2017

American physicians deserve to be paid well for their work. As a physician, myself, I know what it takes to become a doctor in the U.S. Four years of late nights in the college library in hopes of achieving a GPA commensurate with medical school admission; then four years of medical school, which makes the college work load feel light in retrospect; then, in my case, three years of residency …

If you cut payments to surgeons, don’t be surprised if they do more procedures

Peter Ubel, MD

Policy

September 25, 2017

Knee replacements are booming. Between 2005 and 2015, the number of knee replacement procedures in the U.S. doubled, to more than one million. Experts think the figure might rise another sixfold in the next couple of decades because of our aging population.

Since many people receiving knee replacements are elderly, Medicare picks up most of the cost of such procedures. It shouldn’t be surprising, then, that the program is experimenting …

Unpaid medical bills are an invitation to negotiate

Peter Ubel, MD

Patient

May 15, 2017

When Lorie Duff was pregnant with her third child, she did what all good moms are supposed to do. She went to the OB/GYN clinic for prenatal care. But she fell behind on the clinic payments. She only made about $25,000 a year managing an auto parts store while her husband stayed home with their kids. The out-of-pocket expenses were outpacing her ability to pay.

That’s when she …

If pharmaceutical companies don’t restrain themselves, someone else will

Peter Ubel, MD

Meds

May 7, 2017

Imagine that you are gasping for breath, literally on the verge of death. Then someone injects you with a medicine and — miracle! — you are perfectly healthy again.

Would you pay $300 for that injection?

The treatment is epinephrine; your illness was a life-threatening allergy. And that $300 price? That reflects a six-fold increase from a couple of years ago. It’s one thing for medications to be …

Peter Ubel, MD

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