Let’s talk about catastrophic expenditures in health

This piece originally appeared in the WorldBank DATA Blog.

Two thousand years ago, the story goes, an itinerant carpenter-prophet in Palestine met a woman who had suffered from a bleeding condition for twelve years. She had gone to see this man because she had already “suffered a great deal under the care of many doctors”—which, fair enough—“and had spent all she had.” [1]

Shutterstock: rudall30

Today, we’ve given that a name: “Catastrophic expenditure for health.”

And that concept — financial catastrophe in health care — feels quite new. It wasn’t until 2009 that we knew that over 60% of bankruptcy in the…


The Great Barrington Trojan Horse

My old college roommates are really smart.

Like, really smart. While I mostly shout into the void of social media, one of them now flies jet planes and another writes papers with phrases like “the phenomenologically relevant properties of string compactifications which arise in the context of heterotic line bundle models.”

Like I said, really smart.

This week, one of them told me he’d become intrigued by something called the Great Barrington Declaration. He wanted to know what we public health folks thought about it, and why its ideas hadn’t gotten more attention.

He also forwarded an article from the…


Today, I want to talk about testing. It’s become a bit of a hot topic, especially with the #BlackLivesMatter protests of the last few weeks. Governor Andrew Cuomo has made coronavirus testing free to New Yorkers, and Governor Charlie Baker followed suit a week later in Massachusetts.

(On the other hand, the Stable Genius told us the other day that “If we stop testing right now, we’d have very few cases, if any.” So, there’s that).

The thing is, of all the coronavirus information we’ve had to cram since January, testing is probably the most confusing. I mean, just take…


The other day, this brilliant meme made its internet rounds:

Silly rabbit! Masks are for sheep!

and we need to talk about it.

But first, let’s talk about prisoners. Before you go any further, I’ve got two disclaimers at the bottom of this post that you should read. I’ll be here when you get back.

Right. Prisoners.

Let’s do a little thought experiment: imagine you and one of your acquaintances—we’ll call him Herb—have been apprehended by the police. They’ve got you both on video during a drug sale, but they can’t quite tell from the surveillance camera who made the actual sale.

To figure it out…


Over the last week or two, pre-emptive postmortems on the continuing worldwide shutdowns due to Covid-19 have begun to metastasize. Their authors stand in judgment over these shutdowns, claiming to present incontrovertible facts that prove that the shutdowns were unnecessary.

These postmortems get published in widely-read, respected periodicals like The Telegraph, The Hill, and even the Wall Street Journal. The way they’re written, they sound like so much Serious Thought.

Today, I want to suggest that they’re the opposite. They’re rife with serious epidemiologic errors, and—perhaps more damningly—they conceal insidious privilege and a touch of implicit bias.

Buckle in. This…


Failure is the opportunity to begin again, this time more intelligently. —Henry Ford

It’s been a month of quarantine. Guaranteed you’ve seen this Venn diagram floating in the ether:

On its face, this figure feels existentially true. A call to action.

We’ve been sent to our rooms by this pandemic, locked away from others (or with others) for an eternity. We’re surrounded by uncertainty: when will this be over? Will it be over? Will there be more waves? Am I going to get covid? And what the hell, why am I hungry again?

Enter this graphic, here to save you…


Two weeks ago, I started wearing a cloth mask in public.

Not going to lie. It feels weird. It’s hot. It’s kinda gross. And when I started wearing it, people gave me wide berth. Boston’s a walking city; we’re used to crowded sidewalks. But my mask guaranteed I’d get six feet of physical distancing—no one wants to walk near a bald, bearded brown guy wearing a mask.

Two days ago, Los Angeles mandated cloth masks for anyone walking outside. Even the President himself, despite his resolute “what’s the big deal” stance toward the pandemic, announced that the CDC recommends everyone…


Social isolation often feels like the opposite of heroism. But now is the time to swallow our pride.

Photo: Noam Galai/Getty Images

Nothing about quarantine feels heroic. Nothing about sitting in an empty apartment, checking the Johns Hopkins Covid-19 tracker every 10 minutes, feels like saving the world.

Nothing about the paper I’m writing, the pantry you’re stocking, the sale he’s completing, the workout she’s posting, the pizza they’re making — none of that feels heroic when our social media feeds are peppered with dramatic pictures of the USNS Comfort sailing into New York Harbor to provide medical services to a city desperate for help.

Seriously, though. This is an iconic picture. It’ll be in history books.

Except we desperately want…


Here are my unfiltered, unedited thoughts on the virus and the lockdown.

Isn’t this just a bad cold?

No. Although coronaviruses do cause respiratory tract infections in humans, they’re not all the same. SARS was a coronavirus, as was MERS. In fact, the virus’s actual name is SARS-CoV-2.

OK, maybe it’s just the flu, then. After all, flu kills so many people per year and we don’t freak out about it.

Flu does kill thousands of Americans every year, and we do freak out about it. We’ve developed a vaccine for it — that’s how much we freak out about…

Mark Shrime, MD, PhD

O’Brien Chair of Global Surgery, Royal College of Surgeons in Ireland | Global surgeon | Decision analyst | Climber | 3x American Ninja Warrior Competitor

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