Dear clients and friends: Given your interest in health and medicine, we would like to share with you our collection of the most interesting perspectives on our industry's trends and developments. We are happy to share them with you — and hope you share your thoughts with us.

1. First, Do No Harm – And Check the Box

The Guardian collects a mountain of data showing health disparities and proposes a radically simple solution for doctors and medical staff: use a checklist. Pilot programs show promise for patients – particularly women and people of color:

After introducing the checklist, the percentage of patients getting the right clot prevention surged, and preventable clots in trauma and internal medicine were close to eliminated. One study of a month of hospital admissions found that the number of internal medicine patients who returned to the hospital with blood clots within 90 days of discharge fell from 20 to two. And after the introduction of the checklist, the rate of fatal pulmonary embolism was cut in half.

2. Second, Roll Your Eyes

…speaking of checklists! The blog LessWrong assesses checklist mania by looking back at Atul Gawande’s 2009 book The Checklist Manifesto. It’s not so simple

From early on, the data looked conclusive; checklists in a hospital setting saved lives. But over and over, Atul Gawande mentions the difficulties he and others faced in getting buy-in from medical staff to adopt new checklists. They were too time-consuming. The items were confusing or ambiguous. The staff rolled their eyes at how stupidly obvious the checklist items were; whatever the data showed, it just didn’t feel like they ought to be necessary.

Making a good human-usable checklist takes a lot of workshopping. Airlines are still constantly revising their 200-page manual of individually optimized checklists for every possible emergency, as plane designs change and new safety data rolls in. (Amusing fact: the six-item checklist for responding to engine failure while flying a single-engine Cessna plane starts with “FLY THE AIRPLANE”.)

3. “Precautions Kill”

Cass Sunstein, former regulator in the Obama administration, reviews a new book, You Bet Your Life, to ask: is risk aversion itself a risk? Sunstein elaborates:

In life and in public policy, many people in Europe and the United States are drawn to the “precautionary principle,” which essentially calls for a high degree of risk aversion: Whenever an innovation threatens to cause harm, we should be exceedingly cautious before we allow it. The history of medical advances, demonstrate that in its most extreme forms, the precautionary principle is self-defeating. Simply put, precautions kill. Whether we are speaking of anesthesia, heart transplants, antibiotics, chemotherapy or blood transfusions, the precautionary principle would have vastly slowed down innovations that, yes, carried serious risk and led to real harm, but were ultimately a great boon to humanity.

4. Gender, Race, and Ethnicity at the NEJM

Beginning in 2022, The New England Journal of Medicine will introduce new standards on diversity in research:

Our research papers often, but not always, comment on gender, race, and ethnicity within the study sample. But as of January 1, 2022, we will require, as a new step, that authors of research studies prepare a supplementary table that provides background information on the disease, problem, or condition and the representativeness of the study group, to be posted with the article at the time of publication online…We will seek the same clarity and transparency in these descriptions of the selection and representativeness of study participants that we seek in any important methodologic feature of research.

5. COVID, Mental Health, and LMICs

The Lancet has published a landmark meta-analysis of research on COVID and mental health. It attributes 53 million cases of depression and 76 million cases of anxiety to the pandemic.

But what the study doesn’t find is equally revealing:

We found very few surveys that met our inclusion criteria from low-income and middle-income countries, meaning that findings from our regression analysis might be less generalisable to these locations. For example, we estimated large increases in prevalence within Latin America and the Caribbean, north Africa and the Middle East, and south Asia, despite not finding any surveys from these super-regions that met our inclusion criteria. Given the absence of high-quality data for most countries, and the wide UIs around our estimates, we emphasise caution against extrapolating direct rankings between countries and territories.