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Previous research has found that American patients strongly believe that more testing and more treatment lead to better outcomes and, to a lesser extent, that newer treatments are more effective. We conducted five focus groups with privately insured, healthy, middle-aged Americans (n = 43) to explore these apparent preferences. Contrary to previous research, an unexpected distinction emerged. Participants placed enormous value on testing and screening, reacting with hostility to guidelines recommending less of either. However, they were suspicious of overmedication. The wariness of pharmaceuticals and enthusiasm for testing and screening both appear to reflect participants' efforts to take responsibility for their health. But recommendations to test and screen less conflicted with their active, engaged, information-seeking roles. Nonetheless, given patients' concerns about overuse of pharmaceuticals, we maintain that they can learn to understand the connections between over-testing and over-treatment, and can actively choose to do less. We close with suggestions about how treatment guidelines can better communicate these connections to patients. Our findings cannot necessarily be generalized beyond privately-insured, healthy, middle-aged Americans. But because we found that, among these individuals, attitudes towards pharmaceuticals differ from attitudes towards testing and screening, we maintain that future research should also distinguish among and compare attitudes towards different types of medical interventions.

Employers can use price transparency data to reconsider their choice of carriers or plans, negotiate prices with their carriers, and steer employees toward high-quality, reasonably priced providers.Employers can use price transparency data to reconsider their choice of carriers or plans, negotiate prices with their carriers, and steer employees toward high-quality, reasonably priced providers.

This article explains how regulators use categorization, quantification, and labeling to change how corporations manufacture commercial products. The Food and Drug Administration wanted to create an incentive for manufacturers to replace trans fats by requiring food labels to disclose trans fat content. The Food and Drug Administration initially proposed categorizing trans fats as saturated fats and quantifying both substances with one number on labels, but industry actors largely favored quantifying trans fats separately from saturated fats. Industry actors argued that such an approach would show consumers which products had been reformulated to contain 0 g of trans fats, thus allowing manufacturers to market reformulated products as 'healthier' and rewarding investments in alternative technologies. The Food and Drug Administration ultimately decided to categorize and quantify the two fats separately, specifically designing the disclosure of quantitative information in order to encourage technological change. Thus, I argue that quantifying information on commercial product labels was not only intended to govern individual consumption but was also intended to govern production in anticipation of individuals governing their consumption. Regulators used their capacity to quantify as a means to govern industrial production.

Trans fats became part of the American food system due to a complex interplay among activism, industrial technology, and nutritional science. Some manufacturers began using partially hydrogenated oils, which contain trans fats, in the early twentieth century. Medical authorities began framing saturated fats as unhealthy in the 1950s. In the 1980s, activist organizations, including the Center for Science in the Public Interest, condemned food corporations’ use of saturated fats and endorsed trans fats as an acceptable alternative. Nearly all targeted corporations responded by replacing saturated fats with trans fats, which fit easily into their existing products. Trans fats thus became the perfect solution to the political problem of saturated fats and to the technical problem of what to use in their place. Activists helped precipitate technological change, but by 1994, trans fats were no longer regarded as a solution. Instead, they became regarded as a new nutritional problem.

Participatory budgeting (PB)—a democratic process where ordinary residents decide directly how to spend part of a public budget—has gained impressive momentum in US municipalities, spreading from one pilot project in Chicago’s 49th ward in 2009 to 50 active PB processes across 14 cities in 2016–2017. Over 93,600 US residents voted in a PB process in 2015–2016, deciding over a total of about $49.5 million and funding 264 projects intended to improve their communities. The vast majority of US PB processes take place in large urban centers (e.g., New York City, Chicago, Seattle, Boston), but PB has also recently spread to some smaller cities and towns [1]. Figure 1 illustrates the growth of PB processes in the USA, and within New York City and Chicago council districts specifically.PB constitutes a rare form of public engagement in that it typically comprises several distinct stages that encourage residents to participate from project idea collection to project implementation (see Fig. 2). The decisive public vote in US PB is practically binding as elected officials commit to implementing the public decision at the outset of the process. Moreover, all current PB processes in the USA have expanded voting rights to residents under 18 years old and to non-citizens. Under President Obama, the White House recognized PB as a model for open governance. Participatory Budgeting Project, a nonprofit organization that advocates for PB, won the 2014 Brown Democracy Medal, which recognizes the best work being done to advance democracy in the USA and internationally.PB has been lauded for its potential to energize local democracy, contribute to more equitable public spending and help reduce inequality [2, 3]. Social justice goals have been explicit in US PB from the start. Grassroots advocates, technical assistance providers, and many elected officials who have adopted it emphasize that PB must focus on engaging underrepresented and marginalized communities [2, 4, 5]. PB steering committees have specified equity and inclusiveness goals in PB rule books [6, 7]. The most conclusive research so far on PB’s potential to reduce social inequalities, however, comes from Brazil, where PB started in 1989. In Brazil, PB has been associated with a reduction in extreme poverty, better access to public services, greater spending on sanitation and health services, and, most notably, a reduction in child and infant mortality [8, 9].In this paper, we outline three mechanisms by which PB could affect health disparities in US municipalities: First, by strengthening residents’ psychological empowerment; second, by strengthening civic sector alliances; and third, by (re)distributing resources to areas of greatest need. We summarize the theoretical argument for these impacts, discuss the existent empirical evidence, and highlight promising avenues for further research.

Many organizations are developing health care price information tools for consumers. However, consumers may avoid low-price care if they perceive price to be associated with quality. We conducted a nationally representative survey to examine whether consumers perceive that price and quality are associated and whether the way in which questions are framed affects consumers' responses. Most Americans (58-71 percent, depending on question framing) did not think that price and quality are associated, but a substantial minority did perceive an association (21-24 percent) or were unsure whether there was one (8-16 percent). Responses to questions framed in terms of high price and high quality differed from responses to questions framed in terms of low price and low quality. People who had compared prices were more likely than those who had not compared prices to perceive that price and quality were associated. We explore implications of these findings, including how behavioral economics can inform approaches to helping consumers use price and quality information.

The abstract is missing from this article despite the fact that the heading “Abstract” appears before the article’s first paragraph.

Background: Vertebral compression fractures (VCFs) are the most prevalent type of osteoporotic fractures, often causing significant pain, morbidity, and mortality. Vertebral augmentation procedures like balloon kyphoplasty (BK) are effective in treating VCFs. These procedures are typically performed using a single fluoroscopy machine (SF) for anteroposterior (AP) and lateral views. We have implemented a dual-fluoroscopy (DF) technique to reduce procedure time and radiation exposure. The goal of this study was to determine whether dual-fluoroscopy could optimize surgical efficiency without compromising safety, offering a more effective alternative to traditional single-fluoroscopy methods. Methods: This retrospective study included 126 patients who underwent BK with either SF (n = 74, 58.7%) or DF (n = 52, 41.3%) between 2020 and 2024. We collected data on procedure duration per pedicle (PDPP), radiation exposure (reference air kerma and dose-area product [DAP]), and radiation duration. A sub-analysis of post-learning phase cases was performed. Results: A learning curve was identified for the first 24 cases and 15 cases using the SF technique and DF technique, respectively, which was followed by a stabilization in procedure duration per pedicle (Levene’s statistic = 10.623, p = 0.002 for SD difference, p < 0.001 for mean PDPP difference). After the completion of the learning phase for both techniques, the DF group demonstrated a significantly shorter PDPP (11.83 ± 4.3 vs. 14.03 ± 5.57 min, p = 0.049). No significant differences were found in radiation exposure, including radiation duration (p = 0.577), reference air kerma, or DAP. Conclusions: Dual-fluoroscopy significantly reduces procedure time after the learning curve is overcome, improving efficiency without increasing radiation exposure. This technique holds promise for optimizing kyphoplasty workflow and safety, supporting broader clinical adoption.

Julie Vanderslice thought fish were disgusting. She didn't like to look at them. She didn't like to smell them. One afternoon in the summer of 2010, Pat's friend Ray showed up on Julie's to present her with a book called The Most Important Fish in the Sea. Ray was an avid recreational fisherman, who lived ten miles up the coast on one of the countless tiny inlets of the Chesapeake. The Chesapeake Bay has 11,684 miles of shoreline. It's about menhaden, small forage fish that grow up in the Chesapeake and migrate along the Atlantic coast. You'll love it, he told her, chuckling as he handed over the book. Julie picked up the menhaden book one summer afternoon, pretty sure she wouldn't make it past the first chapter. She examined the cover, which featured a photo of a small silvery fish with a wide, gaping mouth and a distinctive circular mark behind its eye.