Category Archives: Risky behavior
RWJF Scholars in the News: Scandals and reforms at the VA, excluding the elderly from medical studies, and more.
Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:
In a Washington Post opinion piece, RWJF Scholars in Health Policy Research alumnus Colin Moore, PhD, writes that the budding scandal over patient waiting times at regional Department of Veterans’ Affairs medical centers (VA) could lead to positive reforms, if past troubles at the VA are any guide. “Throughout its history, the VA’s very public failures have shaped its development as profoundly as its successes,” Moore writes. For example, previous failures led to the adoption of the 1996 Veterans’ Health Care Eligibility Reform Act, which transformed the VA by opening more outpatient clinics and embracing new ways to track and measure health care outcomes. The recent scandal involving falsified reporting on patient waiting times could lead to another cycle of much-needed improvements, Moore writes.
“Doctors are often in the dark” when prescribing medications or procedures to older patients, because the elderly are routinely excluded from medical research, Donna Zulman, MD, MS, co-writes in an opinion piece for the New York Times. Studies have shown that 40 percent of medical research excluded individuals over the age of 65. “Clinicians consequently have to extrapolate findings about diseases as diverse as cancer, heart attacks, and mental illness from studies of younger and often healthier people, potentially putting their older patients at risk.” Older patients should be included in medical studies because age can affect the way a person’s body processes medication and other treatments, according to Zulman, an RWJF Clinical Scholars alumna.
Magdalena Cerdá, PhD, MPH, is an assistant professor of epidemiology at the Columbia University Mailman School of Public Health and an alumna of the Robert Wood Johnson Foundation Health & Society Scholars program.
Rates of fatal overdoses caused by analgesic opioids (i.e. opiate-based painkillers) have increased dramatically in the United States over the past five years. The prevalence of nonmedical analgesic drug abuse (i.e. use for recreational or self-treatment purposes without a prescription, or using more medication than prescribed by a physician) is second only to that of marijuana abuse, and currently the number of fatal analgesic overdoses is greater than the number of heroin and cocaine overdoses combined. While research until now has focused on the role of individual characteristics, there is an increasing realization that neighborhoods also play an important role in shaping substance abuse.
Natasha Dow Schüll, PhD, MA, is a cultural anthropologist and associate professor at the Massachusetts Institute of Technology's Program in Science, Technology and Society. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2003-2005). Her recent book, Addiction by Design: Machine Gambling in Las Vegas, examines the ways that the gambling industry has designed gambling machines that encourage addiction.
Human Capital Blog: In your book, you describe how electronic gambling machines—the modern equivalent of slot machines—are designed in such a way that they encourage addiction. Tell us about that, please.
Natasha Dow Schüll: If you have never actually been in a Las Vegas casino and your idea of it comes from a James Bond movie, you'd be surprised by what you'd find. Of course they still have card games and roulette wheels, but most of the money casinos make is from electronic gambling machines, which are amazingly sophisticated versions of the classic three-reel slot machine. Every aspect of their design—the hardware, the software, the math, even the seating components—is carefully designed to keep players at the machine, playing game after game. Play is simple and amazingly fast—it takes only three to four seconds per spin. The machines are programmed so gamblers win every now and then, and they give audiovisual feedback to encourage them to continue. They induce players to gamble quickly and repeatedly, developing a sort of rhythmic flow that can sweep them away. Gamblers talk about getting into a "zone" where everything but the game just drops out of their awareness. After a while, they crave the zone itself, so it stops being about beating the machine and becomes instead about staying on the machine for as long as they can so they can be in that zone. They're addicted, and they develop all the behaviors of an addict as a result.
My point is that it's no accident; the machines are designed to drive the kinds of behavior—playing faster, longer, and more intensively—that turns gamblers into addicts.