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Studies show that sunscreen is too expensive, and it probably encourages people not to use enough. Also, unequal pay for women is still very much a thing in medicine.

John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen -- Graphics

And the housekeeping:
You're doing sunscreen all wrong.  Still.  And women aren't being paid as much as men in medicine.  Still.  This is Healthcare Triage News.


From JAMA Dermatology, "Sunscreen product performance and other determinants of consumer preferences."  Sun, bad.  Sunscreen, good.  Sunscreens with an SPF of 15 or higher really do protect your skin against the sun, but you need to use a lot and you need to reapply it often.  Consumers make choices based on what they hear from commercials, customer reviews, etc and it's no different with sunscreen.

Researchers looked at the top rated products on Amazon to see if those products met recommendations from the American Academy of Dermatology.  Amazon had about 6,500 products categorized as sunscreens.  They looked at the top 65, or 1%.  Of those, the median price was $3.32 an ounce.  

Right off the bat, that's a problem.  As readers of my book or viewers of Healthcare Triage know, you're supposed to use at least an ounce for each application and likely apply it multiple times each time you're out in the sun.  At those prices, no one will do that.  The prices varied per ounce from $0.68, which is better, to $23.47 an ounce, which is insane.  

Next, 40% of the top products didn't have an SPF of at least 30 or weren't water-resistant.  As readers of my book or viewers of Healthcare Triage know, anything above SPF 30 is sort of a waste, but that's what you need as a baseline, and if it rubs off with water or with sweat, what's the point?  

The most cited positive feature, 61% of reviews, was "cosmetic elegance".  That's not what sunscreen's for!  You're all doing sunscreen wrong.  Watch our full episode on this topic again.

While I wish I never had to cover this again, salary discrepancies between physicians of different sexes remain.  This time the discrepancies are in public medical schools, from JAMA Internal Medicine, to the research!

One of the biggest issues facing good research on this topic is a lack of quality data.  You don't want to have to rely on self reported salary, for instance, because it's possible that salaries could be related to whether a subject responds or participates in a survey.  The great thing about this study is that it relies upon the fact that the Freedom of Information laws make it possible to get salaries from many physicians who work for public institutions.  You can get them all.  In 12 states, you don't even have to apply.  The data are published online. 

The authors could get at more than 10,000 physicians working at 24 public medical schools.  They linked that data to another database with detailed information on many other variables, including age, years of experience, faculty rank, specialty, success at funding and publishing, and Medicare reimbursements, and of course, sex.

Before any adjusting, female physicians earned on average $206,641 to males $257,957.  After adjusting for all the other variables, though, the differences became less but still were about $20,000 in favor of males.  The adjusted salaries of female full professors were comparable to those of male associate professors.  

Interestingly, there were differences by institution.  Two centers had no differences in income based on sex.  Five appeared to pay females more than males.  This doesn't mean there's not a problem, though, because many others had high pay gaps favoring males.  What's the difference with those institutions?  Is it policy?  Something else?  That would be worth exploring.  It'd be nice to stop pointing out this problem and start talking about how we might fix it.

Healthcare Triage is supported in part by viewers like you through, a service that allows you to support the show through a monthly donation.  We'd especially like to thank our research associate Joe Sevits and our surgeon admiral Sam.  Thanks Joe!  Thanks Sam!  More information can be found at