Obama Returns to End-of-Life Plan That Caused Stir (NYT)
Cautious progress on plans to reimburse physicians for end-of-life discussions, trying not to inflame death panel myth (which is bound to happen anyway)
Overhaul of food safety laws might not be to GOP’s taste (Wash Post)
Good summary of bill’s benefits. Republicans may deny funding, claiming: “We still have a food supply that’s 99.99 percent safe.”
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Any theory that claims to tell us who and what we are contains a potential for abuse. Advice from “legitimate” sources, addressing itself to areas of human weakness and vulnerability, can deprive an individual of the confidence that he could know for himself who he should be. Religion used to have this potential on a wide scale when the population was less educated, less self-conscious, less “sophisticated.” Organized religion still has the advantage of being able to hide behind a veil of crossed intentions and a choirboy squeaky-clean. But any closed system of thought can gain ascendancy using perfected psychological, that is, commercial, techniques. Read more
Exercise ‘protects brain from ageing’ (NHS)
Not new or unsurprising, but it’s additional evidence that there’s a connection between low levels of physical activity and cognitive decline
Can dairy cut diabetes risk? (NHS)
The association was found only with whole-fat dairy, not low-fat. “The study is not robust evidence that dairy products can lower diabetes risk.” Read more
No one should be allowed to intimidate nurses who report serious wrongdoings they observe. When a nurse goes public about improper medical treatment — a doctor who sewed “part of the rubber tip from suture kit scissors to a patient’s torn, broken thumb” and used olive oil on the abscess of a patient with MRSA — she shouldn’t be fired. Read more
Can Congress Make You Buy Broccoli? And Why That’s a Hard Question (NEJM)
Four reasons why it’s hard to answer this question. A legal opinion (12/23)
Doctor Arrested in Whistle-Blowing Case (NYT)
Doctor accused of practicing substandard medicine worked with his friend, the sheriff, to get nurses fired. Nurses vindicated. Doctor now out on bail. (12/23) Read more
The Hazards of Nerd Supremacy: The Case of WikiLeaks (Atlantic)
Substantial, thought-provoking essay by philosopher of the information age, Jaron Lanier
Secrecy May Be Unnecessary for Placebo Effect (WebMD)
Ted Kaptchuk trial involved 80 IBS patients. “There may be significant benefit to the very performance of medical ritual.” Read more
Most high-income countries today have some form of national health insurance. Why is the US different? What stands in the way? … How to explain American opposition to universal health care. “Nearly every time this country has expanded its social safety net or tried to guarantee civil rights, passionate opposition has followed.” Read more
Court Backs Patents for Diagnostic Tests (NYT)
A closely watched development in personalized medicine. Patents on tests raise costs and impede medical progress (12/21)
Drug Makers New Targets for U.S. Fraud Inquiries, Report Says (NYT)
Drug industry overtakes defense as main target of federal fraud investigations. Pharma makes so much money by bending or breaking the rules on off-label marketing that the fines are worth it. (12/21) Read more
Experts say the trend is partly linked to effective psychotropic drugs (Wellbutrin for depression, Adderall for attention disorder, Abilify for bipolar disorder) that have allowed students to attend college who otherwise might not have functioned in a campus setting. Read more
To see doctors and nutritionists give voice to so much common sense is truly encouraging. Actually, most of them have been saying something like this all along. Their message to eat a balanced diet just wasn’t titillating enough to get the press coverage it deserved. Read more
A reversal on carbs (LA Times)
The country’s big low-fat message backfired. The overemphasis on reducing fat caused the consumption of carbohydrates and sugar in our diets to soar. That shift may be linked to the biggest health problems in America today.
Mental Health Needs Seen Growing at Colleges (NYT)
70s students saw college counselors for existential crisis: Who am I? “Now they’re bringing in life stories involving extensive trauma, a history of serious mental illness, eating disorders, self-injury, alcohol and other drug use.” Read more
I tried to explain that my colleagues and I needed to know the cause of the accidents and the nature of the trauma. Then a bearded tall man approached me “ask me!” he said. I immediately recognised the “plainclothes”. “I wanted to know”, I began. He locked his intense hatred into my eyes. “You have no right to ask any question. At least if you don’t want to join them.” And he pointed to the line of the victims lying on the beds and on the floor. Read more
An epidemic of loneliness (Lancet)
“Doctor”, she asks, “can you give me a cure for loneliness?” Patients whose only misunderstanding is to have lived to an age when they are no longer coveted by a society addicted to youth.
Tackling loneliness in the holidays (Lancet)
The holiday season is the time of the year when our desire for social contact is most likely to outstrip what our circumstances will allow; it is into this gap that loneliness creeps. Read more
Yes, we want affordable health care. No, we don’t want the government interfering in our personal lives. Don’t get emotionally manipulated into believing we can’t have the first without the second. Read more
The U-bend of life: Why, beyond middle age, people get happier as they get older (Economist)
Life improves after the stressful middle years. Interesting comments
Can Congress Force You to Be Healthy? (NYT)
A good point or the wrong question? Virginia judge’s ruling could prove irresistible to the Supreme Court Read more
There’s something inherently liberating about realizing there’s nothing actually wrong with you. It’s just an arbitrary message you’ve received all your life. Society controls people’s behavior by making them feel guilty about not being normal, but who gets to decide what’s normal? Read more
Each one of us who makes the decision to have cosmetic surgery changes the standards of acceptable appearance in which everyone else must live. In that sense, the decision to have cosmetic surgery is communal and thus ultimately moral. Read more
Where was the medical profession? Doctors are supposed to feel an acute responsibility to deliver the best health service to the whole population. It is on this basis that they ask the public and government to support generous pay increases and terms and conditions of service. These attitudes and behaviours are what we commonly mean by professionalism. It seems that doctors failed completely to live up to the rhetoric of their commitment to professional values. Read more
In most branches of medicine, we deal more commonly with old people. So we become much more enthusiastic when a young person comes along. We have more in common with and are more attracted to him or her. Doctors have a limited amount of time, so the younger and more attractive you are, the more likely you are to get more of our time. Read more
Bangladeshi chest doctor Kazi Saifuddin Bennoor has seen many misleading cigarette advertisements, but the one that suggested smoking could make childbirth easier plumbed new depths. … “[I]f a lady smokes, her baby will be smaller and it will be easier to deliver, the labour will be less painful“. Read more
It might be thought the height of poor taste to ascribe good fortune to a healthy man with a young family struck down at the age of sixty by an incurable degenerative disorder from which he must shortly die. But there is more than one sort of luck. To fall prey to a motor neuron disease is surely to have offended the Gods at some point, and there is nothing more to be said. But if you must suffer thus, better to have a well-stocked head. Read more
Ultimately, decisions about a country’s health are not a matter of science, medicine, research, or scholarship. They are essentially political choices. When the US leans right, the solution to the health care crisis is to emphasize personal responsibility (aka prevention through healthy lifestyles). When the country leans left, there’s increased interest in the “negative externalities” of advanced market capitalism (pollution, climate change, ethnic inequities). Neither one is exclusively right or wrong. But when the political climate puts the spotlight on patients who are guilty of unhealthy lifestyles, the focus goes dim on those “fundamental mechanisms leading to disease” that have nothing to do with lifestyle. We lose sight of the genuine solutions that an increased focus on those mechanisms could provide. Read more
Another great example of neoliberal insistence on personal responsiblity: In a 1980 report on the impact of carbon dioxide on climate change – a report requested by Congress – physicist and free-marketer William Nierenberg argued that we should do nothing to prevent climate change because people could simply migrate. “Not only have people moved [in the past], but they have taken with them their horses, dogs, children, technologies, crops, livestock, and hobbies. It is extraordinary how adaptable people can be.” Read more
Here then, we have the highest court in the land saying that those poor people with pre-paid water meters must not think that their water supply has discontinued when their taps run dry because the meter has cut the supply … they must imagine that it is “temporarily suspended” until such time as they can find the money to buy more water credit or until the next month arrives. Such “logic” … is … an insult both to the poor and to the constitutional imperatives of justice and equality. Read more
The supply of water was controlled by prepaid water meters that were installed for each household. Once the “free” allocation was exhausted, the water meters prevented additional water from flowing. That included emergency situations, such as the need to put out a fire. When a fire broke out in Phiri, an urban neighborhood of Soweto in Johannesburg, the outcome was tragic. Read more
in the developing world, over a billion people lack access to safe drinking water. Many women spend over six hours a day collecting enough water for their families (and wait until after dark to relieve themselves). When it comes to sanitation, 2.6 billion do not even have access to “improved” pit latrines – open pits with simple modifications to reduce flies and odors. Read more
From Buenos Aires to Atlanta to Jakarta, the liquid everybody needs–and will need a lot more of in the future–is going private, creating one of the world’s great business opportunities. The dollars at stake are huge. … Water promises to be to the 21st century what oil was to the 20th century: the precious commodity that determines the wealth of nations. … To turn a profit, [the privatizing corporation] must collect far more in water charges than it pays out in salaries, equipment, and interest. Read more
In one of the best scenes of the episode, medical professionals are standing by in the operating room, ready to receive the organs that are about to be removed. Chief Resident Miranda Bailey — my favorite character (played by Chandra Wilson) — is emotionally distraught at the loss of George. She asks for information about the destination of the eyes, the liver, the heart. The details of the organ donations – the benefits they will bring to the particular children and adults who have been waiting and hoping for this opportunity – are quite moving. Read more
The Civil Rights Act barred private businesses such as hotels, bus companies, and restaurants from refusing to sell their products or services to customers on the basis of race. The ACA bars state-licensed health insurers from refusing to sell products to individuals on the basis of health status. … This basic reconceptualization of health insurance as a good whose availability is a matter of national public interest essentially frames health insurance the way the Civil Rights Act framed other business interests. Read more
There was no way to use a catheter or give him an IV. We solved the problem the way we would have 50 years ago, with warm compresses and oral antispasmodics. … It has been very important that the [medical] team include older physicians, like me. Read more
