What Deathbed Visions Teach Us About Living

Phoebe Zerwick

The New York Times

Originally posted March 12, 2024

Here is an excerpt:

At the time, only a handful of published medical studies had documented deathbed visions, and they largely relied on secondhand reports from doctors and other caregivers rather than accounts from patients themselves. On a flight home from a conference, Kerr outlined a study of his own, and in 2010, a research fellow, Anne Banas, signed on to conduct it with him. Like Kerr, Banas had a family member who, before his death, experienced visions — a grandfather who imagined himself in a train station with his brothers.

The study wasn’t designed to answer how these visions differ neurologically from hallucinations or delusions. Rather, Kerr saw his role as chronicler of his patients’ experiences. Borrowing from social-science research methods, Kerr, Banas and their colleagues based their study on daily interviews with patients in the 22-bed inpatient unit at the Hospice campus in the hope of capturing the frequency and varied subject matter of their visions. Patients were screened to ensure that they were lucid and not in a confused or delirious state. The research, published in 2014 in The Journal of Palliative Medicine, found that visions are far more common and frequent than other researchers had found, with an astonishing 88 percent of patients reporting at least one vision. (Later studies in Japan, India, Sweden and Australia confirm that visions are common. The percentages range from about 20 to 80 percent, though a majority of these studies rely on interviews with caregivers and not patients.)

In the last 10 years, Kerr has hired a permanent research team who expanded the studies to include interviews with patients receiving hospice care at home and with their families, deepening the researchers’ understanding of the variety and profundity of these visions. They can occur while patients are asleep or fully conscious. Dead family members figure most prominently, and by contrast, visions involving religious themes are exceedingly rare. Patients often relive seminal moments from their lives, including joyful experiences of falling in love and painful ones of rejection. Some dream of the unresolved tasks of daily life, like paying bills or raising children. Visions also entail past or imagined journeys — whether long car trips or short walks to school. Regardless of the subject matter, the visions, patients say, feel real and entirely unique compared with anything else they’ve ever experienced. They can begin days, even weeks, before death. Most significant, as people near the end of their lives, the frequency of visions increases, further centering on deceased people or pets. It is these final visions that provide patients, and their loved ones, with profound meaning and solace.

The info is here.

Here is a summary:

The article explores the phenomenon of deathbed visions experienced by dying individuals. These visions involve seeing and communicating with angels and departed loved ones, instilling a sense of peace and anticipation for the afterlife. The experiences are described as distinct from hallucinations and are often witnessed by family members and medical staff present during the individual's passing. The article emphasizes how these visions can transform perceptions of death, inspiring awe and encouraging a focus on love and spiritual well-being in daily life.

As guns rise to leading cause of death among US children, research funding to help prevent and protect victims lags

Deidre McPhillips

CNN.org

Originally posted 7 Feb 24

More children die from guns than anything else in the United States, but relatively little funding is available to study how to prevent these tragedies.

From 2008 to 2017, about $12 million in federal research awards were granted to study pediatric firearm mortality each year – about $600 per life lost, according to a study published in Health Affairs. Motor vehicle crashes, the leading cause of death among children at the time, received about $26,000 of research funding per death, while funding to study pediatric cancer, the third leading cause of death, topped $195,000 per death.

By 2020, firearm deaths in the US had reached record levels and guns had surpassed car crashes to become the leading cause of death among children. More than 4,300 children and teens died from guns in 2020, according to data from the US Centers for Disease Control and Prevention – a 27% jump from 2017, and a number that has only continued to rise. But federal dollars haven’t followed proportionately.

Congress has earmarked about $25 million for firearm injury prevention research each year since 2020, split evenly between the CDC and the National Institutes of Health. Even if all of those dollars were spent on studies focused on pediatric deaths from firearm injury, it’d still be less than $6,000 per death.

The info is here.

The article highlights the critical need for increased research funding to prevent firearm-related deaths among children and teens in the U.S. Despite guns becoming the leading cause of death in this demographic, research funding remains insufficient. This lack of investment hinders the development of life-saving solutions and policies to address gun violence effectively. To protect our youth and combat this pressing issue, substantial and sustained funding for research on gun violence prevention is imperative.

Or, we could have more sensible gun laws to protect children and adolescents.

Alcohol overuse causes 140,000 American deaths annually. Why is it so undertreated?

Melinda Fawcett

Psychiatry.ufl.edu

Originally posted 28 Nov 23

Here is an excerpt:

How to treat the disorder

In the last decade, the medical community has come to recognize AUD as a disease that (like all others) needs medical treatment through a range of interventions. With new treatments coming out every day, hope exists that in the years to come more and more people will receive the care they need.

For those with the most severe forms of AUD, treatment aims at stopping the individual’s alcohol consumption entirely (while recognizing that having a drink or breaking abstinence isn’t a failure, but an almost inevitable part of the recovery cycle).

“What’s happened in the last probably 50 years or so is there’s a more medicalized understanding,” said Humphreys. “So there’s been the rise of neuroscience that looks at things like how the brain changes with repeated administration of alcohol, how that limits things like self-control, how that increases phenomena like craving.”

And as with any other mental health diagnosis, successful treatment for AUD often boils down to a combination of therapy and medication, the experts Vox spoke to said. Just as depression is treated with medication to balance chemicals in the brain, and therapy to help patients unlearn harmful behaviors, AUD often needs the same combination of treatments, said Disselkoen.

The Federal Drug Administration approved the first medication to treat AUD, disulfiram, in 1951. Disulfiram, whose brand name is Antabuse, is a daily pill that causes someone to fall ill — face redness, headache, nausea, sweating, and more — if they drink even a small amount of alcohol. Disulfiram is safe and effective, but the same characteristic that makes it successful (the way it induces illness) also makes it unpopular among patients, said Nixon.

The info is here.

Key points:

• Alarming death toll: 140,000 Americans die annually from alcohol overuse, highlighting a major public health crisis.
• Undertreatment disparity: Unlike other dangerous substances, alcohol issues lack the same attention and treatment resources.
• Neurological changes: Repeated alcohol misuse alters the brain, making it a serious health condition, not just a social issue.
• Market forces: The powerful alcohol industry and its growing revenue contribute to lax regulations and limited intervention.
• Policy gap: Inadequate taxation fails to curb consumption, while other harmful substances face stricter controls.
• Blind spot in drug policy: Recognizing alcohol as a harmful drug with addiction potential is crucial for tackling the problem.

Predictable, preventable medical errors kill thousands yearly. Is it getting any better?

Karen Weintraub

USAToday.com

Originally posted 3 May 23

Here are two excerpts:

A 2017 study put the figure at over 250,000 a year, making medical errors the nation's third leading cause of death at the time. There are no more recent figures.

But the pandemic clearly worsened patient safety, with Leapfrog's new assessment showing increases in hospital-acquired infections, including urinary tract and drug-resistant staph infections as well as infections in central lines ‒ tubes inserted into the neck, chest, groin, or arm to rapidly provide fluids, blood or medications. These infections spiked to a 5-year high during the pandemic and remain high.

"Those are really terrible declines in performance," Binder said.

Patient safety: 'I've never ever, ever seen that'

Not all patient safety news is bad. In one study published last year, researchers examined records from 190,000 patients discharged from hospitals nationwide after being treated for a heart attack, heart failure, pneumonia or major surgery. Patients saw far fewer bad events following treatment for those four conditions, as well as for adverse events caused by medications, hospital-acquired infections, and other factors.

It was the first study of patient safety that left Binder optimistic. "This was improvement and I've never ever, ever seen that," she said.

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On any given day now, 1 of every 31 hospitalized patients acquires an infection while hospitalized, according to a recent study from the Centers for Disease Control and Prevention. This costs health care systems at least $28.4 billion each year and accounts for an additional $12.4 billion from lost productivity and premature deaths.

"That blew me away," said Shaunte Walton, system director of Clinical Epidemiology & Infection Prevention at UCLA Health. Electronic tools can help, but even with them, "there's work to do to try to operationalize them," she said.

The patient experience also slipped during the pandemic. According to Leapfrog's latest survey, patients reported declines in nurse communication, doctor communication, staff responsiveness, communication about medicine and discharge information.

Boards and leadership teams are "highly distracted" right now with workforce shortages, new payment systems, concerns about equity and decarbonization, said Dr. Donald Berwick, president emeritus and senior fellow at the Institute for Healthcare Improvement and former administrator of the Centers for Medicare & Medicaid Services.

The info is here.

Are We Ready for AI to Raise the Dead?

Jack Holmes

Esquire Magazine

Originally posted 4 May 24

Here is an excerpt:

You can see wonderful possibilities here. Some might find comfort in hearing their mom’s voice, particularly if she sounds like she really sounded and gives the kind of advice she really gave. But Sandel told me that when he presents the choice to students in his ethics classes, the reaction is split, even as he asks in two different ways. First, he asks whether they’d be interested in the chatbot if their loved one bequeathed it to them upon their death. Then he asks if they’d be interested in building a model of themselves to bequeath to others. Oh, and what if a chatbot is built without input from the person getting resurrected? The notion that someone chose to be represented posthumously in a digital avatar seems important, but even then, what if the model makes mistakes? What if it misrepresents—slanders, even—the dead?

Soon enough, these questions won’t be theoretical, and there is no broad agreement about whom—or even what—to ask. We’re approaching a more fundamental ethical quandary than we often hear about in discussions around AI: human bias embedded in algorithms, privacy and surveillance concerns, mis- and disinformation, cheating and plagiarism, the displacement of jobs, deepfakes. These issues are really all interconnected—Osama bot Laden might make the real guy seem kinda reasonable or just preach jihad to tweens—and they all need to be confronted. We think a lot about the mundane (kids cheating in AP History) and the extreme (some advanced AI extinguishing the human race), but we’re more likely to careen through the messy corridor in between. We need to think about what’s allowed and how we’ll decide.

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Our governing troubles are compounded by the fact that, while a few firms are leading the way on building these unprecedented machines, the technology will soon become diffuse. More of the codebase for these models is likely to become publicly available, enabling highly talented computer scientists to build their own in the garage. (Some folks at Stanford have already built a ChatGPT imitator for around $600.) What happens when some entrepreneurial types construct a model of a dead person without the family’s permission? (We got something of a preview in April when a German tabloid ran an AI-generated interview with ex–Formula 1 driver Michael Schumacher, who suffered a traumatic brain injury in 2013. His family threatened to sue.) What if it’s an inaccurate portrayal or it suffers from what computer scientists call “hallucinations,” when chatbots spit out wildly false things? We’ve already got revenge porn. What if an old enemy constructs a false version of your dead wife out of spite? “There’s an important tension between open access and safety concerns,” Reich says. “Nuclear fusion has enormous upside potential,” too, he adds, but in some cases, open access to the flesh and bones of AI models could be like “inviting people around the world to play with plutonium.”

The article is here.

Yes, there was a Black Mirror episode (Be Right Back) about this issue.  The wiki is here.

San Francisco will allow police to deploy robots that kill

Janie Har

Associated Press

Originally posted 29 Nov 22

Supervisors in San Francisco voted Tuesday to give city police the ability to use potentially lethal, remote-controlled robots in emergency situations -- following an emotionally charged debate that reflected divisions on the politically liberal board over support for law enforcement.

The vote was 8-3, with the majority agreeing to grant police the option despite strong objections from civil liberties and other police oversight groups. Opponents said the authority would lead to the further militarization of a police force already too aggressive with poor and minority communities.

Supervisor Connie Chan, a member of the committee that forwarded the proposal to the full board, said she understood concerns over use of force but that “according to state law, we are required to approve the use of these equipments. So here we are, and it’s definitely not a easy discussion.”

The San Francisco Police Department said it does not have pre-armed robots and has no plans to arm robots with guns. But the department could deploy robots equipped with explosive charges “to contact, incapacitate, or disorient violent, armed, or dangerous suspect” when lives are at stake, SFPD spokesperson Allison Maxie said in a statement.

“Robots equipped in this manner would only be used in extreme circumstances to save or prevent further loss of innocent lives,” she said.

Supervisors amended the proposal Tuesday to specify that officers could use robots only after using alternative force or de-escalation tactics, or concluding they would not be able to subdue the suspect through those alternative means. Only a limited number of high-ranking officers could authorize use of robots as a deadly force option.

The info is here.

U.S. drug overdose deaths reached all-time high in 2021, CDC says

Berkeley Lovelace Jr.

NBC.com

Originally posted 11 MAY 22

More than 107,600 Americans died from drug overdoses last year, the highest annual death toll on record, the Centers for Disease Control and Prevention said Wednesday.

Overdose deaths increased 15 percent in 2021, up from an estimated 93,655 fatalities the year prior, according to a report from the CDC’s National Center for Health Statistics (NCHS), which collects data on a range of health topics, including drug use.

While the total number of deaths reached record highs, the increase appeared to slow compared to the change seen from 2019 to 2020, when overdose deaths rose 30 percent, according to the report.

It's still too early to say whether that slowdown will hold, said Farida Ahmad, a scientist at the health statistics center. The agency's latest report is considered provisional, meaning the data is incomplete and subject to change.

Even if the increase in overdose deaths is smaller compared to last year, the 2021 total is still a huge number, Ahmad said.

The data helps illustrate one of the consequences of the pandemic, which has seen an uptick in substance abuse amid widespread unemployment and more Americans reporting mental health issues.

Overdose-related deaths were already increasing before the pandemic, but there was "clearly a very sharp uptick during the pandemic," said Joseph Friedman, an addiction researcher at the University of California, Los Angeles. He published research in April that found drug overdose deaths among teenagers rose sharply over the last two years.

According to the NCHS report, fentanyl, a powerful synthetic opioid, was involved in the most overdose deaths in 2021: 71,238.

The info is here.

Enhanced Interplay of Neuronal Coherence and Coupling in the Dying Human Brain

R. Vicente, M. Rizzuto, et al. 

Front. Aging Neurosci., 22 February 2022

Abstract

The neurophysiological footprint of brain activity after cardiac arrest and during near-death experience (NDE) is not well understood. Although a hypoactive state of brain activity has been assumed, experimental animal studies have shown increased activity after cardiac arrest, particularly in the gamma-band, resulting from hypercapnia prior to and cessation of cerebral blood flow after cardiac arrest. No study has yet investigated this matter in humans. Here, we present continuous electroencephalography (EEG) recording from a dying human brain, obtained from an 87-year-old patient undergoing cardiac arrest after traumatic subdural hematoma. An increase of absolute power in gamma activity in the narrow and broad bands and a decrease in theta power is seen after suppression of bilateral hemispheric responses. After cardiac arrest, delta, beta, alpha and gamma power were decreased but a higher percentage of relative gamma power was observed when compared to the interictal interval. Cross-frequency coupling revealed modulation of left-hemispheric gamma activity by alpha and theta rhythms across all windows, even after cessation of cerebral blood flow. The strongest coupling is observed for narrow- and broad-band gamma activity by the alpha waves during left-sided suppression and after cardiac arrest. Albeit the influence of neuronal injury and swelling, our data provide the first evidence from the dying human brain in a non-experimental, real-life acute care clinical setting and advocate that the human brain may possess the capability to generate coordinated activity during the near-death period.

From the Discussion

The findings we report here are similar to the alterations in neuronal activity that have been observed in rodents, where an increase of low gamma band frequencies was observed 10–30 s after cardiac arrest (Borjigin et al., 2013). Our data reveals enhanced relative gamma power compared to other bands along with a decrease in theta. An interesting difference between the two studies can be observed when comparing phase-amplitude coupling (cross-frequency coupling): Post cardiac arrest, delta, theta, and alpha modulate low gamma activity in the rodent (Borjigin et al., 2013), whereas in the human brain, such modulation occurs in all gamma bands and is mostly mediated by alpha waves, to a lesser degree by theta rhythms. The alpha band is thought to critically interfere in cognitive processes by inhibiting networks that are irrelevant or disruptive (Klimesch, 2012). Given that cross-coupling between alpha and gamma activity is involved in cognitive processes and memory recall in healthy subjects, it is intriguing to speculate that such activity could support a last “recall of life” that may take place in the near-death state. Unlike previous reports, our study is the first to use full EEG placement, which allows a more complete neurophysiological analysis in a larger dimension. Further, the data was obtained from an acutely deteriorating patient. Previous human reports were limited to frontal cortex EEG signals that were analyzed by neuromonitoring devices, which may have captured artifacts and the focus was set on critically ill patients in chronic settings (Chawla et al., 2009, 2017). In line with our findings, electrical surges were also reported in these studies after cessation of blood circulation.

The case study is here.

Proposal for Revising the Uniform Determination of Death Act

Hastings Bioethics Center

Originally posted 18 FEB 22

Organ transplantation has saved many lives in the past half-century, and the majority of postmortem organ donations have occurred after a declaration of death by neurological criteria, or brain death. However, inconsistencies between the biological concept of death and the diagnostic protocols used to determine brain death–as well as questions about the underlying assumptions of brain death–have led to a justified reassessment of the legal standard of death. We believe that the concept of brain death, though flawed in its present application, can be preserved and promoted as a pathway to organ donation, but only after particular changes are made in the medical criteria for its diagnosis. These changes should precede changes in the Uniform Determination of Death Act (UDDA).

The UDDA, approved in 1981, provides a legal definition of death, which has been adopted in some form by all 50 states. It says that death can be defined as the irreversible cessation of circulatory and respiratory functions or of brain functions. The act defines brain death as “irreversible cessation of all functions of the entire brain, including the brainstem.” This description is based on a widely held assumption at the time that the brain is the master integrator of the body, such that when it ceases to function, the body would no longer be able to maintain integrated functions. It was presumed that this would result in both cardiac and pulmonary arrest and the death of the body as a whole. Now that assumption has been called into question by exceptional cases of individuals on ventilators who were declared brain dead but who continued to have function in the hypothalamus. 

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Revision of the UDDA should first defer to a revision of the guidelines. Clinical criteria for the diagnosis of “cessation of all functions of the entire brain” must include all pertinent functions, including hypothalamic functions such as hormone release and regulation of temperature and blood pressure, to avoid the specter of neurologic recovery in those who fulfill the current clinical criteria for the diagnosis of brain death.

It is likely that the failure to account for a full set of pertinent brain functions has led to inconsistent diagnoses and conflicting results. Such inconsistencies, although well-documented in a number of cases, may have been even more frequent but unrecognized because declaration of brain death is often a self-fulfilling prophecy: rarely do any life-sustaining interventions continue after the diagnosis is made.

To be consistent, transparent, and accurate, the cessation of function in both the cardiopulmonary and the neurological standard of the UDDA should be described as permanent (i.e., no reversal will be attempted) rather than irreversible (i.e., no reversal is possible). We recognize additional challenges in complying with the UDDA requirements that these cessation criteria for brain death include “all functions” of the “entire brain.” In the absence of universally accepted and easily implemented testing criteria, there may be real problems with being in perfect compliance with these legal criteria in spite of being in perfect compliance with the currently published medical guidelines. If the concept of brain death is philosophically valid, as we think is defensible, then the diagnostic guidelines should be corrected before any attempt is made to correct the UDDA. They must then “say what they mean and mean what they say” to eliminate any possibility of patients with persistent evidence of brain function, including hypothalamic function, being erroneously declared brain dead.

The info is here.

How FDA Failures Contributed to the Opioid Crisis

Andrew Kolodny, MD

AMA J Ethics. 2020;22(8):E743-750. 

doi: 10.1001/amajethics.2020.743.

Abstract

Over the past 25 years, pharmaceutical companies deceptively promoted opioid use in ways that were often neither safe nor effective, contributing to unprecedented increases in prescribing, opioid use disorder, and deaths by overdose. This article explores regulatory mistakes made by the US Food and Drug Administration (FDA) in approving and labeling new analgesics. By understanding and correcting these mistakes, future public health crises caused by improper pharmaceutical marketing might be prevented.

Introduction

In the United States, opioid use disorder (OUD) and opioid overdose were once rare. But over the past 25 years, the number of Americans suffering from OUD increased exponentially and in parallel with an unprecedented increase in opioid prescribing. Today, OUD is common, especially in patients with chronic pain treated with opioid analgesics, and opioid overdose is the leading cause of accidental death.

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Oversight Recommendations

While fewer clinicians are initiating long-term opioids, overprescribing is still a problem. According to a recently published report, more than 2.9 million people initiated opioid use in December 2017. The FDA’s continued approval of new opioids exacerbates this problem. Each time a branded opioid hits the market, the company, eager for return on its investment, is given an incentive and, in essence, a license to promote aggressive prescribing. The FDA’s continued approval of new opioids pits the financial interests of drug companies against city, state, and federal efforts to discourage initiation of long-term opioids.

To finally end the opioid crisis, the FDA must enforce the Food, Drug, and Cosmetic Act, and it must act on recommendations from the NAS for an overhaul of its opioid approval and removal policies. The broad indication on opioid labels must be narrowed, and an explicit warning against long-term use and high-dose prescribing should be added. The label should reinforce, rather than contradict, guidance from the CDC, the Department of Veterans Affairs, the Agency for Healthcare Research and Quality, and other public health agencies that are calling for more cautious prescribing.

The information is here.

New York’s Met museum to remove Sackler name from exhibits

Sarah Cascone

artnet.com

Originally posted 9 DEC 21

The Metropolitan Museum of Art in New York has dropped the Sackler name from its building. The move is perhaps the museum world’s most prominent cutting of ties with the disgraced family since their company Purdue Pharma’s guilty plea to criminal charges connected to marketing of addictive painkiller OxyContin in 2020.

The decision, which came after more than a yearlong review by the museum, was reportedly mutual and made “in order to allow the Met to further its core mission,” according to a joint statement issued by the Sackler family and the institution.

“Our families have always strongly supported the Met, and we believe this to be in the best interest of the museum and the important mission that it serves,” the descendants of Mortimer Sackler and Raymond Sackler said in a statement. “The earliest of these gifts were made almost 50 years ago, and now we are passing the torch to others who might wish to step forward to support the museum.”

Institutions have faced increasing pressure to sever relations with the Sacklers in recent years as part of a growing push to hold institutions and other cultural groups accountable over where their money is coming from. (Other donors that have come under fire include arms dealers and oil companies.)

Seven spaces at the Fifth Avenue flagship bore the Sackler name. The biggest was the Sackler Wing, which opened in 1978, and includes the Sackler Gallery for Egyptian Art, the Temple of Dendur in the Sackler Wing, and the 1987 addition of the Sackler Wing Galleries.

The day of the announcement, Patrick Radden Keefe, the author of Empire of Pain: The Secret History of the Sackler Dynasty, visited the museum to find that the family’s name had already been removed.

The information is here.

Drug Overdose Deaths Up 30% in Pandemic Year, Government Data Show

Joyce Frieden

MedPage Today 

Originally published 1 June 2021

Mortality from all types of drug overdoses increased by a whopping 30% over a 1-year period, Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA), reported at the FDA Science Forum.

Data from the National Center for Health Statistics from October 2019 to October 2020 shows that mortality from overdoses from all types of drugs increased 30%, from 70,669 deaths in October 2019 to 91,862 deaths in October 2020, "and I think that that is a number that is very, very chilling," Volkow said at the forum. Among those overdose deaths in both years, more than half came from synthetic opiates -- "the most notable presence is fentanyl," she said. There was also a 46% increase in overdose deaths from other psychostimulants, mainly methamphetamine, and a 38% increase in deaths from cocaine overdoses.

Having any kind of substance use disorder (SUD) also affects the risk of getting COVID-19, she continued. According to a study done by Volkow and colleagues, "Regardless of the specific type of substance use disorder -- legal or illegal -- there was a significant increase in the likelihood of people that have a substance use disorder to become infected," she said. Their study, which included electronic health records from 7.5 million patients with an SUD diagnosis, found that patients with a recent SUD diagnosis -- within the past year -- were nearly nine times more likely to contract COVID-19 than patients without that diagnosis; for those with opioid use disorder in particular, their odds of contracting COVID were 10 times higher.

The info is here.

Death as Something We Make

Mara Buchbinder

sapiens.org

Originally published 8 April 2021

Here are two excerpts:

While I learned a lot about what drives people to MAID (Medial Aid in Dying), I was particularly fascinated by what MAID does to death. The option transforms death from an object of dread to an anticipated occasion that may be painstakingly planned, staged, and produced. The theatrical imagery is intentional: An assisted death is an event that one scripts, a matter of careful timing, with a well-designed set and the right supporting cast. Through this process, death becomes not just something that happens but also something that is made.

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MAID renders not only the time of death but also the broader landscape of death open to human control. MAID allows terminally ill patients to choreograph their own deaths, deciding not only when but where and how and with whom. Part of the appeal is that one must go on living right up until the moment of death. It takes work to engage in all the planning; it keeps one vibrant and busy. There are people to call, papers to file, and scenes to set. Making death turns dying into an active extension of life.

Staging death in this way also allows the dying person to sidestep the messiness of death—the bodily fluids and decay—what the sociologist Julia Lawton has called the “dirtiness” of death. MAID makes it possible to attempt a calm, orderly, sanitized death. Some deliberately empty their bladder or bowels in advance, or plan to wear diapers. A “good death,” from this perspective, has not only an ethical but also an aesthetic quality.

Of course, this sort of staging is not without controversy. For some, it represents unwelcome interference with God’s plans. For people like Renee, however, it infuses one’s death with personal meaning and control.

The info is here.

The Antiscience Movement Is Escalating, Going Global and Killing Thousands

Peter J. Hotez

Scientific American

Originally posted 29 MAR 21

Antiscience has emerged as a dominant and highly lethal force, and one that threatens global security, as much as do terrorism and nuclear proliferation. We must mount a counteroffensive and build new infrastructure to combat antiscience, just as we have for these other more widely recognized and established threats.

Antiscience is the rejection of mainstream scientific views and methods or their replacement with unproven or deliberately misleading theories, often for nefarious and political gains. It targets prominent scientists and attempts to discredit them. The destructive potential of antiscience was fully realized in the U.S.S.R. under Joseph Stalin. Millions of Russian peasants died from starvation and famine during the 1930s and 1940s because Stalin embraced the pseudoscientific views of Trofim Lysenko that promoted catastrophic wheat and other harvest failures. Soviet scientists who did not share Lysenko’s “vernalization” theories lost their positions or, like the plant geneticist, Nikolai Vavilov, starved to death in a gulag.

Now antiscience is causing mass deaths once again in this COVID-19 pandemic. Beginning in the spring of 2020, the Trump White House launched a coordinated disinformation campaign that dismissed the severity of the epidemic in the United States, attributed COVID deaths to other causes, claimed hospital admissions were due to a catch-up in elective surgeries, and asserted that ultimately that the epidemic would spontaneously evaporate. It also promoted hydroxychloroquine as a spectacular cure, while downplaying the importance of masks. Other authoritarian or populist regimes in Brazil, Mexico, Nicaragua, Philippines and Tanzania adopted some or all of these elements.   

As both a vaccine scientist and a parent of an adult daughter with autism and intellectual disabilities, I have years of experience going up against the antivaccine lobby, which claims vaccines cause autism or other chronic conditions. This prepared me to quickly recognize the outrageous claims made by members of the Trump White House staff, and to connect the dots to label them as antiscience disinformation. Despite my best efforts to sound the alarm and call it out, the antiscience disinformation created mass havoc in the red states. 

The info is here.

Beyond burnout: For health care workers, this surge of Covid-19 is bringing burnover

Wendy Dean & Simon G. Talbot

statnews.com

Originally posted 25 Nov 20

Covid-19 is roaring back for a third wave. The first two substantially increased feelings of moral injury and burnout among health care workers. This one is bringing burnover.

Health care systems are scrambling anew. The crises of ICU beds at capacity, shortages of personal protective equipment, emergency rooms turning away ambulances, and staff shortages are happening this time not in isolated hot spots but in almost every state. Clinicians again face work that is risky, heart-rending, physically exhausting, and demoralizing, all the elements of burnout. They have seen this before and are intensely frustrated it is happening again.

Too many of them are leaving health care long before retirement. The disconnect between what health care workers know and how the public is behaving, driven by relentless disinformation, is unbearable. Paraphrasing a colleague, “How can they call us essential and then treat us like we are disposable?”

It is time for leaders of hospitals and health care systems to add another, deeper layer of support for their staff by speaking out publicly and collectively in defense of science, safety, and public health, even if it risks estranging patients and politicians.

Long before the pandemic emerged, the relationships between health care organizations and their staffs were already strained by years of cost-cutting that trimmed staffing levels, supplies, and space to the bone. Driven by changes in health care reimbursement structures, systems were “optimized” to the point that they were continually running at what felt like full capacity, with precious little slack to accommodate minor surges, much less one the magnitude of a global pandemic.

The info is here.

We Don’t Know How to Warn You Any Harder. America is Dying.

Umair Haque
eand.co
Originally poste 29 Aug 20

Right about now, something terrible is happening in America. Society is one tiny step away from the final collapse of democracy, at the hands of a true authoritarian, and his fanatics. Meanwhile, America’s silent majority is still slumbering at the depth and gravity of the threat.

I know that strikes many of you as somehow wrong. So let me challenge you for a moment. How much experience do you really have with authoritarianism? Any? If you’re a “real” American, you have precisely none.

Take it from us survivors and scholars of authoritarianism. This is exactly how it happens. The situation could not — could not — be any worse. The odds are now very much against American democracy surviving.

If you don’t believe me, ask a friend. I invite everyone who’s lived under authoritarianism to comment. Those of us how have?

We survivors of authoritarianism have a terrible, terrible foreboding, because we are experiencing something we should never do: deja vu. Our parents fled from collapsing societies to America. And here, now, in a grim and eerie repeat of history, we see the scenes of our childhoods played out all over again. Only now, in the land that we came to. We see the stories our parents recounted to us happening before our eyes, only this time, in the place they brought us to, to escape from all those horrors, abuses, and depredations.

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There is a crucial lesson there. America already has an ISIS, a Taliban, an SS waiting to be born. A group of young men willing to do violence at the drop of a hat, because they’ve been brainwashed into hating. The demagogue has blamed hated minorities and advocates of democracy and peace for those young men’s stunted life chances, and they believe him. That’s exactly what an ISIS is, what a Taliban is, what an SS is. The only thing left to do by an authoritarian is to formalize it.

But when radicalized young men are killing people they have been taught to hate by demagogues right in the open, on the streets — a society has reached the beginnings of sectarian violence, the kind familiar in the Islamic world, and is at the end of democracy’s road.

The info is here.

Trump lied about science

H. Holden Thorp
Science
Originally published 11 Sept 20

When President Donald Trump began talking to the public about coronavirus disease 2019 (COVID-19) in February and March, scientists were stunned at his seeming lack of understanding of the threat. We assumed that he either refused to listen to the White House briefings that must have been occurring or that he was being deliberately sheltered from information to create plausible deniability for federal inaction. Now, because famed Washington Post journalist Bob Woodward recorded him, we can hear Trump’s own voice saying that he understood precisely that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was deadly and spread through the air. As he was playing down the virus to the public, Trump was not confused or inadequately briefed: He flat-out lied, repeatedly, about science to the American people. These lies demoralized the scientific community and cost countless lives in the United States.

Over the years, this page has commented on the scientific foibles of U.S. presidents. Inadequate action on climate change and environmental degradation during both Republican and Democratic administrations have been criticized frequently. Editorials have bemoaned endorsements by presidents on teaching intelligent design, creationism, and other antiscience in public schools. These matters are still important. But now, a U.S. president has deliberately lied about science in a way that was imminently dangerous to human health and directly led to widespread deaths of Americans.

This may be the most shameful moment in the history of U.S. science policy.

In an interview with Woodward on 7 February 2020, Trump said he knew that COVID-19 was more lethal than the flu and that it spread through the air. “This is deadly stuff,” he said. But on 9 March, he tweeted that the “common flu” was worse than COVID-19, while economic advisor Larry Kudlow and presidential counselor Kellyanne Conway assured the public that the virus was contained. On 19 March, Trump told Woodward that he did not want to level with the American people about the danger of the virus. “I wanted to always play it down,” he said, “I still like playing it down.” Playing it down meant lying about the fact that he knew the country was in grave danger.

The info is here.

Our morally unserious president on display in Kenosha

Michael Sean Winters
National Catholic Reporter
Originally posted 4 September 20

President Donald Trump went to Kenosha, Wisconsin, this week to "survey the property damage" according to a White House transcript. He spoke a lot about law and order and very little about justice, as if the concepts are not necessarily related. To him, they probably are not.

A morally serious person would begin any examination of the damage in Kenosha with a look at an MRI of Jacob Blake's shattered torso. Blake was shot seven times in the back — reports said he was shot at "point blank range," but that phrase covers a range of distances — the gun only a few feet from his body. The video made the shooting look like a public execution.

Donald Trump is not a morally serious person.

A morally serious person would continue his survey of the damage in Kenosha by visiting with the family of Jacob Blake, especially his three young sons who witnessed the shooting. They are ages 3, 5 and 8, and the trauma to which they were exposed is horrific to contemplate. A morally serious person would express sympathy with the family and the community, mindful of how much more shocking the shocking video of Blake's shooting was if you knew the victim.

Donald Trump is not a morally serious person.

A morally serious person would understand that, while it is entirely fitting for the nation's chief magistrate to mourn the death of Aaron "Jay" Danielson, the 39-year old Trump supporter gunned down on the streets of Portland, Oregon, it is wrong to mourn his death publicly without mentioning the shooting of Blake, on the very day you are going to Kenosha. Such uneven treatment epitomizes the very reason it is still necessary to remind the nation that Black lives matter.

Donald Trump is not a morally serious person.

A morally serious person would inquire into the legacy of racism, structural racism, in Kenosha and elsewhere, the racism that made the shooting of Blake horrifying but not surprising. A morally serious person would not take refuge in chatter about "a few bad apples" but confront the police culture that permits such bad apples to poison the bushel. A morally serious person would work, and work hard, at finding ways to ameliorate the effects of racism and call fellow citizens to that deep examination of conscience every episode of police brutality against Black men demands.

Donald Trump is not a morally serious person.

The info is here.

An experiment in end-of-life care: Tapping AI’s cold calculus to nudge the most human of conversations

Rebecca Robbins
statnews.com
Originally posted 1 July 20

Here is an excerpt:

The architects of Stanford’s system wanted to avoid distracting or confusing clinicians with a prediction that may not be accurate — which is why they decided against including the algorithm’s assessment of the odds that a patient will die in the next 12 months.

“We don’t think the probability is accurate enough, nor do we think human beings — clinicians — are able to really appropriately interpret the meaning of that number,” said Ron Li, a Stanford physician and clinical informaticist who is one of the leaders of the rollout there.

After a pilot over the course of a few months last winter, Stanford plans to introduce the tool this summer as part of normal workflow; it will be used not just by physicians like Wang, but also by occupational therapists and social workers who care for and talk with seriously ill patients with a range of medical conditions.

All those design choices and procedures build up to the most important part of the process: the actual conversation with the patient.

Stanford and Penn have trained their clinicians on how to approach these discussions using a guide developed by Ariadne Labs, the organization founded by the author-physician Atul Gawande. Among the guidance to clinicians: Ask for the patient’s permission to have the conversation. Check how well the patient understands their current state of health.

And don’t be afraid of long moments of silence.

There’s one thing that almost never gets brought up in these conversations: the fact that the discussion was prompted, at least in part, by an AI.

Researchers and clinicians say they have good reasons for not mentioning it.

”To say a computer or a math equation has predicted that you could pass away within a year would be very, very devastating and would be really tough for patients to hear,” Stanford’s Wang said.

The info is here.

San Quentin’s coronavirus outbreak shows why ‘herd immunity’ could mean disaster

Rong-Gong Lin II and Kim Christensen
The Los Angeles Times
Originally published 11 August 20

Here are two excerpts:

San Quentin is an imperfect setting to help understand when herd immunity might be achieved. Prisons are crowded settings that will promote coronavirus transmission more so than among people in other settings, like those who live in single-family homes.

But the San Quentin experience — as well as other data — does show that, in the absence of a vaccine, “in order to get to something that approaches herd immunity, we’re going to have to get something well on the far side of 50% of people infected,” Rutherford said. “Which comes with a resultant large cost in mortality and severe morbidity.

“If you believe the San Quentin stuff, you got to get up to way-up-there before you start seeing slowing of transmission,” Rutherford said.

Dr. Anthony Fauci, the U.S. government’s top infectious diseases expert, last week guessed it will probably require 50% to 75% of a population to be immune before achieving herd immunity — a goal that should be achieved not just through infected people recovering but also through vaccination.

California has a long way to go before the vast majority of residents have been infected.

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Sweden famously pursued a herd immunity strategy when it decided not to impose a severe lockdown.

But now, Sweden has among the highest mortality rates among European countries, and has a worse rate than that of the United States.

The info is here.