Here’s why health insurance is not like broccoli

By Ezekiel Emanuel

The Great Debate - Reuters

Originally published March 29, 2012

The fate of universal healthcare coverage that the United States has been trying to achieve for over 100 years may boil down to broccoli.

The broccoli argument is simple and was frequently referred to in the recent Supreme Court arguments: If the government can require people to buy health insurance, why couldn’t it require people to buy broccoli, which also enhances people’s health? This question, at the heart of the conservative objection to the individual mandate to buy health insurance, illustrates the so-called limiting principle the Supreme Court must rule on: Under the Commerce Clause, does Congress have the constitutional power to compel people to act, in ways they might object to, when their inaction can harm others?

The High Court never got clear on why health insurance is not like broccoli and can thus be constitutionally regulated. There are two important differences that inform the principle for limiting congressional power to compel people to purchase goods and services.

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The difference between broccoli and health insurance is simple. It leads to a clear limiting principle. Congress can urge people to eat their broccoli, but not compel them to buy it, because the broccoli market will function regardless of what people do. Congress can compel people to buy their health insurance because otherwise there will be no health insurance market.

The entire story is here.

Doctors' Smartphones And iPads May Be Distracting

By Jenny Gold
Kaiser Health News
This story was produced in collaboration with 
Originally published on March 26, 2012

Dr. Henry Feldman is a mobile technology evangelist. He struts boldly around Beth Israel Deaconess Medical Center, where he works as a hospitalist and programmer, armed with an iPhone and iPad. His nickname is the iDoctor.

Mobile technology, he argues, has made him a better, faster physician. "It lets me do everything I could do if I was sitting at my desktop at the patient's bedside, and actually some things I couldn't easily do," he explains enthusiastically. That includes showing patients impressive new animated apps, diagrams, medical records and even photos from their own surgeries as they recover. 

Beth Israel, a teaching hospital for Harvard Medical School, is one of the most technically advanced hospitals in the country, especially when it comes to mobile technology.

But not everyone at the hospital is quite as gung-ho as Feldman. Recently, Dr. John Halamka, the hospital's chief information officer who helped usher Beth Israel into the electronic world, has been issuing a warning: mobile technology also has a serious downside—it may distract doctors from patient care.

The entire story is here.

Suicides Highlight Failures of Veterans' Support System

By Aaron Glanz
The New York Times
Originally published March 24, 2012

Francis Guilfoyle, a 55-year-old homeless veteran, drove his 1985 Toyota Camry to the Department of Veterans Affairs campus in Menlo Park early in the morning of Dec. 3, took a stepladder and a rope out of the car, threw the rope over a tree limb and hanged himself.

It was an hour before his body was cut down, according to the county coroner's report.

"When I saw him, my heart just sank," said Dennis Robinson, 51, a formerly homeless Army veteran who discovered Mr. Guilfoyle's body.

"This is supposed to be a safe place where a vet can get help. Something failed him."

Mr. Guilfoyle's death is one of a series of recent suicides by veterans who live in the jurisdiction of the Department of Veterans Affairs Palo Alto Health Care System.

The Palo Alto V.A. is one of the agency's elite campuses, home to the Congressionally chartered National Center for Post-Traumatic Stress Disorder.

The poor record of the Department of Veterans Affairs in decreasing the high suicide rate of veterans has already emerged as a major issue for policy makers and the judiciary.

On Wednesday, the V.A. Inspector General in Washington released the results of a nine-month investigation into the May 2010 death of another veteran, William Hamilton.

The report said social workers at the department in Palo Alto made "no attempt" to ensure that Hamilton, a mentally ill 26-year-old who served in Iraq, was hospitalized at a department facility in the days before he killed himself by stepping in front of a train in Modesto.

The story is here.

Military-Funded Brain Science Sparks Controversy

By Charles Choi

InnovationNewsDaily

Originally published March 20, 2012

Brain research and associated advances such as brain-machine interfaces that are funded by the U.S. military and intelligence communities raise profound ethical concerns, caution researchers who cite the potentially lethal applications of such work and other consequences.

Rapid advances in neuroscience made over the last decade have many dual-use applications of both military and civilian interest. Researchers who receive military funding — with the U.S. Department of Defense spending more than $350 million on neuroscience in 2011 — may not fully realize how dangerous their work might be, say scientists in an essay published online today (March 20) in the open-access journal PLoS Biology.

The entire story is here.

Preventing Suicide on Campus May Mean Fences and Nets as Well as Counseling

Chronicle of Higher Education

By Michael Stratford

Originally published March 25, 2012

The families of students who die by suicide often seek to hold colleges responsible.

Lawsuits typically claim that an institution failed to pick up on warning signs or to adequately protect a student whom campus officials knew to be suicidal.

Far less often does a legal action cite, say, the absence of fences on a bridge.

But a lawsuit now pending against Cornell University in federal court takes that approach: It argues that the institution didn't do enough to restrict access to a particular means of suicide.

Specifically, Howard I. Ginsburg alleges that Cornell was negligent for not having installed barriers on the campus bridge where, in February 2010, his son, Bradley, jumped to his death.

A judge this month rejected the university's effort to have the suit dismissed, ruling that the case could continue.

Limiting access to certain methods of suicide, a strategy known as means restriction, has been gaining traction among mental-health researchers.

Some suicides can be prevented, the logic goes, if it's more challenging for an impulsive individual to harm himself.

But on most campuses, that strategy has not taken hold.

 Instead, counseling and education tend to be the centerpiece of suicide-prevention efforts.

 Only at a few institutions, mainly where students' suicides have made headlines in recent years--like Cornell, New York University, and the Massachusetts Institute of Technology--have administrators acted, beyond locking doors to roofs, to significantly alter physical elements of the campus in the name of prevention.

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For not taking steps to block bridge suicides, the lawsuit says, both Cornell and the city were "negligent, careless, and reckless in failing to provide for safety and protection for vulnerable or impulsive individuals."

University and city officials, Mr. Ginsburg argues, knew that area bridges were a recurring site of suicides and therefore had an obligation to restrict access to them.

Cornell says it is "vigorously" fighting the suit, which Mr. Ginsburg filed in November.

The entire story is here.

A subscription to Chronicle of Higher Education is needed for the full article.

Thanks to Ken Pope for this information.

Counseling Conflict

By Allie Grasgreen
Inside Higher Ed
Originally published March 26, 2012

Georgia State University’s decision this month to replace its counseling center staff with outsourced employees is worrying those in the field, who say such moves are extremely rare and will likely prove detrimental to the mental health services available to students.

The shift is doubly troubling because a number of former staff members (as well as others in the field) are accusing the university of outsourcing services as a retaliation for their complaints that some university policies involving the counseling center had the potential to hurt students. While the outsourcing was announced shortly after the complaints were made, the university says there was no relationship between the two developments. The director and two associate directors will stay on as full-time employees of Georgia State, spokeswoman Andrea Jones said.

The university says it replaced its nine counseling center clinical positions (three of which were vacant) with contracted employees “in order to increase institutional effectiveness in delivering mental health services to students.”

Because the staff were eliminated through a “reduction in force” process, which is done without regard to an employee’s performance, the change could not have been retaliatory, Jones said. The new model will mimic that of Georgia State’s psychiatry services and health center (both of which commonly use independent contractors).

The entire story is here.

Publication Bias Mars Psychiatric Drug Literature

By John Gever, Senior Editor

MedPage Today

Originally Published March 23, 2012

Several negative studies of second-generation antipsychotic drugs were never published, leading to an exaggerated portrayal of the agents' effectiveness in the scientific literature, researchers said.

Of 24 registration trials involving eight products submitted to the FDA, four went unpublished in medical journals -- three of which found that the study drug's efficacy was equivalent to placebo or inferior to an active comparator, according to Erick H. Turner, MD, of Oregon Health and Science University in Portland, and colleagues.

Moreover, five of the 20 published trials "showed some evidence of outcome reporting bias," the researchers wrote online in PLoS Medicine.

Turner and colleagues also noted that the scale of the publication bias was relatively modest -- exaggerating the drugs' effectiveness relative to placebo or active comparators by a nonsignificant 8%. The weighted-average effect size in the published trials was 0.47 (95% CI 0.40 to 0.54), which declined only to 0.44 (95% CI 0.37 to 0.50) when the unpublished trials were included.

The entire review is here.

The research paper is below

Publication Bias in Antipsychotic Trials

A Bizarre Outcome on Generic Drugs

The New York Times
The Opinion Pages – Editorial
Originally published March 23, 2012

Dozens of suits against drug companies have been dismissed in federal and state courts because of a decision by the Supreme Court last year that makes it virtually impossible to sue generic manufacturers for failing to provide adequate warning of a prescription drug’s dangers. This outrageous denial of a patient’s right to recover fair damages makes it imperative that Congress or the Food and Drug Administration fashion a remedy.

This situation is particularly bizarre because patients using the brand-name drug can sue when those using the generic form of the drug cannot, as explained by Katie Thomas in The Times on Wednesday. In 2008, the Supreme Court ruled that a Vermont woman who had her hand and forearm amputated because of gangrene after being injected with a brand name antinausea drug could sue the manufacturer for inadequate warning of the risks; she won $6.8 million from Wyeth.

The entire editorial is here.

The Ethical Dangers of Rational Decision Making

The Ethical Dangers of Rational Decision Making