By Jon C. Tilburt and Christine Cassel
JAMA. 2013;309(8):773-774. doi:10.1001/jama.2013.368.
The ethics of rationing health care resources has been debated for decades. Opponents of rationing are concerned that societal interests will supplant respect for individual patient choice and professional judgment. Advocates argue that injustices in the current system necessitate that physicians use resources prudently on behalf of society, even in their daily work with individual patients. The debate is important, potentially divisive, and unavoidable.
Various groups have championed the cause of medicine practiced leanly, consistent with the professional responsibility to use resources wisely. These initiatives, which champion “parsimonious medicine,” have highlighted the 20% of routine practices in US medicine that add no demonstrable value to health care but that persist in the inertia and rituals of clinical work. The specialty societies and the Choosing Wisely collaborative outline commonsense principles for avoiding unnecessary, wasteful care.
Recent calls for waste avoidance and parsimonious care are not just a clever way to help physicians ration health care. Despite the intuitive similarity between themes in rationing and waste avoidance, the ethical rationales underlying the two differ considerably.
The entire article is here.
Friday, March 8, 2013
Thursday, March 7, 2013
Hitler's Philosophers, By Yvonne Sherratt
This book tells the disturbing and important story of how major thinkers abetted genocide
By John Gray - Book Review
The Independent
Originally published February 23, 2013
The only German philosophy professor who actively resisted the Nazis is nowadays virtually unknown. Though one or two scholarly monographs have appeared on him, Kurt Huber will not be found on any university syllabus. The silence that has swallowed his name and his works is almost as complete as that which followed when, after being stripped of his university post and doctoral degree by a Nazi People's Court, he was executed by guillotine in July 1943 for writing a pamphlet against National Socialism as a member of the White Rose resistance group.
A conservative Catholic who produced a classic study of Leibniz and made important contributions to aesthetics and musicology, Huber is today not much more than a footnote in history. When Yvonne Sherratt writes, "Huber's intellectual prowess remains as quiet in the Western world as it was under Hitler", she hardly exaggerates.
In contrast, some active collaborators with the Nazis feature among the most celebrated names of post-war philosophy. Serving the Nazis for a time as a university rector, Martin Heidegger cut off relations with Edmund Husserl, the Jewish philosopher who had secured his professorship, removing the dedication to Husserl from Being and Time (Heidegger's principal work) and failing either to visit his mentor when he was dying or attend his funeral in 1938. As a result of the intellectual campaign waged by his former student and lover Hannah Arendt, and support form prominent figures such as Jean-Paul Sartre, Heidegger succeeded in becoming one of the most influential of late 20th-century philosophers.
The entire review is here.
By John Gray - Book Review
The Independent
Originally published February 23, 2013
The only German philosophy professor who actively resisted the Nazis is nowadays virtually unknown. Though one or two scholarly monographs have appeared on him, Kurt Huber will not be found on any university syllabus. The silence that has swallowed his name and his works is almost as complete as that which followed when, after being stripped of his university post and doctoral degree by a Nazi People's Court, he was executed by guillotine in July 1943 for writing a pamphlet against National Socialism as a member of the White Rose resistance group.
A conservative Catholic who produced a classic study of Leibniz and made important contributions to aesthetics and musicology, Huber is today not much more than a footnote in history. When Yvonne Sherratt writes, "Huber's intellectual prowess remains as quiet in the Western world as it was under Hitler", she hardly exaggerates.
In contrast, some active collaborators with the Nazis feature among the most celebrated names of post-war philosophy. Serving the Nazis for a time as a university rector, Martin Heidegger cut off relations with Edmund Husserl, the Jewish philosopher who had secured his professorship, removing the dedication to Husserl from Being and Time (Heidegger's principal work) and failing either to visit his mentor when he was dying or attend his funeral in 1938. As a result of the intellectual campaign waged by his former student and lover Hannah Arendt, and support form prominent figures such as Jean-Paul Sartre, Heidegger succeeded in becoming one of the most influential of late 20th-century philosophers.
The entire review is here.
Stanford experiment shows that virtual superpowers encourage real-world empathy
Giving test subjects Superman-like flight in a virtual reality simulator
makes them more likely to exhibit altruistic behavior in real life, Stanford
researchers find.
By Bjorn Carey
The Stanford Report
Originally published January 31, 2013
If you give people superpowers, will they use those abilities for good?
Researchers at Stanford recently investigated the subject by giving people the ability of Superman-like flight in the university's Virtual Human Interaction Laboratory (VHIL). While several studies have shown that playing violent videogames can encourage aggressive behavior, the new research suggests that games could be designed to train people to be more empathetic in the real world.
(cut)
"It's very clear that if you design games that are violent, peoples' aggressive behavior increases," Bailenson said. "If we can identify the mechanism that encourages empathy, then perhaps we can design technology and video games that people will enjoy and that will successfully promote altruistic behavior in the real world."
The entire article is here.
Thanks to Ed Zuckerman for a lead on this article.
By Bjorn Carey
The Stanford Report
Originally published January 31, 2013
If you give people superpowers, will they use those abilities for good?
Researchers at Stanford recently investigated the subject by giving people the ability of Superman-like flight in the university's Virtual Human Interaction Laboratory (VHIL). While several studies have shown that playing violent videogames can encourage aggressive behavior, the new research suggests that games could be designed to train people to be more empathetic in the real world.
(cut)
"It's very clear that if you design games that are violent, peoples' aggressive behavior increases," Bailenson said. "If we can identify the mechanism that encourages empathy, then perhaps we can design technology and video games that people will enjoy and that will successfully promote altruistic behavior in the real world."
The entire article is here.
Thanks to Ed Zuckerman for a lead on this article.
Wednesday, March 6, 2013
War zone killing: Vets feel 'alone' in their guilt
By PAULINE JELINEK
Associated Press
Originally published February 22, 2013
A veteran of the wars in Iraq and Afghanistan, former Marine Capt. Timothy Kudo thinks of himself as a killer — and he carries the guilt every day.
"I can't forgive myself," he says. "And the people who can forgive me are dead."
With American troops at war for more than a decade, there's been an unprecedented number of studies into war zone psychology and an evolving understanding of post-traumatic stress disorder. Clinicians suspect some troops are suffering from what they call "moral injuries" — wounds from having done something, or failed to stop something, that violates their moral code.
Though there may be some overlap in symptoms, moral injuries aren't what most people think of as PTSD, the nightmares and flashbacks of terrifying, life-threatening combat events. A moral injury tortures the conscience; symptoms include deep shame, guilt and rage. It's not a medical problem, and it's unclear how to treat it, says retired Col. Elspeth Ritchie, former psychiatry consultant to the Army surgeon general.
The entire story is here.
Associated Press
Originally published February 22, 2013
A veteran of the wars in Iraq and Afghanistan, former Marine Capt. Timothy Kudo thinks of himself as a killer — and he carries the guilt every day.
"I can't forgive myself," he says. "And the people who can forgive me are dead."
With American troops at war for more than a decade, there's been an unprecedented number of studies into war zone psychology and an evolving understanding of post-traumatic stress disorder. Clinicians suspect some troops are suffering from what they call "moral injuries" — wounds from having done something, or failed to stop something, that violates their moral code.
Though there may be some overlap in symptoms, moral injuries aren't what most people think of as PTSD, the nightmares and flashbacks of terrifying, life-threatening combat events. A moral injury tortures the conscience; symptoms include deep shame, guilt and rage. It's not a medical problem, and it's unclear how to treat it, says retired Col. Elspeth Ritchie, former psychiatry consultant to the Army surgeon general.
The entire story is here.
Perspectives on Suicide in the Army National Guard
By James Griffith & Mark Vaitkus
Armed Forces & Society published online 22 February 2013
Abstract
Suicides in the US military were observed rising in 2004, most notably in the Army and Marine Corps, and particularly, in the Army National Guard (ARNG). Alarmed, Army leaders and researchers have offered various explanations and prescriptions, often lacking any evidence. In the present study, three data sets were used to examine evidence for various perspectives on suicide—dispositional risk, social
cognitive, stressor-strain, and social cultural/institutional, each having different emphases on relevant explanatory variables and underlying mechanisms of suicide. Primary risk factors associated with having committed suicide among the 2007–2010 ARNG suicide cases were age (young), gender (male), and race (white), supporting the dispositional risk perspective on suicide. Some evidence supported the stressor-strain perspective in that postdeployment loss of a significant other and a
major life change showed statistically significant, yet weaker associations with increased suicide intentions. Implications of results are discussed for future research and preventive strategies.
Here is part of the discussion:
Military-related variables, including having been deployed and combat exposure, showed little relationship to suicide. These findings are consistent with analyses of the active component Army suicides. US Army Public Health Command has consistently reported suicide cases as occurring disproportionally among males, Caucasians, younger in age (eighteen to twenty-four years), and often having an untreated behavioral condition and/or substance abuse.
The entire journal article is here.
Armed Forces & Society published online 22 February 2013
Abstract
Suicides in the US military were observed rising in 2004, most notably in the Army and Marine Corps, and particularly, in the Army National Guard (ARNG). Alarmed, Army leaders and researchers have offered various explanations and prescriptions, often lacking any evidence. In the present study, three data sets were used to examine evidence for various perspectives on suicide—dispositional risk, social
cognitive, stressor-strain, and social cultural/institutional, each having different emphases on relevant explanatory variables and underlying mechanisms of suicide. Primary risk factors associated with having committed suicide among the 2007–2010 ARNG suicide cases were age (young), gender (male), and race (white), supporting the dispositional risk perspective on suicide. Some evidence supported the stressor-strain perspective in that postdeployment loss of a significant other and a
major life change showed statistically significant, yet weaker associations with increased suicide intentions. Implications of results are discussed for future research and preventive strategies.
Here is part of the discussion:
Military-related variables, including having been deployed and combat exposure, showed little relationship to suicide. These findings are consistent with analyses of the active component Army suicides. US Army Public Health Command has consistently reported suicide cases as occurring disproportionally among males, Caucasians, younger in age (eighteen to twenty-four years), and often having an untreated behavioral condition and/or substance abuse.
The entire journal article is here.
Tuesday, March 5, 2013
Bitter Pill: Why Medical Bills Are Killing Us
By Steven Brill
Time: Health & Fitness
Originally published February 20, 2013
Here are some excerpts:
I got the idea for this article when I was visiting Rice University last year. As I was leaving the campus, which is just outside the central business district of Houston, I noticed a group of glass skyscrapers about a mile away lighting up the evening sky. The scene looked like Dubai. I was looking at the Texas Medical Center, a nearly 1,300-acre, 280-building complex of hospitals and related medical facilities, of which MD Anderson is the lead brand name. Medicine had obviously become a huge business. In fact, of Houston’s top 10 employers, five are hospitals, including MD Anderson with 19,000 employees; three, led by ExxonMobil with 14,000 employees, are energy companies. How did that happen, I wondered. Where’s all that money coming from? And where is it going? I have spent the past seven months trying to find out by analyzing a variety of bills from hospitals like MD Anderson, doctors, drug companies and every other player in the American health care ecosystem.
When you look behind the bills that Sean Recchi and other patients receive, you see nothing rational — no rhyme or reason — about the costs they faced in a marketplace they enter through no choice of their own. The only constant is the sticker shock for the patients who are asked to pay.
Yet those who work in the health care industry and those who argue over health care policy seem inured to the shock. When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?
What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab? Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?
The entire story is here.
Time: Health & Fitness
Originally published February 20, 2013
Here are some excerpts:
I got the idea for this article when I was visiting Rice University last year. As I was leaving the campus, which is just outside the central business district of Houston, I noticed a group of glass skyscrapers about a mile away lighting up the evening sky. The scene looked like Dubai. I was looking at the Texas Medical Center, a nearly 1,300-acre, 280-building complex of hospitals and related medical facilities, of which MD Anderson is the lead brand name. Medicine had obviously become a huge business. In fact, of Houston’s top 10 employers, five are hospitals, including MD Anderson with 19,000 employees; three, led by ExxonMobil with 14,000 employees, are energy companies. How did that happen, I wondered. Where’s all that money coming from? And where is it going? I have spent the past seven months trying to find out by analyzing a variety of bills from hospitals like MD Anderson, doctors, drug companies and every other player in the American health care ecosystem.
When you look behind the bills that Sean Recchi and other patients receive, you see nothing rational — no rhyme or reason — about the costs they faced in a marketplace they enter through no choice of their own. The only constant is the sticker shock for the patients who are asked to pay.
Yet those who work in the health care industry and those who argue over health care policy seem inured to the shock. When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?
What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab? Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?
The entire story is here.
Sale of personal gene data condemned as 'unethical and dangerous'
Critics say companies could acquire personal information that would identify NHS patients without their consent
By Jaime Doward
The Observer
Originally published February 16, 2013
Private firms will soon be able to buy people's medical and genetic data without their consent and, in certain cases, acquire personal information that might enable them to identify individuals.
The revelation, which contradicts government claims that such material would be completely anonymous, has raised fears that pharmaceutical firms and insurance companies will be able to determine the identities of people susceptible to particular diseases. It has prompted claims that fundamental changes to the use of NHS patient data are being introduced without adequate public debate or regulatory oversight.
The government is keen for Britain to be at the forefront of the genetic revolution, a potential multibillion-pound industry. Last year David Cameron launched a £100m scheme to map the genomes of up to 100,000 people, saying it would help to save lives by delivering new treatments. The move was seen as the first step in the construction of a national human genome database.
Under the scheme, firms would be able to access the information at a cost, but ministers insist that all data will be strictly anonymous. However, material released under the Freedom of Information Act reveals that firms can invoke an appeal process to demand "patient-identifiable data", such as age and postcode.
The entire story is here.
By Jaime Doward
The Observer
Originally published February 16, 2013
Private firms will soon be able to buy people's medical and genetic data without their consent and, in certain cases, acquire personal information that might enable them to identify individuals.
The revelation, which contradicts government claims that such material would be completely anonymous, has raised fears that pharmaceutical firms and insurance companies will be able to determine the identities of people susceptible to particular diseases. It has prompted claims that fundamental changes to the use of NHS patient data are being introduced without adequate public debate or regulatory oversight.
The government is keen for Britain to be at the forefront of the genetic revolution, a potential multibillion-pound industry. Last year David Cameron launched a £100m scheme to map the genomes of up to 100,000 people, saying it would help to save lives by delivering new treatments. The move was seen as the first step in the construction of a national human genome database.
Under the scheme, firms would be able to access the information at a cost, but ministers insist that all data will be strictly anonymous. However, material released under the Freedom of Information Act reveals that firms can invoke an appeal process to demand "patient-identifiable data", such as age and postcode.
The entire story is here.
Monday, March 4, 2013
Anti-human-trafficking efforts gain momentum
New policies and new laws on human trafficking are spreading across several states
By Yamiche Alcindor
USA TODAY
Originally posted on February 16, 2013
A growing wave of efforts to stop human trafficking has spread across the country as lawmakers and others look to combat the problem through law, policy, and grass-roots activism.
While approaches vary, advocates say more must be done to stop the crime, dubbed "modern day slavery" and defined by the U.S. State Department as the recruitment, transportation or harboring of people by means of deception or coercion. Victims, often mentally and physically abused, can be forced into prostitution, unfair working conditions, or other exploitative situations.
"Consciousness and outrage have reached a different level because of the perverseness but also the impact of human trafficking," said Sen. Richard Blumenthal, D-Conn. "People understand that everyone has a responsibility to fight human trafficking and every individual can have an impact."
The entire story is here.
By Yamiche Alcindor
USA TODAY
Originally posted on February 16, 2013
A growing wave of efforts to stop human trafficking has spread across the country as lawmakers and others look to combat the problem through law, policy, and grass-roots activism.
While approaches vary, advocates say more must be done to stop the crime, dubbed "modern day slavery" and defined by the U.S. State Department as the recruitment, transportation or harboring of people by means of deception or coercion. Victims, often mentally and physically abused, can be forced into prostitution, unfair working conditions, or other exploitative situations.
"Consciousness and outrage have reached a different level because of the perverseness but also the impact of human trafficking," said Sen. Richard Blumenthal, D-Conn. "People understand that everyone has a responsibility to fight human trafficking and every individual can have an impact."
The entire story is here.
Advocates Seek Mental Health Changes, Including Power to Detain
By BRANDI GRISSOM
The Texas Tribune/The New York Times
Published: February 23, 2013
Here are some excerpts:
Mr. Thomas, who confessed to the murders of his wife, their son and her daughter by another man, was convicted in 2005 and sentenced to death at age 21. While awaiting trial in 2004, he gouged out one of his eyes, and in 2008 on death row, he removed the other and ate it.
At least twice in the three weeks before the crime, Mr. Thomas had sought mental health treatment, babbling illogically and threatening to commit suicide. On two occasions, staff members at the medical facilities were so worried that his psychosis made him a threat to himself or others that they sought emergency detention warrants for him.
Despite talk of suicide and bizarre biblical delusions, he was not detained for treatment. Mr. Thomas later told the police that he was convinced that Ms. Boren was the wicked Jezebel from the Bible, that his own son was the Antichrist and that Leyha was involved in an evil conspiracy with them.
He was on a mission from God, he said, to free their hearts of demons.
Hospitals do not have legal authority to detain people who voluntarily enter their facilities in search of mental health care but then decide to leave. It is one of many holes in the state’s nearly 30-year-old mental health code that advocates, police officers and judges say lawmakers need to fix. In a report last year, Texas Appleseed, a nonprofit advocacy organization, called on lawmakers to replace the existing code with one that reflects contemporary mental health needs.
(cut)
Hospital officials say they face a Catch-22 under current law: if they detain a mentally ill person against his or her will, they face liability because they have no legal authority to do so. If they allow the person to leave and something tragic happens, they risk a lawsuit like the one the Boren family filed.
The entire story is here.
The Texas Tribune/The New York Times
Published: February 23, 2013
Here are some excerpts:
Mr. Thomas, who confessed to the murders of his wife, their son and her daughter by another man, was convicted in 2005 and sentenced to death at age 21. While awaiting trial in 2004, he gouged out one of his eyes, and in 2008 on death row, he removed the other and ate it.
At least twice in the three weeks before the crime, Mr. Thomas had sought mental health treatment, babbling illogically and threatening to commit suicide. On two occasions, staff members at the medical facilities were so worried that his psychosis made him a threat to himself or others that they sought emergency detention warrants for him.
Despite talk of suicide and bizarre biblical delusions, he was not detained for treatment. Mr. Thomas later told the police that he was convinced that Ms. Boren was the wicked Jezebel from the Bible, that his own son was the Antichrist and that Leyha was involved in an evil conspiracy with them.
He was on a mission from God, he said, to free their hearts of demons.
Hospitals do not have legal authority to detain people who voluntarily enter their facilities in search of mental health care but then decide to leave. It is one of many holes in the state’s nearly 30-year-old mental health code that advocates, police officers and judges say lawmakers need to fix. In a report last year, Texas Appleseed, a nonprofit advocacy organization, called on lawmakers to replace the existing code with one that reflects contemporary mental health needs.
(cut)
Hospital officials say they face a Catch-22 under current law: if they detain a mentally ill person against his or her will, they face liability because they have no legal authority to do so. If they allow the person to leave and something tragic happens, they risk a lawsuit like the one the Boren family filed.
The entire story is here.
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