The Conversation & End-of-Life Care:
How Not to Die
Jonathan Rauch
(The Atlantic, May 2013)
"Unwanted treatment is American medicine’s dark continent. No one knows its extent, and few people want to talk about it. The U.S. medical system was built to treat anything that might be treatable, at any stage of life -- even near the end, when there is no hope of a cure, and when the patient, if fully informed, might prefer quality time and relative normalcy to all-out intervention...What should [take place is]...what is known in the medical profession as The Conversation. The momentum of medical maximalism should [slow]...long enough for a doctor or a social worker to sit down...explain, patiently and in plain English, [a patient’s]...condition...treatment options, [and] learn what...goals were for the [remaining] time...to establish how much and what kind of treatment [is]...really desired. Alas, evidence shows that The Conversation happens much less regularly than it should, and that, when it does happen, information is typically presented in a brisk, jargony way that patients and families don’t really understand. Many doctors don’t make time for The Conversation, or aren’t good at conducting it (they’re not trained or rewarded for doing so), or worry their patients can’t handle it. This is a problem, because the assumption that doctors know what their patients want turns out to be wrong...Though no one knows for sure, unwanted treatment seems especially common near the end of life...Unwanted treatment is a particularly confounding problem because it is not a product of malevolence but a by-product of two strengths of American medical culture: the system’s determination to save lives, and its technological virtuosity. Change will need to be consonant with that culture."
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Related Story:
Religious Support Tied to Intensive End-of-Life Care
Genevra Pittman
(Reuters, May 7, 2013)
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Sarah Kliff and Dan Keating
(The Washington Post, May 8, 2013)
"[T]he federal government will release the prices that hospitals charge for the 100 most common inpatient procedures...What the numbers reveal is a health-care system with tremendous, seemingly random variation in the costs of services...Experts attribute the disparities to a health system that can set prices with impunity because consumers rarely see them -- and rarely shop for discounts...The public release of the data is part of an effort by Medicare to increase transparency in the health system. The agency will...[fund] new...data centers that can analyze and publish research on health-care prices...Hospitals nationwide showed a large variation for many common procedures."
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Kathryn Doyle
(Reuters, May 8, 2013)
"In a test of services geared toward making sure [emergency room (ER)] patients took their prescribed medications after leaving the emergency room, none made a difference, a large new study suggests. Based on the experiment involving nearly 4,000 ER patients, researchers found that information packets, personal assistance and even access to an on-call medical librarian to answer questions about the drugs did not lead patients to fill more prescriptions or to take them as directed when they left the hospital. There is a great deal of evidence that patients who don't follow medication regimens have worse health outcomes and end up spending more for healthcare in the long run."
Alex Wayne
(Bloomberg, May 7, 2013)
"People with health insurance saw increases in their medical costs slow from 2009 to 2011, signaling potential structural changes in the industry that could cut health-care inflation and save the U.S. hundreds of billions of dollars, according to two studies. The changes include greater use of generic drugs, higher out-of-pocket costs and more efficient care, a trend encouraged by the 2010 health-care overhaul...The research...suggest that while the recession accounted for almost 40 percent of the decline, hitting those who can’t afford care, other factors also were at work...The analysis will be part of the debate...over how to control spending growth for Medicare and Medicaid."
See also:
Many Medical Guidelines Don't Consider Costs
Andrew M. Seaman
(Reuters, May 7, 2013)
Sandra G. Boodman
(The Washington Post, May 6, 2013)
"Diagnoses that are missed, incorrect or delayed are believed to affect 10 to 20 percent of cases, far exceeding drug errors and surgery on the wrong patient or body part, both of which have received considerably more attention. Recent studies underscore the extent and potential impact of such errors...A meta-analysis published last year...found that fatal diagnostic errors in U.S. intensive care units appear to [number around] 40,500."
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Maura Lerner
(Star Tribune, Minneapolis, May 6, 2013)
"The idea was to hire people with no medical background, give them two weeks of training, and send them off to clinics to start seeing patients. Five years later, these so-called 'care guides' are fixtures at more than two dozen...clinics in the Twin Cities [metro-area of Minnesota], and groups around the country are calling to find out how the concept works. The guides are part of a fast-growing, and hotly debated, trend in medicine: Putting people with minimal (if any) medical expertise on the front lines -- with titles like patient navigator or coach -- to help improve care, and rein in the costs, of patients with chronic illnesses."
Ricardo Alonso-Zaldivar
(Associated Press, May 4, 2013)
"[Americans] with serious medical problems are in danger of losing coverage under [the Affordable Care Act (ACA)]...because of cost overruns, state officials say. At risk is the Pre-Existing Condition Insurance Plan, a transition program...for the so-called 'uninsurables' -- people with serious medical conditions who can't get coverage elsewhere. The program helps bridge the gap for those patients until next year, when under the [ACA]...insurance companies will be required to accept people regardless of their medical problems...The root of the problem is that the...law capped spending on the program at $5 billion, and the money is running out because the beneficiaries [are]...costlier to care for than expected."
Tia Mitchell
(Tampa Bay Times, May 4, 2013)
"The historic U.S. Supreme Court ruling upholding the [Affordable Care Act] law...[gives] states a choice whether to expand [Medicaid]...Part of the law that remained in place requires businesses with more than 50 full-time employees to provide health insurance coverage to anyone working more than 30 hours a week. Many people in agriculture, tourism and hospitality would have been eligible for an expanded Medicaid program...If they use a federal exchange, their bosses will be penalized. And the fines are steep. In Florida, about 400,000 people who would have qualified for Medicaid expansion are eligible to purchase insurance on exchanges."
John Ingold
(The Denver Post, May 7, 2013)
"[T]he Colorado...stoned-driving limit [gained]...final approval [this week]...House Bill 1325, now goes to Gov. John Hickenlooper, who has said he supports the plan. The bill sets a limit of active THC -- the psychoactive chemical in marijuana -- that drivers can have in their blood before juries can presume they were too high to drive...Opponents of the plan say the science behind the limit is unsettled and that...medical-marijuana patients [might be unfairly punished]...The bill does not change anything about how police identify, stop, question or test stoned drivers...drivers would have to give consent [but]...could lose their licenses if they refuse a request for a blood test."
David Brown
(The Washington Post, May 5, 2013)
"After they leave military service, veterans of the two wars have a 75 percent higher rate of fatal motor vehicle accidents than do civilians. Troops still in uniform have a higher risk of crashing their cars in the months immediately after returning from deployment than in the months immediately before. People who have had multiple tours in combat zones are at highest risk for traffic accidents. The phenomenon has been revealed by various pieces of evidence...If further research supports the observations, motor vehicle crashes will join suicide and interpersonal violence as a fatal, if indirect, consequence of the war...Motor vehicle crashes have long been a serious problem in the military."
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Joe DeCapua
(Voice of America, May 7, 2013)
"The humanitarian organization Save the Children has released its annual State of the World’s Mothers report. It says despite much progress being made in reducing maternal and child deaths, every year, three million babies die within the first month of life. Many just live a few hours...Forty percent of first day newborn deaths are in sub-Saharan Africa...four simple interventions...could turn things around...While the recommendations are simple and cheap, they’re often not implemented in developing countries. The report blames that, in part, on a lack of political will by government leaders."
Related story:
More Indian Newborns Die on the First Day Than in Any Other Country
Jayashree Nandi
(The Times of India, May 7, 2013)
Related graphic:
U.S.: Infant Mortality Rates
John Duchneskie
(The Philadelphia Inquirer, May 7, 2013)
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Marthe Van Der Wolf
(Voice of America, May 7, 2013)
"African and Chinese delegates have come together in Botswana to exchange experiences on how to tackle health problems. Usually Africa is the one receiving advice from abroad. But African countries say they can teach other nations about health policies and how to tackle AIDS. China...is willing to listen...China and Africa both face challenges with AIDS and family planning issues, while Africa lacks doctors and researchers necessary to improve health care. But most of the discussions at the Roundtable were focused on getting Chinese knowledge, resources, and investment opportunities to Africa."
Ron Nixon
(The New York Times, May 7, 2013)
"The Food and Drug Administration [FDA], which inspects everything but meat and poultry, is struggling to find the money to inspect foreign foods under a new food safety law...The Obama administration’s 2014 budget calls for an increase in agency financing, but the most money would come from fees that the food industry and Congress oppose. Lawmakers in March did approve an additional $40 million in one-time financing for the agency to put the new law into effect, but food safety experts say more money will be needed...Americans are biting into more and more foreign food and the rate of illness from imported food is rising."
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FDA: Budget Cuts Won't Reduce Food Inspections
Elizabeth Weise
(USA Today, May 6, 2013)
Yang Jingjie
(Global Times, China, May 4, 2013)
"The Supreme People's Court (SPC)...vowed to severely punish crimes related to food safety by unveiling more specific criteria in handing out sentences, after the country saw a significant increase in such cases over the past three years. Sun Jungong, spokesperson of the SPC, [said that]...the country's food safety situation is still 'very grave,' given that the number of criminal cases related to food safety has seen a significant rise over the past three years...the SPC and the Supreme People's Procuratorate...issued explanations that specify crimes related to food safety and set standards for the punishment for these crimes."
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Terri Hallenbeck
(Burlington Free Press, Vermont, May 8, 2013)
"A revised bill that would allow terminally ill Vermonters to legally hasten their own deaths...appears headed into law...The [Vermont] Senate voted...for an altered version of the bill that is a hybrid of an Oregon-style law and something less restrictive...the bill goes back to the House...[before it can be signed into law by the] supportive Gov. Peter Shumlin...The alternative grants doctors immunity from prosecution for providing a lethal dose of medication if they follow a list of rules, including making sure the patient is terminally ill and making a voluntary, informed decision...In 2016, that list of rules expires, with the idea that doctors will have established their own protocol."
Andrew M. Seaman
(Reuters, May 6, 2013)
"Based on comparisons of people in their 90s, their spouses, siblings, children and their children's spouses, researchers found that the offspring of people with exceptional longevity were about 40 percent less likely than peers to be cognitively impaired between ages 65 and 79...By the time the older generation of study volunteers were in their 90s, however, their risk of being cognitively impaired was fairly high...Loosely defined, longevity means living beyond the average age of death among peers...In the U.S. today, for instance, a 65 year old man can expect to live to age 83, on average, and a woman to age 85...Both longevity and dementia risk have some degree of heritability."
Kay Lazar
(The Boston Globe, May 6, 2013)
"With reduced funding for home-based services to help ease the burden, and mounting economic pressures to shorten hospital stays, legions of baby boomers are caring for aging parents and shouldering more complex nursing tasks once performed by professionals in hospitals and nursing homes, according to a recent national survey...These caregivers are...overwhelmed [and]...afraid they are going to make a mistake...the findings...noted that policy makers [need to update the]...measures used to determine...home-based services [eligibility]...descriptions [currently used]...do not begin to measure the complicated tasks family members are routinely providing."
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Stephen S. Hall
(National Geographic, May 2013)
"In a field historically marred by exaggerated claims and dubious entrepreneurs hawking unproven elixirs, scientists studying longevity have begun using powerful genomic technologies, basic molecular research, and, most important, data on small, genetically isolated communities of people to gain increased insight into the maladies of old age and how they might be avoided. In Calabria, Ecuador, Hawaii, and even in the Bronx, studies are turning up molecules and chemical pathways that may ultimately help everyone reach an advanced age in good, even vibrant, health...Could genetic anomalies protect against diseases of age?"
Related graphic:
Genetic Clues to Long Life
John Tomanio and Matthew Twombly, NGM Staff; Megan Cassidy
(National Geographic, May 2013)
Amelia Wade
(The New Zealand Herald, May 9, 2013)
"In New Zealand, the Government has this month released a major new review of evidence to guide suicide prevention activities in schools. It found programmes run through schools can be effective in recognising and supporting young people at risk of suicide, but that care must be taken to identify and manage any unintended negative consequences...cyber-bullying [was specifically targeted]...because of concerns it was helping to fuel New Zealand's high youth suicide rate...Inciting someone to commit suicide will be punishable with up to three years in jail under the new laws...[and] the Government is drafting legislation to make cyber-bullying a criminal offence."
Craig Whitlock
(The Washington Post, May 7, 2013)
"President Obama expressed frustration...with the Pentagon’s struggles to cope with sex crimes in the military, saying he expected 'consequences' for sex offenders...Obama’s stern comments came as the Pentagon prepared to release a report showing that the estimated number of military personnel who may have been sexually assaulted rose by nearly one-third over the past two years. The Pentagon, using anonymous surveys and sampling research, estimated that about 26,000 personnel experienced 'unwanted sexual contact' last year...Military officials said they are concerned that most troops may be reluctant to press charges or formally report sexual assault to authorities."
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Related opinion:
The Military's Sexual Assault Crisis
Editorial
(The New York Times, May 7, 2013)
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Katrine Dermody
(GlobalPost, May 7, 2013)
"Aid to Children and Adolescents at Risk (ANAR)...joined forces [with a Spanish ad agency] in an innovative effort to shed some light on the growing problem of child abuse -- and if their public project is successful, they may just be able to give children the means to seek help without alerting their abuser. The savvy ad campaign uses lenticular printing...to produce printed images with an illusion of depth, or in this case, the ability to change or move as the image is viewed from different angles. The ad shows individuals below a certain height -- children, in this case -- one image, while taller people -- namely, adults -- see a different image with a starkly different message."
Pam Belluck and Benedict Carey
(The New York Times, May 6, 2013)
"Just weeks before the long-awaited publication of a new edition...the federal government’s most prominent psychiatric expert has said the...[Diagnostic and Statistical Manual of Mental Disorders (DSM)]...suffers from a scientific 'lack of validity'...Dr. Thomas R. Insel, director of the National Institute of Mental Health, said...that his goal was to reshape the direction of psychiatric research...While the [DSM]...is the best tool now available for clinicians treating patients and should not be tossed out, he said, it does not reflect the complexity of many disorders, and its way of categorizing mental illnesses should not guide research."
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Chelsea Conaboy
(The Boston Globe, May 6, 2013)
"People who work in Boston’s world-class hospitals are trained to deal with trauma, but most are unaccustomed to dealing with mass casualties caused by an attack in their own neighborhood, or working under lock-down. Now, with many of the Marathon patients discharged or moved to rehabilitation facilities, [Boston-area] hospitals are helping their staff members process what they have been through, with counseling sessions and interfaith services...One goal is to let caregivers know that what they are feeling, including sleeplessness, anxiety, or muscle aches, is a normal response to trauma. For most people, those symptoms will dissipate."
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Brady Dennis
(The Washington Post, May 6, 2013)
"Citing growing evidence of the health risks associated with sunlamps and tanning beds, the Food and Drug Administration [FDA]...said [this week that] it would seek tighter regulations and more-detailed labeling...The agency proposed reclassifying tanning beds from a low-risk to a moderate-risk device, a new designation that would allow the FDA to review the products before they are sold. Manufacturers would be required to meet performance and safety standards and to clearly spell out the risks of using them. The FDA wants the labels to include a recommendation that people under 18 steer clear of the devices...Dozens of states already regulate tanning beds to varying degrees."
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Karen Herzog
(Journal Sentinel, Milwaukee, May 6, 2013)
"HPV-related head and neck cancers are growing exponentially...If the trend continues, by 2020, HPV-related oropharyngeal cancer will overtake cervical cancer, experts predict...HPV [human papillomavirus], now the most common sexually transmitted infection, is found in saliva, semen and genital secretions. Three times as many men as women get oropharyngeal cancer, because vaginal transmission during oral sex is the most common mode of transmission...In most cases, HPV [is cleared from the body by]...the immune system...A small percentage of people can't clear the virus and may develop problems...increases in HPV-associated cancers are prompting more attention to vaccinating adolescents against HPV."
Related story:
Drugmakers, Health Groups Bring Poor Girls Vaccine
Linda A. Johnson
(Associated Press, May 9, 2013)
Editorial
(The Observer, London, May 5, 2013)
"It has been a big week for tobacco [in the U.K.]...plans that would have forced cigarette companies to sell their products in plain packs [were dropped]...a relentless lobbying campaign...to attack the plan has paid dividends...Dire warnings were made of small shops going [under]...and thousands of jobs going abroad. The Treasury was warned that plain packs would [provide a new avenue for]...the counterfeit (untaxed) cigarette manufacturers. Similar arguments were made in Australia by a big tobacco-funded campaign...But...plain packaging [was introduced there] last December...[with] no evidence [so far] that the dire predictions...have been realized...The UK government has a mandate to improve the health of its citizens. Last week, it failed them."
Related story:
No 10 Accused of 'Caving In' to Cigarette Lobby as Plain Packs Put On Hold
Jamie Doward
(The Observer, London, May 5, 2013)
Alison Young and Christopher Schnaars
(USA Today, May 3, 2013)
"[F]ull-body X-ray scanners at U.S. airports underwent more than 700 inspections last year with all tests showing radiation levels below standards used by their manufacturer and the Transportation Security Administration [TSA]...While the TSA and [the] scanner-maker...say the reports offer additional proof of safety...the TSA is in the final phases of removing the last of [the] scanners from airport checkpoints by June. Full-body scanners using a different technology that does not involve ionizing radiation, called millimeter wave, will remain in use to screen passengers...passengers on a flight from New York to Los Angeles are exposed to about 4,000 microrem of cosmic radiation."
Ellen Knickmeyer and Betsy McKay
(The Wall Street Journal, New York, May 6, 2013)
"Saudi Arabia's announcements...of seven new deaths from a SARS-like virus have heightened fears that the Mideast outbreak is entering a more-aggressive phase...The kingdom's Ministry of Health disclosed...in a brief statement that all of the current new cases of the virus appear to be clustered at a single hospital in Hofuf, one of the main cities of Eastern province...The terse announcement by Saudi health officials triggered renewed international complaints that the kingdom has been slow in reporting details of the outbreak, sought by international organizations and countries trying to assess and prevent the spread of the virus."
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Emerging Disease
(The Wall Street Journal, New York, May 6, 2013)
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James Gallagher
(BBC News, May 6, 2013)
"Outbreaks of measles are putting Europe's commitment to eliminate the disease by 2015 under threat, the World Health Organization (WHO) has warned. Levels of vaccination have been too low in some countries, particularly in rich western European nations. It says catch-up vaccination campaigns, such as the one launched in the UK, are needed across the continent. Experts said it was not too late to hit the target, but 'extraordinary' effort was needed...The 53 nations which form the WHO's European region...have pledged to stop the disease spreading on the continent. However, there are high numbers of cases in the UK, Turkey, Ukraine and Romania."
Dan Browning
(Star Tribune, Minneapolis, May 5, 2013)
"[A] set of groundbreaking experimental treatments...proved that transplants of insulin-producing cells known as 'islet cells' can treat -- and sometimes cure -- Type 1 diabetes...the [University of Minnesota (U of M)]...is [now] preparing to apply...for a [manufacturing] license...[which] would allow them to commercialize the new treatment...a unique example of a university bringing a new treatment directly from academic research to human applications without any company funding...Some 26 million Americans have diabetes...About 95 percent have Type 2 diabetes, which is caused largely by poor diet and insufficient exercise...About 1.5 million people have Type 1 diabetes, which results when the body’s autoimmune system destroys its own islet cells."
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Severin Carrell and Denis Campbell
(The Guardian, London, May 3, 2013)
"Scottish ministers have won the first round in a lengthy court battle against the whisky industry after a judge ruled their plans to fix a minimum price for alcohol were legal and justified. In a major victory for health campaigners, Lord Doherty ruled...that the Scottish parliament was within its powers to introduce Europe's first minimum pricing law on all alcoholic drinks, because it would protect health. The judge also dismissed claims by the Scotch Whisky Association (SWA) that ministers were in breach of European competition law. The SWA is backed by two powerful European wine and spirits organisations in a case being watched closely by governments in several EU member states."
Kay Lazar
(The Boston Globe, May 9, 2013)
"Massachusetts is the first state that will require independent labs to test the safety and quality of marijuana sold for medical use, under final rules that regulators unanimously approved...The tests will screen for contaminants such as heavy metals, pesticides, and mold. They will also identify and measure the active chemical compounds in the marijuana...state officials said [the move was] to ensure the integrity of the tests...Connecticut is considering a similar requirement. The provision is among dozens of changes made by the Department of Public Health to draft rules the agency released in March, after [reviewing]...suggestions from advocates on all sides of the issue."
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Jerry Markon
(The Washington Post, May 7, 2013)
"Gun violence dropped dramatically nationwide over the past two decades, but nearly three-quarters of all homicides are still committed with a firearm...The report, by the [Justice] department’s Bureau of Justice Statistics, painted an encouraging picture of long-term trends...Yet the document also made clear that when people are killed, it is still most likely to be with a gun...The report is straightforward and highly statistical, and it does not offer any reasons for the decrease in gun violence. Criminologists and other experts have said that explanations for the decline remain elusive, although the Justice Department has in part credited smarter policing practices and investments in law enforcement."
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