There are some who say, and I quote here, that “RedEye sucks.” Indeed, a Google search for that phrase yields my long-ago post as the No. 1 hit. Cool!
That said, I am glad that I’ve a RedEye newspaper box within a block of home. Why? Without RedEye, I’d have to pay 50 cents for a paper to scoop up the dog’s poop on those rare occasions when I forget to bring along a plastic bag.
Thank you, RedEye!
The lede:
More than 100 Michigan intensive-care units cut their average catheter-related bloodstream infection rate 66% by implementing a simple checklist of proven infection-control practices such as hand washing and removing unnecessary catheters.
But the Dept. of Health and Human Services’ Office for Human Research Protections last fall ordered the hospitals to suspend collecting data documenting the research project’s success because researchers did not properly comply with federal regulations aimed at safeguarding patients.
Now each participating hospital must seek institutional review board approval for the project, which was organized by the Johns Hopkins University School of Medicine in Baltimore and whose results were published in the Dec. 28, 2006, New England Journal of Medicine.
The study already has been cited more than 20 times in other medical journals, with experts in one patient safety publication dubbing it an “instant classic.” The safety effort reduced the median infection rate to zero per 1,000 catheter days, compared with national rates as high as 5.2 per 1,000 catheter days.
The whole shebang.
The lede:
Since their rise more than three decades ago, hospital ethics committees have sought to help physicians, patients and their families resolve ethical disagreements and navigate the treacherous terrain that so often accompanies medical care at the end of life.
The role of these committees was cemented in 1992 when the Joint Commission mandated that health care organizations come up with some way of addressing ethical concerns. Ninety-five percent of general hospitals surveyed in 1999 and 2000 offered ethics consultation or were starting up a consult service.
Yet at the median, these services handled only three cases in the previous year, according to the survey of more than 500 general hospitals whose results were published in February 2007 in The American Journal of Bioethics.
The use of ethics consultation services varies widely from hospital to hospital, but physician experts and ethicists agree that they frequently are underused. That leads, they say, to increased medical costs and ugly disputes among physicians, patients and families.
Physicians’ reluctance to seek aid when dilemmas arise is partly grounded in the notion that a call for help is equivalent to hauling in the “ethics police.” But the problem, experts say, goes far deeper.
The whole shebang.
The lede:
Nearly half of physicians use placebos in clinical care, and only 4% tell their patients the truth about it, according to a survey of Chicago academic physicians that was published this month in the Journal of General Internal Medicine.
Only 8% of the 231 physicians surveyed used placebos more than 10 times during the last year, but experts were alarmed by doctors’ self-reported, less-than-straightforward conversations with patients about placebos.
The study is troubling because deceptive use of placebos is “inconsistent with what we now understand as the rights of patients to decide on treatment in a knowledgeable way and the duties of physicians to disclose to patients the treatments that they are providing,” said Paul S. Appelbaum, MD, director of the
division of psychiatry, law and ethics in the psychiatry department of Columbia University College of Surgeons.
The whole shebang.
The lede:
Nearly 100,000 Americans are waiting for an organ transplant. Every day, the wait for 17 of those people ends in death.
It is a wait that could be drastically shortened or even eliminated if a market for live and cadaveric organs were allowed to operate, according to a paper co-authored by Nobel Prize-winning economist Gary S. Becker, PhD, and published last year in the Journal of Economic Perspectives.
The study comes on the heels of what observers say is slow but steady progress in breaking down opposition to testing the idea of financial incentives in an effort to combat an organ shortage growing by 5% each year. But resistance among many in the transplant community is still fierce, as other efforts such as paired donation exchanges begin to take off.
The whole shebang.
The lede:
A recent American College of Obstetricians and Gynecologists’ position statement outlining the limits of conscientious refusal in reproductive medicine is drawing fire from physicians who oppose abortion.
The ACOG Committee on Ethics opinion says doctors whose personal beliefs may require them to “deviate from standard practices” such as providing abortion, sterilization or contraceptives should:
- Give patients prior notice of their moral commitments and provide accurate and unbiased information about reproductive services.
- Refer patients in a timely manner to another doctor who can provide the requested service.
- Provide medically indicated services in an emergency when referral is impossible or might affect a patient’s physical or emotional health.
- Practice close to physicians who will provide legal services or ensure that referral processes are in place so that patient access is not impeded.
The opinion, published in November 2007, comes in response to heated debate over some pharmacists’ refusal to fill patient prescriptions for Plan B, known as the morning-after pill. The Food and Drug Administration in September 2006 approved Plan B for over-the-counter status, but the debate over the right to refuse certain procedures or medication has not disappeared.
The whole shebang.
The only way for a libertarian who is also a political junkie to get through a presidential campaign is to develop some kind of rooting interest. This usually involves rooting against the most odious person in the race.
The libertarian side of me is constantly making mental calculations about the leading presidential contenders and how their election might affect the perennial struggle between individual liberty and government power. Picking between the Democrat and the Republican on this basis is sort of like trying to choose between a turtle and a snail about who will add the most to your track team. Both will be terribly lousy, so it’s just a matter of degree.
With only minimal policy differences to differentiate the contenders, my political junkie side, the human side, develops very superficial opinions about who I simply won’t be able to stomach watching on my TV for at least the next four years.
Since becoming a libertarian in 1994, these interests have usually coincided. It was easy to root for Dole against Clinton in 1996, as Dole had both the policy and personality advantages going for him.
You’ll recall that Dole, while always a moderate, was proposing major tax reform and was set to work with a GOP Congress which at that point had not completely sold out its limited-government ideals. In fact, they’d just shut down the government in a bruising budget battle with Clinton. Dole’s wicked sense of humor, curmudgeonly personality and constant references to himself in the third person made him easy to like on a personal level.
He certainly was not as smarmy, self-satisfied, duplicitous and odious as Bill Clinton, who was fresh from likening those who blew up the Oklahoma City federal building to Republicans who favored slowing the growth of spending on Medicare. He also had passed an entirely symbolic semiautomatic gun ban, raised taxes, and attempted to have the government “manage competition” in the health insurance industry. By election time, he was running on supporting school uniforms.
In 2000, it was a very tough call. Bush was clearly running away from the ideas of free markets and smaller government, while Gore was running on obnoxious “people vs. the powerful” theme. He was a liberal technocrat’s wet dream, and on the personal level I still held against him his despicable 1996 Democratic convention speech where he used his sister’s lung-cancer death to score political points. His obnoxious debate performances only confirmed how insufferable he would be to have as president for four years.
Bush, with his frequent malapropisms, would make excellent fodder for the late-night comics, I thought. So I gave him the very, very slight edge.
By 2004, Bush had already established himself as one of the worst presidents in U.S. history for self-evident reasons. His awfulness on policy filled me with so much rage that I could hardly generate a chuckle at his occasionally stupid and embarrassing remarks.
Kerry was no prize on personality, and you’ll recall that on the war he argued not that it should be ended but that he could fight it better. I suspected, though, that he would be much more likely to pull out were he elected. And indeed, he’s since come to favor withdrawing from Iraq. More than anything, I hoped a Kerry victory would be seen as a rebuke of the idea of pre-emptive war. In the time since, the course of the war itself has become such a rebuke.
And how about now? Normally, I’d be rooting for a Republican under the assumption that the Democrats will retain Congress and it’s best to aim for divided government and gridlock. But it seems likely the GOP nominee will remain committed to a forever war in Iraq and that the Democrats won’t be able to get a veto-proof majority to stop it. And the war is sort of a binary issue, and one the president will determine. So that means I’ve to root for a Democrat.
Also, I think George Will is right to note that it is almost certain that a Democrat will win the presidency this year:
Today, all the usual indicators are dismal for Republicans. If that broad assertion seems counterintuitive, produce a counterexample. The adverse indicators include: shifts in voters’ identifications with the two parties (Democrats now 50 percent, Republicans 36 percent); the tendency of independents (they favored Democratic candidates by 18 points in 2006); the fact that Democrats hold a majority of congressional seats in states with 303 electoral votes; the Democrats’ strength and the Republicans’ relative weakness in fundraising; the percentage of Americans who think the country is on the “wrong track”; the Republicans’ enthusiasm deficit relative to Democrats’ embrace of Hillary Clinton and Barack Obama, one of whom will be nominated.
So which one should I root for? Which one should libertarians root for?
First, the policy argument. Barack Obama was right on the war, and I believe he is more likely to follow through with his promise to end it. While Obama’s far from a noninterventionist, he is not the hawk that Hillary’s proven herself to be over time (remember the Kosovo war she got Bill to start as a price for standing by him after the Lewinsky fiasco?).
Both Hillary and Obama are terribly liberal, and both want to dramatically increase government control of health care. But I think that tactically, Hillary may be far preferable on policy. Obama — a magnetic, likeable and fresh face — could very will win a sweeping victory that goes all the way down the ticket, giving Democrats a much larger margin in Congress.
The Republicans are clearly flummoxed about how they could attack him. Their only hope would be a major foreign-policy crisis that they could use to highlight his allegedly slim resume (which is relative, I say; he has more foreign-policy experience than most governors or mayors).
Hillary, on the other hand, is deeply hated by Republicans and not much liked by independents. The trends would still carry her to victory, but it would be a much smaller victory. And once in office, I believe it would be much harder for her to marshal support for the many, many, many grandiose schemes she has in mind. Her mandate will be minimal, compared to the 55% or even better popular vote I think Obama could easily win.
Then again, I cannot stand the woman. Her voice irritates me. Her disdainful attitude toward those who disagree with her is disgusting. She literally cries, “Woe is me.” She shares all of her husband’s flaws and none of his charm. Once she is endowed with the terrible and expansive powers of the modern presidency (for which she’s expressed an alarming fondness), I’m quite sure my hatred for her will grow even stronger.
But, given the likely and frightening alternative of a popular, effective liberal president such as Obama, I guess this grinch may be rooting for Hillary after all.
(Also posted to Sinners in the Hands of Angry Blog.)
The lede:
The movement to align patient safety and payment seems to be picking up a full head of steam. Hospitals and payers are coalescing around the idea that no one should get paid for so-called never events — serious reportable events, such as wrong-site surgery, that kill or maim patients.
Perhaps most significantly, the BlueCross BlueShield Assn. announced in November 2007 that its plans will work toward ending payment for never events. The change will be phased in over several years as the Blues alters its coding and claims processes. A spokesman said adoption will vary among the 39 Blues plans, which insure more than 100 million people, because the change requires renegotiating contracts and securing agreements from local physicians and hospitals.
The whole shebang.
The lede:
A recent study estimates that between 1.5% and 2% of all cancers can be attributed to radiation from the 62 million computed tomography scans Americans get each year. The finding comes on the heels of earlier, similar risk estimates, and it has some experts saying physicians should think twice about ordering the test.
The review article in the Nov. 29, 2007, New England Journal of Medicine arrives at its estimate by examining the cancer effects on the 25,000 Japanese who survived the 1945 atomic bombs and received radiation doses equivalent to the x-rays emitted by several CT scans.
The authors, David J. Brenner, PhD, and Eric J. Hall, PhD, are professors at the Columbia University Center for Radiological Research and have studied the cancer-causing effects of imaging for years. They write that the evidence of cancer risk from CTs is “reasonably convincing” for adults and “very convincing for children.”
The whole shebang.
kboreilly.com 