Sunday, April 19, 2009
Daily Kos' Darksyde links to an article in the Times Online reporting on a terrific advance in stem cell research. The website provides,
Times Online is reporting that a British research team has developed a promising treatment for the most common causes of blindness using embryonic stem cells:
The treatment will tackle age-related macular degeneration (AMD), the most common cause of blindness. It affects more than 500,000 Britons and the number is forecast to increase significantly as people live longer.
There’s roughly a 50/50 chance that anyone who lives to age one-hundred will develop AMD to some extent. Some will be blind as a bat long before reaching the century mark. With early diagnosis and aggressive treatment using newer drugs, the onset of advanced AMD can often be delayed or halted. Some of those drugs cost thousands of dollars a dose and they have to be taken regularly for life. Can’t say how that might work in the UK, but here in the US it means the eyesight of millions of baby boomers will be tossed into the vicious snapping jaws of our profit-obsessed health insurance industry. . . .
The website provides further interesting information about this research and the response it has received.
Saturday, April 18, 2009
The New York Times reports on President Obama's new approach to federal financing of human embryonic stem cell research. Gardiner Harris writes,
The Obama administration announced Friday that it planned to lift some but not all federal financing restrictions on human embryonic stem cell research, drawing criticism both from abortion opponents and from scientists who had expected a more liberal policy.
Guidelines proposed by the National Institutes of Health to carry out an order made last month by President Obama would allow research with federal financing only on stem cells derived from surplus embryos at fertility clinics. The money would still be prohibited for stem cell lines created solely for research purposes and for embryos created through a technique known as therapeutic cloning.
During the campaign last year, Mr. Obama said he supported “therapeutic cloning of stem cells,” a policy his administration rejected Friday. A White House spokesman, Reid Cherlin, said the president “directed N.I.H. to formulate the best method for moving forward with stem cell research, both ethically and scientifically,” in an independent process.
Many scientists praised the new guidelines as an expected compromise. “I think it’s a big step forward,” said Richard O. Hynes, a cancer researcher at the Massachusetts Institute of Technology, “although there are aspects of stem cell research that will still be outside federal funding.”
Others called the proposed rules a sellout. “I’m disappointed,” said Dr. Irving Weissman, the director of the Stem Cell Biology and Regenerative Medicine Institute at Stanford. Dr. Weissman accused the health institutes of “putting this ideological barrier in the way” of treating disease. . . .
Sitting on more than $10 billion in stimulus money, health institute officials have been eager to expand financing for stem cell research. Under restrictions put in place by President George W. Bush, just 21 stem cell lines have been eligible for federal financing. But researchers using private money have created more than 700 stem cell lines, some with specific diseases or mutations, many of which may now be eligible for federal financing.
Some scientists said new rules requiring that donors be informed of all options could render too many new cell lines ineligible. And the rules could make ineligible for future federal financing even some cell lines approved by Mr. Bush.
Dr. George Q. Daley, the director of the stem cell transplantation program at Children’s Hospital Boston, said his team had used private financing to create 15 stem cell lines from poor-quality embryos that clinicians had told couples they should discard. Not all couples may have been told that they could donate the weakened embryos to other couples, a requirement under the new guidelines. “My major concern,” Dr. Daley said, “is grandfathering all those medically important lines” made under less stringent consent policies, including some approved by Mr. Bush.
The announcement on Friday is likely to kick off a rush of applications from scientists eager for federal support for stem cell research. The health institutes has approved 20 such proposals for financing, although the projects have been delayed until the stem cell guideline is finalized. . . .
In fiscal year 2008, the health institutes financed 260 research projects, at a cost of $88 million, that involved stem cell lines approved by Mr. Bush.
The new guidelines will be published next week in the Federal Register, and the health institutes then will accept comments for 30 days. The rules are to be final by July 7.
Some in Congress have promised to introduce legislation that would allow financing of more stem cell lines. Representative Diana DeGette, Democrat of Colorado, said in a statement that the proposed legislation would “promote all forms of ethical stem cell research.” A statement from Representative Michael N. Castle, Republican of Delaware, said there was “opportunity for more expansive guidelines.” Staff members for both lawmakers said they could not describe details of the legislation or whether it would seek to legalize federal financing of research using embryos created by therapeutic cloning. . . .
Friday, April 17, 2009
Some researchers at McGill University recently issued the results of a study completed on the level of response to a placebo that various personalities had. According to a story in the New Scientist Health, personality type does in fact impact the degree of response to a placebo that an individual experiences. Ewen Callaway writes,
If rollercoasters and rock concerts sound fun but leave you with a headache, a drug-free sugar pill might be all that's needed to soothe you. Thrill-seekers enjoy a stronger placebo response than people with more restrained personalities, new research shows.
It's too early to prescribe phoney pain treatments based on personality tests, says neuroscientist Petra Schweinhardt, of McGill University in Montreal, whose team tested 22 male university students. But if confirmed in larger trials, her team's findings could help pharmaceutical companies avoid testing experimental drugs on people with strong placebo responses, she says.
Her team injected a pain-inducing saline solution into the left and right legs of willing volunteers for 20 minutes. "It's a dull pain, a dumb pain, it's aching, it's annoying," she says. Before the injection, her team told volunteers they were testing an experimental analgesic cream – really just skin lotion. To make the ruse more believable, researchers said they would test one leg with the treatment and one leg with a non-medicated lotion. . . .
"We really told them the whole story in order to counteract any doubts in the treatment," Schweinhardt says. Volunteers then rated their pain across both trials, and the difference amounted to the placebo response. Not everyone got pain relief from the placebo, but those that did scored higher on tests that gauge sensation-seeking personalities. These characteristics explained about a third of the differences in placebo responses between volunteers.
"The fact that they show a pretty strong correlation between a personality trait and strength of placebo response, I do find interesting," says Jon Stoessl, a neurologist at the University of British Columbia, who has studied placebo response in patients with Parkinson's disease. But he notes that a person's placebo response can change over time and varies depending on the condition, so personality alone probably won't explain his or her response. "If whatever condition you're suffering from is severe on one occasion and really a minor nuisance on another occasion, that could affect the degree of placebo response," he says. . .
Andrew Sullivan at the Atlantic Monthly has been writing on the costs of health care and had this reader response about Americans view of health care and what the reader called "the Burger King" mentality of health care. From Mr. Sullivan's blog,
Your reader's response to Megan got a lot closer to the core of the problem with healthcare costs. I am a physician in an emergency room in New York City, and every day I see tons of cash needlessly flying out the door due to "the Burger King factor." American patients often come to the ER with very minor complaints - back pain for which they have not even tried tylenol, nasal congestion for two days, itchy mosquito bites, and so forth. All of them expect something from you, quickly, for their trouble - and it must meet their preconceptions or they will accuse you of ripping them off.
Many of them become virtually incandescent with anger if they aren't given some kind of medical test that they (or one of their friends) thinks is a good idea, but they don't really need. They insult you, they threaten you, they loudly announce that they're going to call their lawyer or the hospital administrator, etc. Sometimes we stand up to them, and sometimes we're too exhausted to fight. Sometimes it's just easier to get the x-ray on the patient with back pain rather than take the abuse and argue with them for 40 minutes and then have them send an angry letter to the review board. Others are simply beyond the pale and can't put anyone else ahead of themselves. Some are incensed that I have to see a critically ill patient before I see them, because "I got here first." People will literally interrupt cpr to scream that they want a sandwich or something to eat NOW. People want a blood test, a cat scan, an EKG, anything in exchange for their time. People will quote TV shows as medical authorities. All of us have our favorite 'placebo' methods to try and gratify these patients, from ultrasounding their skulls (safe, dramatic, shows nothing but costs nothing) to pointing an ultraviolet flashlight into their maalox before they drink it. It's our version of wearing a wooden mask and shaking a rattle - we hate it, and patients love it.
The amazing thing is that when needless tests come back negative, the patient is completely satisfied. There is never a sense of regret, or how much money they just wasted, but rather one of accomplishment, even if they still have the same problem they walked in with. . . .
Thursday, April 16, 2009
The New York Times has an interesting article concerning two studies in the New England Journal of Medicine that discuss the issues scientists are facing as they attempt to make use of the decoded human genome. Nicholas Wade writes,
The era of personal genomic medicine may have to wait. The genetic analysis of common disease is turning out to be a lot more complex than expected. Since the human genome was decoded in 2003, researchers have been developing a powerful method for comparing the genomes of patients and healthy people, with the hope of pinpointing the DNA changes responsible for common diseases.
This method, called a genomewide association study, has proved technically successful despite many skeptics’ initial doubts. But it has been disappointing in that the kind of genetic variation it detects has turned out to explain surprisingly little of the genetic links to most diseases. A set of commentaries in this week’s issue of The New England Journal of Medicine appears to be the first public attempt by scientists to make sense of this puzzling result.
One issue of debate among researchers is whether, despite the prospect of diminishing returns, to continue with the genomewide studies, which cost many millions of dollars apiece, or switch to a new approach like decoding the entire genomes of individual patients. The unexpected impasse also affects companies that offer personal genomic information and that had assumed they could inform customers of their genetic risk for common diseases, based on researchers’ discoveries.
These companies are probably not performing any useful service at present, said David B. Goldstein, a Duke University geneticist who wrote one of the commentaries appearing in the journal. “With only a few exceptions, what the genomics companies are doing right now is recreational genomics,” Dr. Goldstein said in an interview. “The information has little or in many cases no clinical relevance.” . . .
The problem addressed in the commentaries is that these diseases were expected to be promoted by genetic variations that are common in the population. More than 100 genomewide association studies, often involving thousands of patients in several countries, have now been completed for many diseases, and some common variants have been found. But in almost all cases they carry only a modest risk for the disease. Most of the genetic link to disease remains unexplained. . . .
Here is a funny adverstisement meant to encourage physical fitness. I hate to say it but I can think of people who might be tempted to behave the way that these individuals did when the escalator broke down. Click here.
Thanks to my wonderful colleague, Professor Rachel Smith. for the link.
Wednesday, April 15, 2009
William Saleton, writing at Slate.com, is quite upset that there exists some movement for a tax on sugared soda pop. He states,
The food police are closing in on their next target: a soda tax.
New York City's health commissioner, Thomas Frieden, is leading the way. He's the guy who purged trans fats from the city's restaurants and made them post calorie counts for menu items. Lately he's been pressuring food companies to remove salt from their products.
Now he's going after soda. Writing in the New England Journal of Medicine, Frieden and Kelly Brownell, the director of Yale's Rudd Center for Food Policy and Obesity, propose a penny-per-ounce excise tax on "sugared beverages." That's nearly $3 per case. Why so much? Because this tax, unlike the petty junk-food taxes of yesteryear, is designed to hurt. Its purpose is to discourage you from buying soda, on the grounds that soda, like smoking, is bad for you.
Persuading Americans to regulate soda the way we regulate cigarettes won't be easy. Isn't soda a kind of food? Isn't food a good thing? And isn't it a matter of personal choice? Doesn't taxation to control people's eating behavior cross a fundamental line of liberty?
In their article, Frieden and Brownell methodically attack these objections. Going well beyond science, they lay out a political battle plan for the war on junk food. . . .
The National Journal hosts a discussion/debate on health reform and how to pay for it at its website. Some of the contributors includes: Jason Rosenbaum, Deputy Director of Online Campaigns, Health Care for American Now; Uwe Reinhardt, James Madison Professor of Political Economy, Professor of Economics and Public Affairs; Karen Davis, President, The Commonwealth Fund; John C. Goodman, President and CEO, National Center for Policy Analysis; Henry J. Aaron, Bruce and Virginia MacLaury Senior Fellow, The Brookings Institution; and Marian Wright Edelman, President, Children's Defense Fund as well as several others.
Peter Orzag, Director of the Office of Management and Budget, responds to some of the commentators here.
Tuesday, April 14, 2009
The New York Times brings our attention to a worthy and lucrative endeavor to reform our health care system. Although Catherine Rampell reports the story - she seems less than hopeful about a positive outcome. She writes,
The X Prize Foundation and the health insurance company WellPoint will give $10 million to whoever can come up with the best new health care system for the United States. According to a news release, the purpose of the contest is to help reinvent “the health care system in a bold, measurable and scientific fashion to enable dramatic improvement in health care value in the United States.” The parameters of the contest will be announced, and available for public comment, next week.. . . I don’t know how possible it will be to win the Health Care X Prize.
Never say never, but I’m not sure there’s much left to be discovered in the quest to find ways to restructure the health care system. It seems that policy wonks of all stripes agree that our current infrastructure and its rising costs are unsustainable. And it also seems that just about every possible alternative system is already on the table. But the stakeholders just can’t agree on which permutation to choose, mostly because some faction is always ideologically opposed to the means needed to get to any particular end (such as raising taxes, or having greater government involvement in price-setting, or deregulating, or greater limiting access to health care…).
Ezra Klein further notes the politics of the reform effort,
I don't think all the relevant stakeholders are ideologically opposed to certain outcomes. Many of them are also professionally unable to accept them. Wellpoint, for instance, would be rather disadvantaged by a system that no longer required Wellpoint's involvement. So that would seem to bias the contest from the outset. Indeed, it seems the X Prize people are selling off their credibility in order to secure Wellpoint's funding for this stunt.
On the other hand, there's a depressing symmetry between this contest and the actual path health reform is going to take. Here, a particular stakeholder is funding a particular organization to come up with a solution. Over in Congress, a lot more stakeholders fund a lot more campaign organizations and the beneficiaries of those campaign organizations will be responsible for coming up with a solution. If anything, there's a comforting transparency and reassuring purity to the industry capture in the X Prize contest that the congressional process sadly lacks.
National Public Radio's Fresh Air program hosted an interesting interview with Michelle Goldberg on her new book - The Means of Reproduction: Sex, Power, And The Future of the World. A brief overview is here:
In her new book The Means of Reproduction: Sex, Power, And The Future of the World, Journalist Michelle Goldberg argues that granting reproductive rights to women internationally can help to control overpopulation, banish poverty and slow the spread of AIDS.
Goldberg is also the author of the bestseller Kingdom Coming: The Rise of Christian Nationalism. She previously worked as a senior writer for Salon.com and her work has appeared in Rolling Stone, The Guardian and The New Republic. In 2008, The Means of Reproduction won the J. Anthony Lukas Work-in-Progress Award.
Monday, April 13, 2009
The Center for Health Law Studies at Saint Louis University and The American Society of Law, Medicine & Ethics (ASLME) are pleased to announce the 2009 Health Law Scholars Workshop The Health Law Scholars Workshop is a collegial forum in which faculty new to health law and bioethics scholarship present works-in-progress and receive in-depth advice from experienced scholars and teachers in the field of health law and bioethics. Each author’s work-in-progress accepted for the Health Law Scholars Workshop will be read in advance by several faculty members in relevant fields. During the Workshop weekend, each author presents his or her paper to the full group. After extensive oral feedback from the readers, the floor is opened for a sustained exchange between the presenter and full group. A nominating committee selects the papers to be presented at the Workshop. The committee looks for papers that have an original thesis and will contribute to scholarly literature. The Workshop is designed primarily to provide feedback on articles intended for spring submission to law review journals. The Workshop is not designed to review published work or papers already accepted for publication. Those interested in presenting a health law or bioethics work-in-progress at the Health Law Scholars Workshop should submit a one-page abstract of the proposed paper together with a resumé to Mary Ann Jauer at Saint Louis University School of Law by May 1, 2009. Because a blind selection process is used, please do not include the author’s name or institutional affiliation on the abstract. SEND SUBMISSIONS TO: Mary Ann Jauer, Program Coordinator, Center for Health Law Studies, Saint Louis University School of Law, 3700 Lindell Boulevard, St. Louis, MO 63108; Phone: 314.977.3067; Fax: 977.3332; Email: email@example.com View the Scholars Workshop Brochure at law.slu.edu/healthlaw
The Center for Health Law Studies at Saint Louis University and The American Society of Law, Medicine & Ethics (ASLME) are pleased to announce the 2009 Health Law Scholars Workshop
The Health Law Scholars Workshop is a collegial forum in which faculty new to health law and bioethics scholarship present works-in-progress and receive in-depth advice from experienced scholars and teachers in the field of health law and bioethics. Each author’s work-in-progress accepted for the Health Law Scholars Workshop will be read in advance by several faculty members in relevant fields. During the Workshop weekend, each author presents his or her paper to the full group. After extensive oral feedback from the readers, the floor is opened for a sustained exchange between the presenter and full group.
A nominating committee selects the papers to be presented at the Workshop. The committee looks for papers that have an original thesis and will contribute to scholarly literature. The Workshop is designed primarily to provide feedback on articles intended for spring submission to law review journals. The Workshop is not designed to review published work or papers already accepted for publication.
Those interested in presenting a health law or bioethics work-in-progress at the Health Law Scholars Workshop should submit a one-page abstract of the proposed paper together with a resumé to Mary Ann Jauer at Saint Louis University School of Law by May 1, 2009.
Because a blind selection process is used, please do not include the author’s name or institutional affiliation on the abstract.
SEND SUBMISSIONS TO:
Mary Ann Jauer, Program Coordinator, Center for Health Law Studies, Saint Louis University School of Law, 3700 Lindell Boulevard, St. Louis, MO 63108;
Phone: 314.977.3067; Fax: 977.3332; Email: firstname.lastname@example.org
View the Scholars Workshop Brochure at law.slu.edu/healthlaw
National Public Radio's Morning Edition had an interesting discussion about the use of elder mediators to help families cope with elder care when disagreements arise among family members and between the elder parent and other caregiving relatives. The brief overview of the program provides,
They are disputes that can split apart families: Mom's left a pot on the stove again, so her daughters want her to give up her house. Dad's got more scrapes on his car, so his kids want to take away the car keys. Now there's a new option for families: Call in an elder mediator, like Rikk Larsen. Larsen comes in as a neutral third party to help families negotiate difficult situations and choices.
He talks about one case where an elderly father was getting forgetful and wasn't paying his monthly bills. His children — who lived far away — found out when the father's heat and electricity were turned off. But the elderly man got angry when the kids tried to help. "Dad simply didn't want any of his kids to know how much money he had and how his finances were organized," says Larsen, and things were getting worse. One son insisted on going to court to get his father declared mentally incompetent, so the family could take control of the father's finances. But after Larsen mediated, the brothers and sisters — along with the father — came up with a simpler solution. The father's accountant sent an assistant every couple of weeks to help the elderly man pay his bills. "It became this kind of business meeting that the father had, and he got to maintain his dignity and his sense of control, and the bills got paid," Larsen says. . . .
Sunday, April 12, 2009
Hope everyone is enjoying a great day! Here is a lovely evoluationary tale about how we got the rabbits that we know and love today. Thanks to DarkSyde from DailyKos for the site and the interesting information:
Even as a young skeptic Easter Sunday was exciting for me. As children, my sisters and I could always count on finding a basket full of yummy chocolate treats waiting for us on Easter morning. How exactly the most important date in the Christian calendar came to be associated with an anthropomorphic pagan rabbit hiding colored candy eggs is a story for another day. But real rabbits also have a story. One every bit as interesting, and as fun for the whole family, as Peter Cottontail's.
Rabbits are mammals of course and at first glance they appear to fall in with squirrels, mice, chipmunks and a bunch of other adorable little critters that make up the most successful order of mammals on earth today: rodents. The first proto-mammals are often referred to collectively as cynodonts, some looked and acted an awful lot like modern rodents, and they really did lay eggs! Cynodonts appear in the fossil record during the Permian over 250 million years ago and slowly evolved into placental mammals that give birth to live young.
Unlike the familiar large mammals we know today, those rodent-sized pioneers didn't have to wait for dinos to fade into natural history before they could inherit the wind. They were already thriving along side the reptilian titans long before the solar system cruelly tossed a space mountain into the Yucatan 65 million years ago. As luck would have it, with their furry insulation, small size and short generations, varied diet, and warm burrows, small mammals were especially equipped to survive and adapt in the harsh aftermath of the K-T Extinction. And that’s where the rabbit picture gets fuzzy. . . .
Friday, April 10, 2009
Professor Justin Barnard writes on the Public Discourse: Ethics, Law and the Common Good website, and provides an excellent argument against the use of cognitive enhancing drugs. He argues,
Recent calls for the widespread use of cognitive enhancements are based on a narrow, mechanistic view of what it means to be human. In a recent issue of Nature, several prominent intellectuals call for public policies that support the “responsible use” of cognitive-enhancing drugs by healthy citizens. “We should welcome new methods of improving our brain function,” they write. “In a world in which human work-spans and life-spans are increasing, cognitive enhancement tools—including the pharmacological—will be increasingly useful for improved quality of life and extended work productivity, as well as to stave off normal and pathological age-related cognitive declines. Safe and effective cognitive enhancers will benefit both the individual and society.”
Their essay is illustrative, not merely of a new public policy challenge we will face in the biotech age, but also of the kind of reasoning one invariably hears in public discussions about such issues. In a nutshell, their case is pragmatic and utilitarian. And along the way, they are utterly dismissive of the most substantive arguments, reasons that, if heard, would threaten to undermine the apparent sober-mindedness of their perspective. . . . .
Of course, no citizen of good will should disregard these three in conversations about the shape of public policy, especially on issues such as the production and distribution of powerful narcotics. But the idea, as this essay suggests, that such practical or utilitarian concerns are matters of first or perhaps even exclusive importance is mistaken. Rather, as the logic of the essay itself tacitly reveals, it is our conception of human nature, along with our understanding of the purpose and meaning of human life that is foundational to the arguments we will make and conclusions we will draw about the moral legitimacy of cognitive enhancement for the healthy.
At the heart of the defense of cognitive enhancement for the healthy is an argument by analogy that depends upon an assumption about the nature of human beings and the purpose(s) of the life of the mind. Specifically, these authors suggest that cognitive-enhancing drugs are just like (or at least more or less similar to) other forms of mental “enhancement” (e.g., “written language, printing, and the Internet” or “exercise, nutrition and sleep”). Since the latter are legally permissible, the former ought to be—or so they argue. . . .
The defense of cognitive enhancement depends upon a view of mind as mere machine. This is an understanding of human nature (or at least of one’s mental life) that is thoroughly mechanistic. The mind (or if we’re being honest, the brain) is a computer. Thus, “improvements” come in two forms: (1) increased storage capacity or more information, and (2) increased processing efficiency or speed. This is a view of human nature that is fundamentally ateleological; it is without purpose beyond the mere acquisition and processing of information. Holding such a view, as a matter of logical necessity, commits one to the conclusion that the summum bonum for human beings consists in maximizing our machine-like functions to the highest degree feasible. Thus, it is no surprise that the authors conclude: “We should welcome new methods of improving our brain function . . .” as a means of “extended work productivity.”
Such a view of human nature is thoroughly reductionist. It is also mistaken. That this is so can be grasped by a simple thought experiment involving the use of another form of enhancement and America’s pastime. Imagine attending a baseball game in which no human beings were participants. Imagine sitting for several hours watching a pitching machine throw to a mechanical arm swinging a bat. Can you honestly imagine being spellbound by such a game? Would you pay top dollar for seats behind home plate?
My hypothesis is that while a thoroughly-perfected game of robotic baseball might commandeer an initial measure of fascination, it would simply fail to captivate our imaginations over time. Moreover, our intuitive reluctance in being enthusiastic about this imagined scenario is telling, not simply as an indication that something is amiss in the use of performance-enhancing drugs, but more importantly as a clue to a proper understanding of human nature.
That we find the prospect of robotic baseball uninteresting should not lead us to conclude that the skills of baseball are in no way machine-like. Indeed, the fact that baseball players hone their skills, often by means of machines in connection with machine-like repetition, is evidence of the degree to which the cultivation of such skills can be perfected by treating them mechanistically. To treat a skill mechanistically is simply to analyze it into its constituent parts with a view toward training one’s body to perform the most efficient and effective sequence of parts with as much precision and accuracy as possible. Think of Tiger Woods' own success in rebuilding his golf swing.
But we err in thinking that our mental life is exhausted, or even most uniquely expressed, in exercising that narrow range of computer-esque cognitive functions alone. And this is the error of those who promote the use of cognitive-enhancing drugs for the healthy. Like the athlete who uses steroids, those who advocate the “responsible use” of cognitive-enhancing drugs among the healthy falsely presuppose that one or two cognitive goods among many are the most important goods among the many that constitute the life of the mind considered as a whole. They presume, in other words, that cognitive improvement (and by extension, human improvement) is exclusively a function “adding” information and “better” information processing.
This presumption is simply false. For while the capacities to procure and to process information are indeed goods of human life, they are neither the highest of human goods nor are they ends in themselves. Yet, the use of cognitive enhancers by the healthy implicitly treats the single good at which the drug aims as though it were the most important or only good of one’s mental life considered as a whole. As our thought-experiment about robotic baseball makes clear, if merely thinking (very fast!) about lots of information were the most important or only good of the human mental life considered as a whole, why not simply replace us with computers?
Herein lies the proverbial rub. The logical trajectory of arguments supporting the wholesale use of cognitive enhancers among the healthy is ultimately destructive of human nature. And this would be the case even if one conceded what is most assuredly dubious—namely, that public policy could be crafted and enforced so as to minimize the deleterious effects of the widespread distribution and use of such drugs. Proponents of cognitive enhancement may still protest that benefits would accrue to “both the individual and society.” But such benefits may come at the expense of individuals and societies that are uniquely human in nature.
Thursday, April 9, 2009
Ok, so it isn't the Senator Stevens trial misconduct, but perhaps the Department of Justice will be a bit more careful about ensuring that ethical rules and constitutional values are upheld when pursuing criminal charges against anyone, including doctors. Vanessa Blue from the South Florida Sun-Sentinel writes,
Calling the actions of prosecutors "profoundly disturbing," a federal judge in Miami has ordered the U.S. government to pay sanctions topping $600,000 in the case of a South Florida physician charged with illegally prescribing painkillers. U.S. District Judge Alan Gold is forcing the government to pay Dr. Ali Shaygan more than half the costs he incurred to defend himself at trial as punishment for secretly recording his defense team.
In a harshly-worded 50-page order, Gold said the "win-at-any-cost behavior" of federal prosecutors Sean Cronin and Andrea Hoffman raised "troubling issues about the integrity of those who wield enormous power over the people they prosecute." Shaygan, 36, a Miami Beach resident, was found not guilty March 12 of 141 counts of unlawful prescribing. Prosecutors had accused Shaygan of selling prescriptions for powerful pain medications without legitimate medical purpose, leading to the overdose death of a West Palm Beach man.
As his trial was under way, defense lawyers learned that two witnesses had secretly recorded their phone conversations with the defense team with approval from prosecutors and government agents. The investigation, purportedly to look into witness tampering by the defense, resulted in three recordings that were not disclosed to Gold or Shaygan's lawyers, David O. Markus, Marc Seitles and Robin Kaplan. The recordings captured of Markus and his investigator violated internal policies of the U.S. Attorney's Office and federal evidentiary rules because defense lawyers were not informed of their existence. "We regret that any of this ever happened in the first place but we are grateful that Judge Gold took it seriously and did the right thing," Markus said. . . .
Thanks to Professor Froomkin at Discourse.net for the website.
At Balkanization, Professor Ian Ayres writes about a potential way to solve the current food safety crisis. It might be worth a try - only I don't think I would want to see the commercials. He argues,
By now, virtually everyone in the country has heard that the Peanut Corporation of America knowingly shipped peanut products contaminated with salmonella bacteria, leading to the deaths of at least nine people and sickening 22,500 others. Last year, the Westland/Hallmark slaughterhouse processed meat from “downer” cattle that were too sick to stand, forcing a recall of 143 million tons of beef. President Obama has spoken of a food-safety “crisis” confronting the country, and that over-used term does not seem to be an exaggeration in this case.
So what should we do? Government inspectors are too few in number to visit all of the thousands of food preparation facilities, let alone conduct thorough inspections. . . .
Maybe we should take a lesson from the 1980’s commercials for the Hair Club for Men. You may remember those cheesy ads, which concluded with the pitchman declaring that “I’m not only the Hair Club president, I’m also a client.” The right way to align the incentives of management with those of the customers, in other words, may be to make sure that the managers are customers. One way we could implement this would be to require inspectors to certify that they saw the president of the company (or perhaps the plant manager) eating a substantial helping of the product being sold. (Maybe the inspectors should be required to eat some as well!) Someone who knows that his downer-burger was made from a cow that was too sick to stand, or his salmonella-butter-and-jelly sandwich contained infested nuts, might not be so happy about his working lunch.
The idea is really an update of a very old idea. The court food taster’s job was to make sure that the food was not tainted — and the chief chef, like the C.E.O., is the perfect person to take action to make sure that a food product is safe. Managers would likely be more careful about inspecting their plant’s output if they knew they’d have to eat enough of it to make them pretty sick. . . .
Megan McArtle writes in the Atlantic Monthly about the expenses and the reason behind those expenses in the way that our health care is provided. She writes,
To my mind, the real answer is threefold:
1) We pay more for our medical services. But though the pharma industry is important, the real action is in wages. Our medical personnel cost vastly more than their counterparts abroad in almost every category.
2) We consume more services. Americans get shiny new facilities--my British colleagues once derisively commented that American hospitals are "like hotels". American hospitals don't have open wards for almost anyone. They staff at very high levels. Doctors conduct an inordinate amount of tests. We use an expensive machine rather than watchful waiting. And often, those expensive machines catch conditions that never would have turned into anything, which we then treat. Natasha Richardson probably would have lived if she'd had an accident here, because doctors would have done a cat scan, and there would have been a Medevac helicopter available. That's tens, maybe hundreds of thousands of dollars to save a single life.
3) There are inefficiencies. I don't mean "compared to other systems"--every system has some screwed-up illogicality that costs it money and makes patients worse off. But compared to what we could have. For example, Medicare pays for procedures, not wellness, which means that there's a chronic undersupply of geriatricians, because the specialty isn't particularly well paid even though the nation's largest healthcare provider is specifically designed for old people. This is madness. But every real-world system that has attempted to pay physicians for wellness has ended up giving up in disgust.
So how much scope is there for reducing our costs, relative to the rest of the world? Some, obviously, though it's not clear that this would actually be a net benefit to either us and the world, since the iatrogenic effect would probably be to wipe out most industry research into new drugs and medical devices. But not really that much, for both political and practical reasons.
Politically, state health care systems have so far proven unable to control labor costs--indeed, the health care unions are some of the most powerful political forces in most states, while the AMA has dominated the Medicare reimbursement schedule. There's no evidence that is going to change any time soon. Politically, also, conservatives have got to face the fact that we are not going to stop providing health care to people who are in dire need, and that this will undercut any attempt to move towards a fully private model.
Practically, we have to pay healthcare workers a lot because we have to pay everyone a lot; in a rich country, wages for healthcare workers are high. And measuring healthcare productivity is really insanely difficult, which makes it very hard to figure out what's worth spending money on. As long as Americans don't want to sacrifice access to procedures--and they don't--there's just not much room for decreasing costs.
That doesn't bother me that much. The mindless trend extrapolation about how much we'll spend on health care in the future elides the point that we'll be much richer in the future; why shouldn't we spend all that extra income on healthcare? Your ancestors spent 2/3 of their daily income on food. Now you spend about 15-20%. But spending much more of your income on clothes and housing doesn't mean that you're starving; it means that you're so rich, you only spend a small fraction of your income on food. When I look around at our incredibly bountiful economy, I don't see any obvious lack that we're creating by spending ever more of our income on leading longer, healthier lives.
Former Congressman Richard Gephardt provides some thoughts about health care reform in a New York Times article by John Harwood who writes,
Now Mr. Gephardt says universal or near-universal coverage cannot pass this year — and he is urging the White House to defer that goal until it enacts cost-saving reforms in health care delivery. Otherwise, he argues, the new president risks the same losing argument about paying for expanded coverage that stymied President Bill Clinton 15 years ago.
Leading Democrats have balked at Mr. Obama’s initial financing idea, curbing tax deductions for high-income Americans. Republicans have attacked another alternative, taxing employer-provided health benefits, since Mr. Obama criticized a proposal to do that last fall by Senator John McCain of Arizona.
“I feel so much now like déjà vu all over again,” said Mr. Gephardt, who now lobbies for corporate America on issues including health care. Universal coverage “is absolutely imperative, and it needs to be dealt with. But the way to get to it is to show that we can deal with some of these problems first.” . . .
Wednesday, April 8, 2009
The Sixth Circuit has held that that hospitals may have a duty to third parties arising from EMTALA when treating mentally ill patients. The opinion in Moses v. Provident Hospital may be found here. An article in the ABAJournal reports on the details of the case. Martha Neal writes,
The estate of a suburban Detroit woman murdered by her husband 10 days after he was released by a Michigan hospital can proceed with a suit against the medical facility under a federal law that requires emergency treatment to stabilize patients, the 6th U.S. Circuit Court of Appeals held yesterday.
Reversing a federal trial court's dismissal in 2007 of the case brought against Providence Hospital by the estate of Marie Moses Irons, a three-judge panel said a jury must decide whether Christopher Howard had an emergency condition--or whether doctors at the hospital believed he did--when he was released. One doctor at the hospital had recommended that Howard be transferred to psychiatric unit, but another disagreed when Howard was later released, the news agency writes.
"We recognize that our interpretation ... may have consequences for hospitals that Congress may or may not have considered or intended," says Judge Eric Clay in the court's opinion. "However, our duty is only to read the statute as it is written."
Howard, now 42, is serving a life sentence for first-degree murder. He killed his 41-year-old estranged wife with an ax as she slept, the AP reports. The company that runs the hospital declined to comment to the AP about the 6th Circuit ruling. However, the hospital had earlier argued that Irons' estate has no standing to sue, as a third party, and that the Emergency Medical Treatment and Active Labor law is inapplicable because Howard didn't have an emergency condition. . . .
The FDA announced that makers of certain older and risky medical devices will have to prove that their products are safe and effective according to the New York Times. Gardiner Harris reports,
Such legacy devices, as they are known, were originally allowed on the market with minimal testing. But in the 1976 law Congress instructed the F.D.A. to gradually reclassify these older devices and decide which ones needed extensive testing before approval of new versions and which ones did not.
The agency never finished that process, leaving 27 different types of devices unexamined — products that include artificial lung membranes, external defibrillators and various pacemaker components.For decades, the F.D.A. has approved devices in these categories for sale without demanding rigorous tests showing that they work safely. Investigators for the accountability office stated that “it is imperative that F.D.A. take immediate steps” to fix its system for approving such devices, and the agency agreed.
The agency has already undertaken a review of two of these older device types, and it announced Wednesday that it was requiring makers of the other 25 types of devices to submit information to the agency within 120 days detailing the products’ safety and effectiveness. . . .