In a perfect world, doctors would not prescribe – and patients would not take – drugs that do more harm than good. But it’s complicated. The benefits and harms of drugs are determined in randomized, controlled clinical trials. For many reasons, the outcomes of such trials may not provide doctors with the information they need to decide who should take what.
The reason pessimists are multiplying is that we dishonor the intellect and the knowledge of history in this country by refusing to admit that corruption is the source of our ills. It takes no great mental effort to realize that there’s no effective political forces either in Washington or locally that are able to do anything serious to correct our self-delusions about being the world’s policeman, because any sensible solution would seriously cut into profits of this or that interest group.
The problem in America is not that a minority has grown super rich, but that for decades now, it has done so to the detriment of the lower social classes. The big question is: why does the majority in a seemingly free society tolerate this, and even happily vote against its own economic interests? A plausible answer is that it is under a self-destructive meritocratic spell … Rather than move towards greater fairness and egalitarianism, it promotes a libertarian gospel of the free market with minimal regulation, taxation, and public safety nets. What would it take to break this spell?
It’s time to focus on the corporate CEOs and speculators. … “In U.S. states facing a budget shortfall, revenues from corporate taxes have declined $2.5 billion in the last year. In Wisconsin, two-thirds of corporations pay no taxes, and the share of state revenue from corporate taxes has fallen by half since 1981.” The same is true in other states. These facts must be stressed, repeatedly and aggressively, if the debate is going to shift from cuts in public services and education to demands for fair taxes and the revenues necessary for services and schools.
Unfortunately, he [Gawande] dismisses what, from the standpoint of reducing total health-care expenditures, is the single most serious drawback to such an approach; namely, the probability that effectively case-managed patients will survive longer than they would without intensive ambulatory care and will thereby offset their reduced frequency of hospitalization with an increase in their time at risk. If an intervention reduces a patient’s frequency of hospitalization from ten admissions annually to five, but simultaneously increases that patient’s survival from one year to two, the intervention is fully justified medically but is a wash from a cost perspective. If it increases that patient’s survival to two years and one month, it’s a net liability.
In 1911 the medical profession complained of the “commercialization” of medicine, contending that this led to abuses in pharmacology and the practice of medicine. The Romans failed to check these abuses, which increased as Rome declined. “[I]f we are to avoid such unfortunate deterioration in our own time, we must not shrink from recognizing and resisting the evils which do so easily beset commercialized ages like those of the first and twentieth centuries A. D.”
Although the mechanisms linking taste and behaviour are not yet clear, the authors [of the study] ask whether jurors should avoid bitter tastes and whether food preferences play a role in shaping political ideals.
We have to really listen and think about why a child is telling us something. The behaviour of children and young people is fundamental to a well-functioning society, because they can tell us what is going on more honestly than we tell ourselves.
How did ordinary women and men with ordinary lives and ordinary bodies learn that they need plastic? The answer: the plastic ideological complex, a set of cultural texts that are both highly contested and yet tightly on message. It is itself so ubiquitous that it might even be described as hegemonic. In other words, the “need” for cosmetic procedures is impossible to avoid. Through advertising and TV shows, movies and magazines, we learn to want cosmetic intervention in our aging faces and imperfect bodies. This need is now so firmly implanted in our cultural psyche that it has become “common sense” to embrace cosmetic procedures.
The real beauty of direct-pay primary care is not only that it’s attractive to patients. It can be a way for struggling primary care physicians to maintain a financially viable practice. The average patient pays $700 to $800 a year for membership. According to a report from Kaiser Health News, this is three times more than a doctor makes for each patient in an insurance-based practice. Not to mention the extra time and the absence of aggravation that comes when doctors eliminate insurance companies.
Rawls’s cautious, prudential argument for equality could not be uncoupled in the minds of conservative intellectuals from their distress at the new affirmative action projects, their anger at busing for racial equalization, and their recoil from the gender-blurring prospects of the Equal Rights Amendment. The once common distinction between equality of opportunity and the (dangerous) passion for equality of results fused into a general criticism of equality-driven politics in all its forms. Freedom, merit, and excellence: these, not equality, were the aims of the good society. Michael Novak put the conservative consensus succinctly in 1990: “The rage for equality is a wicked project.”
Medicine is a profession. Economically, it’s sufficiently different from other marketplace transactions that it shouldn’t be run as a for-profit business. When I made that argument in a recent post, I mentioned: “The health care market is basically not price competitive – a patient contemplating brain surgery is not going to be tempted by a surgeon offering a deep discount.” That may still be true of brain surgery, but it’s obviously not true of plastic surgery.
Whatever our eventual conclusions on inequality, we’re going to have trouble acting on them if the political system can’t bring itself to care about the average American a little bit more. … We at least need to recognize what it is that we keep doing: green-lighting the policies that make the rich richer or, in the case of the crisis, keep them rich, while dithering and drifting on the problems and needs of the vast middle.
Despite the increasing understanding that clinicians routinely ignore alarms due to noise fatigue and their perceived nuisance, more vendors of monitoring equipment have responded by making their alarms louder or more irksome, hoping to out-compete related equipment by ensuring their alarm gets attention. Yet equipment alarms are not equally important and there is currently no system that prioritizes disparate alarms. Additionally, there is no incentive for a given vendor to work with its peers on this problem. The result is an “arms race” mentality that is fundamentally detrimental to the quality of patient care.
The University of California, San Francisco (UCSF) has a team of robots that fills prescriptions for its medical center. Orders are submitted electronically. The drugs are retrieved from a secure, sterile environment. The dosage is as exact as a computer is logical. Medications are packaged for each patient – even assembled into 12-hour packets for the day. It eliminates possible errors by both pharmacists and nurses.
The current case in the spotlight is Baby Joseph Maraachli. He suffers from a “progressively deteriorating neurological condition” of unknown origin and is in a permanent vegetative state. He is 13 months old. A court in Ontario ruled that the health center treating Baby Joseph could remove the breathing tube keeping him alive. The parents have transferred the child to a hospital in St. Louis, where he will receive a tracheotomy.
