Group items tagged

'If you met me, you'd never know I was mentally ill. In fact, I've gone through most of my adult life without anyone ever knowing - except when I've had to reveal it to a doctor. And that revelation changes everything. It wipes clean the rest of my résumé, my education, my accomplishments, reduces me to a diagnosis. I was surprised when, after one of these run-ins, my psychopharmacologist said this sort of behavior was all too common. At least 14 studies have shown that patients with a serious mental illness receive worse medical care than "normal" people. Last year the World Health Organization called the stigma and discrimination endured by people with mental health conditions "a hidden human rights emergency." If you met me, you'd never know I was mentally ill. In fact, I've gone through most of my adult life without anyone ever knowing - except when I've had to reveal it to a doctor. And that revelation changes everything. It wipes clean the rest of my résumé, my education, my accomplishments, reduces me to a diagnosis. I was surprised when, after one of these run-ins, my psychopharmacologist said this sort of behavior was all too common. At least 14 studies have shown that patients with a serious mental illness receive worse medical care than "normal" people. Last year the World Health Organization called the stigma and discrimination endured by people with mental health conditions "a hidden human rights emergency." I never knew it until I started poking around, but this particular kind of discriminatory doctoring has a name. It's called "diagnostic overshadowing." According to a review of studies done by the Institute of Psychiatry at King's College, London, it happens a lot. As a result, people with a serious mental illness - including bipolar disorder, major depression, schizophrenia and schizoaffective disorder - end up with wrong diagnoses and are under-treated. That is a problem, because if yo

Peter B. Bach, M.D., M.A.P.P.: The Debate over Regional Variation in Health Care Spending: "The regional variations in health care spending that are documented by the Dartmouth Atlas of Health Care have been cited by many as a justification, and possible basis, for changes in provider payment rates. ..."

>"...Offering a default option of opting in, rather than opting out (as many have suggested with organ donations as well) doesn't take away choice but guides us to make better ones, according to Richard H. Thaler, an economics professor at the University of Chicago, and Cass R. Sunstein, a professor at Chicago's law school, authors of "Nudge: Improving Decisions About Health, Wealth and Happiness". Making choices can be most difficult in the area of health. While we don't want to go back to the days when doctors unilaterally determined what was best, there may be ways of changing policy so that families are not forced to make unbearable choices. >Professor Iyengar and some colleagues compared how American and French families coped after making the heart-wrenching decision to withdraw life-sustaining treatment from an infant. In the United States, parents must make the decision to end the treatment, while in France, the doctors decide, unless explicitly challenged by the parents. >French families weren't as angry or confused about what had happened, and focused much less on how things might have been or should have been than the American parents.

Readers largely support measures to allow death in dignified environment with palliative approach, as opposed to repeated aggressive interventions that are rarely successful when the prognosis is poor.

Bob Doherty is the main Washington lobbyist of the ACP - after the AMA, the largest organization of US doctors (representing internal medicine physicians, whether primary care or subspecialist). He's had some very interesting posts since the Massachusetts Senate upset. His blog is a finalist in the sixth annual Medical Weblog Awards for the Best Health Policies/Ethics Weblog. Doherty articulates the ACP's case for supporting the current Senate&House Health Care Reform legislation (whose failure he & many others will end up leading eventually to more draconian limits on doctors & patients, in order to control the currently unsustainable growth in US health care costs (now approaching 20% of GDP).

Need to still address MD SGR (perhaps gradual intro with gradual decr in reimbursement for some docs)

Moral quandaries often pit concerns about principles against concerns about practical consequences. Should we ban assault rifles and large sodas, restricting people's liberties for the sake of physical health and safety? Should we allow drone killings or torture, if violating one person's rights could save a thousand lives? We like to believe that the principled side of the equation is rooted in deep, reasoned conviction. But a growing wealth of research shows that those values often prove to be finicky, inconsistent intuitions, swayed by ethically irrelevant factors. What you say now you might disagree with in five minutes. And such wavering has implications for both public policy and our personal lives. Philosophers and psychologists often distinguish between two ethical frameworks. A utilitarian perspective evaluates an action purely by its consequences. If it does good, it's good. A deontological approach, meanwhile, also takes into account aspects of the action itself, like whether it adheres to certain rules. Do not kill, even if killing does good. No one adheres strictly to either philosophy, and it turns out we can be nudged one way or the other for illogical reasons.... Regardless of whether you endorse following the rules or calculating benefits, knowing that our instincts are so sensitive to outside factors can prevent us from settling on our first response. Objective moral truth doesn't exist, and these studies show that even if it did, our grasp of it would be tenuous. ...But we can encourage consistency in moral reasoning by viewing issues from many angles, discussing them with other people and monitoring our emotions closely. In recognizing our psychological quirks, we just might find answers we can live with.

'A few drugs - such as beta-blockers, statins and glycogen control medications - have proved very effective at managing hypertension, heart disease, diabetes and strokes. Most insurance plans charge something for them. Why not make drugs like these free? Not for everyone, but just the groups for whom they are provably effective. In traditional economics, such a policy creates waste. The basic principle is moral hazard: consumers overuse goods that are subsidized. But people don't always follow a cost-benefit logic. The problem is basic human psychology. Heart disease is silent, with few noticeable symptoms. You feel fine most of the time, so it's all too easy to justify skipping the statin. The problem here is the exact opposite of moral hazard. People are not overusing ineffective drugs; they are underusing highly effective ones. This is a quandary that ... call "behavioral hazard." We've found that co-payments do not resolve behavioral hazard. They make it worse. They reduce the use of a drug that is already underused. My proposal is targeted: Take drugs that are shown to be of very high benefit to some people, and make those drugs free for them. All co-pays should depend on measured medical value; high co-pays should be reserved for drugs and medical services that have little proven value. Why not focus instead on the behaviors - eating unhealthy foods or shunning exercise - that created the conditions we must now treat with drugs? [This]has some merit. But [it] fails the "perfect as the enemy of the good" test.

Brooks states Obama mistook 2008 landslide as American readiness for a new New Deal, rather than a referendum on GWBush. Americans are reacting against "government over-reaching." He sees 2 alternatives (among 4 available): Harsh&Arrogant (pass health reform by reconciliation) vs. Weak&Feckless (switch to incremental changes). Brooks favors the latter as less likely to bring a political rebellion that will "decimate policy-making for a generation." (He thinks the actual current "alternative" being pursued is "Incoherent & Internecine."

Mark Lillo charts how both right and left libertarianism & radical individualism have led to "communities of like-mindedness"; and now to an angry movement that wants to be free from government agencies that protect their health, wealth, and well-being; free from problems and policies too difficult to understand; free from parties and coalitions; free from experts who think they know better than they do; free from politicians who don't talk or look like they do.

... not quality of pt care

Light boxes for seasonal affective disorder

Poor analysis of mis-spent $ at EOL

Hilarious 3-D cartoon of PHARMA's efforts to force Mass. legislature to repeal ban on drug reps "free lunches" for docs, to push brand-name drugs - in the name of "helping restaurants during the recession."