Wednesday, February 2, 2005
FactCheck: MoveOn.org Social Security Ad
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FactCheck.org got its start during the presidential election cycle and aims to "reduce the level of deception and confusion in U.S. politics." A project of the Annenberg Public Policy Center of the University of Pennsylvania, it periodically published 'fact checks' when it feels facts need to be checked (obviously). Their latest analysis is titled 'MoveOn.org Social Security Ad: Liberal group's ad falsely claims Bush plan would cut benefits 46 percent'.
" Summary
MoveOn.org launched a false TV ad in the districts of several House members, claiming through images and words that President Bush plans to cut Social Security benefits nearly in half. Showing white-haired workers lifting boxes, mopping floors, shoveling and laundering, the ad says "it won't be long before America introduces the working retirement."
Actually, Bush has said repeatedly he won't propose any cuts for those already retired, or near retirement. What MoveOn.org calls "Bush's planned Social Security benefit cuts" is actually a plan that would hold starting Social Security benefits steady in purchasing power, rather than allowing them to nearly double over the next 75 years as they are projected to do under the current benefit formula. The White House has discussed such a proposal, and may or may not adopt it when the President puts forth a detailed plan expected in late February. "
As physicians I think we need to be familiar with the facts about such major policy changes and FactCheck helps. If you like, you may sign up to receive future reports automatically.
Friday, January 7, 2005
Does Race-based Affirmative Action Help Professional Students?
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An article is about to be published in the Stanford Law Review that is already creating a great deal of buzz in the law community. UCLA Law School professor Rick Sanders has written "Systematic Analysis of Affirmative Action in American Law Schools" which argues that African American students have been materially and tangibly harmed by law school affirmative action policies (a summary is here).
" "In the case of blacks, at least, the objective costs of preferential admissions appear to substantially outweigh the benefits. The basic theory driving many of these findings is known as the “academic mismatch” mechanism; attending an advanced school where one’s credentials are far below those of one’s peers has a variety of negative effects on learning, motivation, and goals that harm the beneficiary of the preference. Over the past several years, a wide range of scholars have documented the operation of the mismatch mechanism in a number of fields of higher education. " "
Based on my experience as a medical student and then as a member of medical school admissions committees, these finding resonate with me. I hope that a similar analysis can be done for medical school admissions. More importantly, I hope we can have an open discussion focussed on what's best for the individual students.
Sunday, December 19, 2004
Ambulatory Care, Procedures Requiring Surgical Site Marking
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JCAHO: Ambulatory Care, Procedures Requiring Surgical Site Marking:
" "marking the site is required for procedures involving right/left distinction, multiple structures (such as fingers and toes), or levels (as in spinal procedures). Site marking is not required (nor is it prohibited) for other procedures." "
Thursday, December 9, 2004
Unreliable System Fails Doctors and Patients
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" "The Washington Post takes a detailed look at a single medical malpractice case--one that began when Dr. Kevin Kearney of Maryland's Eastern Shore urged an 18-year-old mother to have her baby without a Caesarean section. What followed was a complicated delivery resulting in permanent injuries to the child, and a multi-year legal battle, filled with dramatic moments that illustrate how an unreliable system can fail both doctors and patients." "
[Via MedWatch]
Tuesday, December 7, 2004
Laparoscopy and Ambulatory Surgery Centers in PA
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The Pennsylvania Department of Health sent a letter to all Ambulatory Surgery Centers in Pennsylvania reminding them that they are not to perform laparoscopic surgeries which:
" 'require major or prolonged invasion of body cavities.' "
Noting that:
" 'the risk of injury to abdominal and other internal organs and structures is not lessened. In fact, there are some reports that the risk of injury may be increased. (Peter D. Jacobson, Medical Liability and the Culture of Technology, PEW Project on Medical Liability, released 9/22/04). ' "
My reading of the Pew report turns up no data implicating ambulatory surgery centers (ASC's) specifically in injuries from laparoscopic procedures. Nothing to suggest that eliminating most laparoscopic procedures from ASC's will improve patients safety. In an era when 'evidence based medicine' is the watchword for practitioners, this kind of blanket policy by the government is difficult for me to swallow.
I suspect (though cannot prove) that hospitals have brought political pressure to bear on the Governor and/or Department of Health to make this policy change in order to bring a very profitable class of surgery back to the hospital setting. The facility fees collected for laparoscopic surgery are considerable, and hospitals feel they've been missing out.
Another example to suggest hospitals have been active in this area is the requirement by some payors that orthopedic implant surgeries be performed in hospitals rather than free standing ASC's. For example, we used to perform rotator cuff repairs (which use an anchor suture) in the ASC, but they can no longer be done here because the insurance company will only pay for the anchors if placed in a hospital. There is just no reason I can think of for this requirement other than to force surgeries back into hospitals and away from ASC's.
12/8/04 update: it is on the state servers at: http://app2.health.state.pa.us/commonpoc/content/facilityweb/FacMsgBoardDetails.asp?msgid=819&msgindex=2&Selection=ALL
Friday, December 3, 2004
Legalize It
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Froggy Ruminations an excellent argument for why we should Legalize It:
""I’m talking about completely legalizing it and selling it much in the same way as alcohol. I’m not going to trot out statistics about how alcohol is more harmful to the body than pot because you already know that. Besides, that’s not part of my argument either.
"The enforcement of marijuana smuggling is a massive distraction to the interdiction of really dangerous narcotics like cocaine, methamphetamine, and heroin. Smugglers do not care if a 100 lb. weed load is intercepted at a US Port of Entry. They don’t care because it’s the cost of doing business when your actual goal is to cross 5 lbs of heroin or 20kg of coke. The smugglers send some broke migrant farm worker with a green card across in a stolen car with the promise of $500 dollars if the poor sap actually makes it. But when the dope is spread out all around the car, the dogs are sure to catch it, and even if the dogs are taking a nap, any inspector that’s half awake can see the guy’s hand shaking and the beads of sweat forming on his brow. Right after that guy is sent to Secondary Inspection and all of the attention focused on a load car with unknown contents, 10 carloads of real dope crosses. In my two years working dope cases on the Southwest border, I caught a handful of dope loads containing anything but marijuana. Confidential Informants tell us the tactics that the smugglers use, and it is information from them that accounts for 90% of non-marijuana seizures at the Port.""
[Via Froggy Ruminations]
Friday, November 26, 2004
Common Good Promoting Special Health Courts
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Common Good is planning a brochure for mass distribution to 'advance the concept of a special health court.' I've written about this organization before. Their proposal, which has some pretty big names behind it, calls for the creation of special health courts. Some of the details include:
- Full-time judges
- Neutral experts
- Speedy processing at lower cost
- Schedule for non-economic damages
- Liberalized standard for patient recovery
Common Good is accepting donations (tax deductible) to help with the mass distribution of their brochures.
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Thursday, November 18, 2004
Recommended Adult Immunization Schedule
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From the CDC: QuickGuide: Recommended Adult Immunization Schedule --- United States, October 2004--September 2005. (PDF)
Tuesday, November 16, 2004
Would Specter Be Bad News For Tort Reformers?
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There's (another) good reason for physicians to take an interest in who is appointed Chair of the Senate Judiciary Committee--his record suggests Specter would be bad for tort reform.
"" A brief look at Mr. Specter's record makes that clear. In May of 1995, weeks into the new Republican majority, Mr. Specter tried to derail a product-liability reform bill. He voted against limits on attorney fees for medical liability suits and against limiting punitive damages to three times economic damages (not a hard cap, since economic damages would not be capped).
"Mr. Specter also voted against an amendment to limit non-economic damages to $500,000 and against another to protect OB/GYNs from being sued for problems they didn't cause. Mr. Specter also voted against the final bill. " --Washington Times"
More at NotSpecter.com.
[Via Overlawyered ]
Monday, November 15, 2004
Family Presence--A Really, Really Bad Idea
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There's a movement gaining steam to allow family members of very ill patients to watch resuscitation efforts by the medical team. This Fox News article states: "Better access to information and witnessing for themselves the measures taken, they argue, often help survivors through the grieving process."
I couldn't disagree more. As an anesthesiologist, I frequently find myself in situations where family members want to be present--at cesarean sections, at surgery for their children, etc. I just don't see how being present to witness the invasiveness of a modern 'code' is 'more holistic patient care.' We cram tubes down people throats, stick them with big needles to gain venous access, shock them with lots of electricity. During all of this they are often naked, sometimes vomit and, unfortunately, don't survive a majority of the time. Plus there's frequently chaos. The person 'running the code' is usually a medicine resident whose crisis management skills are, um, developing, shall we say?
Really, really bad idea.
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