We have heard the substantially different demands articulated by spokespersons from each major national political party concerning health reform, and today we heard that two federal courts have said that the Patient Protection and Affordable Care Act of 2010 is constitutional and two have declared it unconstitutional, moving the ACA in the direction of America's highest court which will be asked to offer a raised or lowered thumb.
In my earlier blogs, I asked the Democratic administration for a simple explanation of its ethical basis for moving ahead with health care reform. Neither I, nor - more importantly - the American electorate, received an answer. So now, it's the Republican party's turn: what is the ethical foundation for the Republican party's opposition to health care reform?
I can't figure out whether what is at stake is pragmatic politics, a sophisticated view of the health care needs of America's men, women and children, a greater respect for material wealth than human values, or exactly what each political party's ethical standards are. Where we are going? What are the points on the ethical compass we are being told to follow?
Will someone from the Republican party fill the void left by the Democrats? What are the ethical considerations of the Republican party in formulating its opposition to health care reform?
Monday, January 31, 2011
Tuesday, January 25, 2011
Dementia-Impaired Physicians
Today I received confirmation that my chapter dealing with HIV-infected health care workers, in Thompson-Reuters' Health Law Guide (a near- encyclopedic publication for attorneys), has been forwarded to the publisher. In that chapter, I describe the low risk of blood borne HIV infection transmission from health professional to patient, or from patient to health professional, but the unquantified risk of judgment deficiencies in AIDS-dementia affected health care professionals in practice. The term "unquantified" indicates that I have not been able to determine the number of professionals who have the condition, the measurable effect of that deficiency on that population's judgment, or its consequences for patients.
Today's New York Times features a thoughtful article about aging physicians with dementia, a troubling subject which deserves attention (not just for physicians, but for those in other professions, as well). These demented physicians may go unnoticed and unreported by their colleagues and noticed, but not necessarily dealt-with by family members and others who are emotionally and economically related to them.
My only significant point of disagreement with the Times article is that periodic neuropsychological testing should be more frequently used by credentialing bodies to evaluate physicians' and other health (and non-health) professionals ability to practice safely. Use of testing would protect not only patients, but the professionals whose judgments and learning capacities are impaired, and thus prevent calamities and tragedies for both groups.
As one who has had the experience of a quiet conversation with a professional, telling him(or her) that the time has come to retire to protect patients and himself from deterioration in his judgment and skills, and then been thanked by the practitioner and (separately) his family for doing so, I know that it can be done.
Today's New York Times features a thoughtful article about aging physicians with dementia, a troubling subject which deserves attention (not just for physicians, but for those in other professions, as well). These demented physicians may go unnoticed and unreported by their colleagues and noticed, but not necessarily dealt-with by family members and others who are emotionally and economically related to them.
My only significant point of disagreement with the Times article is that periodic neuropsychological testing should be more frequently used by credentialing bodies to evaluate physicians' and other health (and non-health) professionals ability to practice safely. Use of testing would protect not only patients, but the professionals whose judgments and learning capacities are impaired, and thus prevent calamities and tragedies for both groups.
As one who has had the experience of a quiet conversation with a professional, telling him(or her) that the time has come to retire to protect patients and himself from deterioration in his judgment and skills, and then been thanked by the practitioner and (separately) his family for doing so, I know that it can be done.
Tuesday, January 18, 2011
If A Little X-Ray Is Good For You, Is More Better?
A recent airport visit and and article on an online medical service, prompted me to recall a superb lecture at an American Society of Hematology Annual Meeting several years ago and the nagging question with which I left the hall. The subject was the biologic effect of radiation and the speaker scientist guided his audience through the intricacies of cellular responses to radiation, making the point that cellular repair systems spring into action within 10 seconds of exposure and may remain activated. And then he said something disconcerting, to the effect that he had been impressed with the interest of certain officials involved in the American defense system, in upping the exposure of Americans to radiation with the expectation that this exposure would augment their bodies' "resistance" to further radiation. The idea struck me as bizarre, since I and generations of physicians had been taught that there is no safe dose of radiation, and that with each increase in exposure, the frequency of mutations (with increased risk of cancer) increases. But then at the airport was this machine, supposedly in the interest of preventing terrorism, radiating a portion of the population . . . Oh really?
Added April 6, 2011: Drugs for treatment of radiation exposure.
Added April 6, 2011: Drugs for treatment of radiation exposure.
Wednesday, January 12, 2011
HHS - Psychotherapy Notes and Testing Data Study Announcement
NOTE: FOLLOW All of the instructions below to register
HHS to Host Webinar as Part of Psychotherapy Notes and Testing Data Study under the HITECH Act
HHS to Host Webinar as Part of Psychotherapy Notes and Testing Data Study under the HITECH Act
January 12, 2011
The Substance Abuse and Mental Health Services Administration (SAMHSA) is conducting a Confidentiality and Privacy Issues Related to Psychological Testing Data study, in close cooperation with the Office for Civil Rights (OCR) pursuant to section 13424 of the Health Information Technology for Economic and Clinical Health (HITECH) Act, a component of the American Recovery and Reinvestment Act (ARRA) (P.L. 111-5). This study is addressing whether the HIPAA Privacy Rule’s special protections relating to the use and disclosure of psychotherapy notes should also be applied to “test data that is related to direct responses, scores, items, forms, protocols, manuals or other materials that are part of a mental health evaluation.”
As part of this study, SAMHSA is hosting an interactive webinar on January 18, 2011, 12:00pm – 2:00pm (EST), to bring together professionals in the areas of mental health and privacy protection, summarize what its project team has learned to date, and provide participants with opportunities to ask questions and submit comments.
Pre-registration is requested and can be accomplished at the following website: https://www.mymeetings.com/
If you have any questions about the webinar or the Confidentiality and Privacy Issues Related to Psychological Testing Data project, please contact David Bercham at 301-251-0300, x215, or through email at David.Bercham@AMSAQ.com.
Sunday, January 9, 2011
US Income, Poverty and Health: FindThe Facts Yourself
If you prefer facts to rhetoric:
The world's industrial development, wealth and health: where do we stand? A brief informative video illustrates changes over the last 200 years.
http://www.youtube.com/watch?
http://www.cdc.gov/nchs/
http://www.nih.gov/
http://www.macfound.org/atf/cf/{B0386CE3-8B29-4162-8098-E466FB856794}/HCD_NET_Status_Health.pdf
http://www.census.gov/prod/2006pubs/p60-231.pdf
For more, Google "US income poverty and health". Read, think and then communicate with your Congressperson who needs input from constituents rather than more campaign support from lobbyists.
The world's industrial development, wealth and health: where do we stand? A brief informative video illustrates changes over the last 200 years.
http://www.youtube.com/watch?
http://www.cdc.gov/nchs/
http://www.nih.gov/
http://www.macfound.org/atf/cf/{B0386CE3-8B29-4162-8098-E466FB856794}/HCD_NET_Status_Health.pdf
http://www.census.gov/prod/2006pubs/p60-231.pdf
For more, Google "US income poverty and health". Read, think and then communicate with your Congressperson who needs input from constituents rather than more campaign support from lobbyists.
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