The grotesque slaughter of innocents in Tucson, Arizona over the week-end has led many progressives to focus on the violent rhetoric that pundits on the Right often employ when attacking liberals. No question, this hate-speech has created a toxic atmosphere. Perhaps Jared Lee Loughner was influenced by that language. This might help explain why he shot into a crowd where Rep. Gabrielle Giffords (D-AZ) was addressing supporters, killing six people, including a child.

But if you look at what Loughner has written and said in the past, it seems that, as Alternnet Washington Bureau Chief Adele Stan suggested yesterday, while he was brimming over with “violent impulses” his words lacked any “coherent ideology.” 

That said, I agree with Stan that many of the metaphors that have laced far right commentary in recent years have been ugly. And when the media blindly broadcasts words into the night, that rhetoric has the power to support bloody urges. “It’s too soon to say what, exactly, motivated the man apprehended for the shooting . . .”  Stan writes, “but the Tea Party culture of political intimidation affirmed his violent impulses.” 

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Below , a story by Lawrence Dyche from Pulse: Stories from the Heart of Medicine.  I wish that more people like Dyche observed residents, taught them, and learned from them. I’m sure that most residents would appreciate the encounter.

As regular HealthBeat readers know, Pulse is an online magazine made up of outstanding true stories and poems written by doctors, patients, nurses, medical students and other healthcare professionals recording their personal experiences in our health care system. The quality of the writing is extraordinarily high, and the stories and poems are riveting.

A book that gathers some of the best Pulse stories from the magazine’s first year was recently reviewed in the Journal of the American Medical Association  (JAMA) where Perri Klass wrote  “All of the stories in this book . . . are told with a kind of urgency; these encounters change lives and mark memories. This collection is in some sense about writing for one's life."

 You can buy the collection here https://cart.bookmasters.com/marktplc/cart.php?buy=9780984291007M&pub=51900

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 “The Calling”

By Lawrence Dyche

I am a non-physician who teaches physicians. A clinical social worker by training, I help doctors learn to be more compassionate and skilled in their human interactions. I sit in with residents as they see their patients. I help them to become better listeners, I remind them that as they touch the body they also touch the soul. I emphasize the enormity of witnessing. And after two decades of doing this work with innumerable students, I still regard the medical profession with awe–not simply the doctors but the calling, and the extraordinary way I've seen some people answer it.

Back in the Eighties, when I was beginning this work, I shadowed a resident for an entire day on the wards of a city hospital. Despite the years that have passed, my memory of that day remains vivid.

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Anyone who suggests that “we don’t really know where the waste is” in our healthcare system just hasn’t been reading the news. There is so much over-ripe, low hanging fruit waiting to be plucked that the stench of excess has become difficult to ignore.

Even Bloomberg News, which is a business news website, not a health care reform website, pulled no punches in a December 30 story titled “Doctors Getting Rich with Fusion Surgery Debunked by Studies.”   Here Bloomberg focuses on Twin Cities Spine, a Minneapolis group that performs 3,000 spine surgeries a year at Abbott Northwestern, a hospital that boasts performing more spine procedures than any other medical center in the country. Following the money, Bloomberg reporters Peter Waldman and David Armstrong reveal that in the first nine months of 2010, spine surgeons at Twin Cities received $1.75 million in “royalties and consulting fees” from Medtronic, a medical device company which sells Infuse, a bone-growing material widely used in a type of back surgery called “fusion.”

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Naomi’s post (below, January 5) says everything that should be said about the administration’s decision to reverse its position on end-of-life planning. She nailed the story (thank you, Naomi).  

I’m tacking on a postscript only to report that tonight (January 5), Boston surgeon and New Yorker writer Dr. Atul Gawande talked about the turnaround, calling it “a tragedy” in an interview with Chris Hayes on MSNBC’s “Countdown with Keith Olbermann.” (This evening Chris Hayes was filling in for Olbermann.) 

As Gawande explained, research shows that when patients have more time with their doctors to discuss end-of-life care, they are less likely to die in a hospital or in an ICU.  

Most of us want to die at home. In a hospital, we are tended by strangers. Many may be kind, but, still, we are subject to the hospital’s schedule and hospital rules. As one physician who worked in an ICU explained when I was writing Money-Driven Medicine: “The patient becomes part of ‘the system.’” When she said that, I couldn’t help but think of criminals entering our prison system. Most of the time, hospital patients, like inmates, are told what will happen next. Rarely are they asked: “What would you like to happen next? Would you like to see your children this evening?”

In an ICU, visits from family and friends are even more limited, and some patients wind up strapped to their beds. Admittedly, this can be necessary. Otherwise, when patients are delirious or in pain, they may try to leap out of bed or tear out the tubes that are keeping them alive. Hospitals cannot station a nurse at the bed of each patient 24/7. And they don’t want to be sued because a patient hurt himself.

 At home, relatives and close friends can take turns being at the patient’s bedside–especially if the family has help from hospice or palliative care workers taking on other tasks.  

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On the first day of 2011, Princeton economist Paul Krugman ran an eye-opening chart in his New York Times column, illustrating the relationship between economic growth and unemployment.

The horizontal axis shows annual growth rates of real GDP [after adjusting for inflation]; the vertical axis shows the year-to-year change in the unemployment rate. “Two things are clear,” Krugman writes. “First, the economy has to grow around 2 1/2 percent per year just to keep unemployment from rising. [See the cluster of blue squares in the center of the chart where the change in unemployment ranges from 0 to -1% while GDP rises by at least 2.5%] Second, growth above that level leads to a less than one-for-one fall in unemployment, (because hours per worker rise, more people enter the work force, etc.). [People who have jobs are given more hours, and those who had given up looking for work, as well as recent graduates, join the work force.] Roughly, it takes two point-years of extra growth to reduce the unemployment rate by one point.”

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Summary: The “Dream Act” seemed to come and go so quickly in the news cycle. Legislation to repeal “Don’t Ask, Don’t Tell,” plus the hoped-for treaty with the  Soviets  pushed the failed bill off the media’s radar screen.

I wrote this post Saturday, but then didn’t put it up on Health Beat because I felt I wasn’t adding anything new to the debate. (Ask long-time Health Beat readers “What do you think Maggie thinks about the Dream Act”? and many could probably write the post themselves.) But as I thought about it, it seems to me that I do have something to say.

We should stop to grieve for these students. And we should put the Dream Act at the top of a liberal agenda next year. I realize that as the Tea Party joins Congress, it will be harder to welcome new immigrants to this country. But the Latino vote will be extraordinarily important in 2012. If only for political reasons, liberals should show their support for this legislation—and force conservatives to try to justify cutting off opportunities for 17-year-olds who live in this country.
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When the Obama-McConnell tax compromise passed the House last week, 112 Democrats voted against the legislation. Just 139 Democrats supported the bill. The split within President Obama’s own party underlines the uncertainty as to whether passage of the legislation really represented a “win” either for the president–or for the country.

Bloomberg that “Representative David Obey, a Wisconsin Democrat who is retiring after 40 years,” was among those who expressed his disgust with the deal. “’Wonderful,' he said, as he left the House floor for one of the last times in his career. “Just what we need: [a law that] further exacerbates income inequality in this country.”

“It is a huge giveaway to the super-rich in these tough economic times,” added Representative Jim McDermott, a Washington Democrat. “It just boggles the mind. It’s indefensible, unconscionable.”

According to Bloomberg, even House Speaker Nancy Pelosi, who played the role of a loyal lieutenant by selling the legislation to House liberals, sounded less than thrilled: “I salute President Obama for getting in the bill what is in there,” she said. “I’m sorry for the price that has to be paid by our children and our grandchildren to the Chinese government,” she added, referring to the fact that this bill will add $860 billion, plus interest, to the deficit– for a total of more than $1 trillion. (China is among the many foreign investors who buy our Treasuries, lending us the money needed to carry an extraordinary amount of debt. As of July 2010, the U. S. Treasury reports that China owned $846.7 billion, or 20.8 percent of U.S. debt held by foreigners.)

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When President Obama struck a deal with conservatives on tax cuts, his opponents set the stage for 2012. With this legislation, the conservative agenda of the Bush administration once again becomes national policy. The goal: to redistribute wealth upward–even if that means letting the deficit balloon.
Not long ago, conservatives on the Deficit Commission were warning that the deficit represents a “cancer” that will "destroy the country from within."

Now, politicians on the right are arguing for tax cuts that will add $858 billion to the deficit over ten years—plus $383 in interest over the same span—bringing the total impact on the national debt to $1.24 trillion through 2020. And somehow, that is suddenly a brilliant idea?

Trust me, there is a method to Mitch McConnell’s madness: The larger the deficit, the more compelling the conservative case for  shrinking entitlements such as  Medicare, Medicaid, Social Security and Health Care reform in 2012.

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It’s nice to know that the liberals are not the only politicians who know how to form a circle, and then shoot directly into the center.

Today, with a critical procedural vote on the tax deal scheduled in the Senate, some Tea Party activists and other conservatives are denouncing an agreement that gives the Republican leadership virtually everything that they might conceivably hope to win from the White House. 

Not satisfied, the party’s right wing is launching an attack. According to The New York Times “a group called the Tea Party Patriots is circulating a petition accusing Republican lawmakers of cutting a bad, backroom deal with the president that violates the principles that Tea Party candidates campaigned on during the midterm elections.

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Over the weekend, the New York Times published a head-turning tale about Dr. Mark Midei, a star cardiologist at St. Joseph Medical Center in Townson, Maryland. According to federal investigators, Dr. Midei implanted potentially dangerous cardiac stents in the arteries of as many as 585 patients who didn’t need them. A hard worker, he managed to knock off those 585 procedures in just two years, from 2007 to 2009. Medicare paid $3.8 million of the $6.6 million charged for the treatments.

The Baltimore Sun broke Dr. Midei’s story in January. In February the U.S. Senate Committee on Finance, which oversees Medicare and Medicaid, began investigating. Monday, the Finance Committee released a 1200-page report.

The report reveals that Midei was a favorite son of Abbott Laboratories, the company that manufactured the stents. Indeed, in August of 2008, Abbott celebrated the fact that the handy doctor had inserted 30 of the company’s cardiac stents into trusting patients in a single day: “Two days later, an Abbott sales representative spent $2,159 to buy a whole, slow-smoked pig, peach cobbler and other fixings for a barbecue dinner at Dr. Midei’s home.”  Employees from St. Joseph’s attended the feast.

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