Demystifying Death: Compassionate, Practical Advice for Patients and Families

Did you know that when there is “no hope of recovery” there are still things for the patient to hope for?

Did you know that a “living will” is not a legal document in New York State or Massachusetts?  

Did you know that environmentalists have created nature preserves where you can be buried?  “What we are doing is basically land conservation,” says Dr. Billy Campbell, who has created a preserve along Ramsey Creek in South Carolina. “By setting aside woods for natural burials, we protect it from development. At the same time, I think we put death in its rightful place, as part of the cycle of life. Our burials honor the idea of ‘dust to dust.’”  Ramsey Creek is just one place where families can arrange “green burials.”

These are a few of the things I learned yesterday at a “Leadership Connection” lunch for women in business, politics and the non-profit sector.  There, New York Times health editor Jane Brody spoke about her new book : Jane Brody’s Guide to the Great Beyond: A Practical Primer to Help You and Your Loved Ones Prepare, Medically, Legally, and Emotionally for the End of Life.

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He Said What?

When Brandeis professor Stuart Altman appeared before the Senate Finance Committee last week, he acknowledged, “I’m reluctant to mention it— but,  why waste money on in-depth treatment for people who won’t live long anyway? Better to warehouse them and save the resources for the young.”

At least, that’s what hotair.com says Altman said.  

Writing on “Hot Air,” Ed Morrissey takes his interpretation of Altman’s testimony and runs with it: “What happens when the state controls all the resources? New resources do not develop, and the government winds up rationing care based on its own priorities, and not the priorities of the patients or caregivers. . . . Anyone whose value does not show a positive “cost-benefit” ratio to the state will also likely wind up without the kind of care necessary to stay alive and healthy. . . . We’ve essentially returned to the eugenics arguments of the early 20th century, a dark period of human history we should be avoiding rather than embracing on the floor of the Senate.”

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Torture: “Cherchez la Femme”

            

               Torture may not seem a HealthBeat topic. But I’m willing to declare torture a medical problem. (Whether the victim or the torturer suffers from the greater problem is open to debate).            

            As regular readers know, I could go on at length.  But let me just say this. Why has the media focused on Nancy Pelosi?  Was she the Secretary of Defense at the time? Was she the director of the CIA?  Was she the president?  Could she possibly have  been  responsible for authorizing the torture?

         No. 

         Did she receive information from those responsible that should have told her that the U.S was engaging in inhumane behavior? I don’t know. But Pelosi is just one of many members of Congress who may well have known what was going on, and given the Bush administration’s stubborn refusal to share power with Congress  I doubt any of them could have stopped it.

       More importantly, as Washington Post's Greg Sargent pointed out yesterday, “Nancy Pelosi's claims about what she was told and when about torture are getting far more intense media scrutiny than the CIA's claims are. Simple fairness demands that both side’s claims get treated with a similar level of skepticism,” Sargent continues. “And they’re not. Sargent also notes that most news reports omit the fact that two other senior Democrats–Bob Graham and Jay Rockefeller–have publicly claimed that the CIA didn’t brief them about the use of torture in the manner the agency has claimed.

        Why, then, the focus on Pelosi?  The answer: “Cherchez la Femme”

       “Find the woman” is based on the Medieval belief that women are the root of all evil.  In Eden, Eve committed the first sin by succumbing to Satan and eating the apple. (Or at least that is what Genesis tells us.)  In the Middle Ages, religious scholars took this as a justification for primal misogyny.  More recently, the 1854 book The Mohicans of Paris by Alexandre Dumas warned: Il y a une femme dans toutes les affaires; aussitôt qu'on me fait un rapport, je dis: Cherchez la femme (There is a woman in every case; as soon as they bring me a report, I say, 'Look for the woman')

The phrase then became a truism for both the detective novel and film noir: no matter what the problem, a dame is probably at the bottom of it.

 Little wonder then, that when a great crime has been committed, many still believe that here is only one solution: Cherchez la Femme.

Thus, the media’s “expose” of torture zeroes in on Nancy Pelosi—distracting everyone from who in the Bush administration knew about the torture, when they knew about it, and who authorized it.

Money-Driven Medicine—N.Y. Premiere of Film, June 11

At last, Money-Driven Medicine is finished.  This  90-minute documentary was produced by Alex Gibney, best known for his 2005 film, Enron: The Smartest Guys in the Room  and his 2007 Academy Award Winning documentary, Taxi to the Dark Side.

The film was directed by Andy Fredericks, and is based on my book, Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper Collins).

The Century Foundation and the New York Society for Ethical Culture are co-hosting the New York premiere on June11,  7p.m.  at the New York Society for Ethical Culture, 2 West 64th Street at Central Park West. Doors open at 6:30.  Admission is free.  If you’re planning to attend, please RSVP  Loretta Ahlrich, ahlrich@tcf.org  or (212) 452-7722 so that we can have a rough idea of how many people will be coming.

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FDA Approves Devices Without Scrutiny, Putting Patients At Risk

There was real excitement two weeks ago among some FDA officials and drug and medical device lobbyists when reports came out that Senator Charles Grassley (R-IA) might leave his position as leader of the Senate Finance Committee to take over Arlen Specter’s spot as ranking member of the Judiciary Committee. Grassley has been a tenacious critic the Food and Drug Administration’s oversight of food, drug and medical device safety. He’s also fought to curtail industry payments to physicians and researchers who conduct trials on new drugs and devices.

 As it turns out, the cheering was premature. The FDA—and its new leadership—will still have to answer to Chuck Grassley, at least for the near future: The Judiciary position was given to Senator Jeff Sessions (R-Ala), although Grassley is likely take over leadership at the end of next year.

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Advice to Insurers on How to Capture Customers — Appeal to Emotions, Not Reason

As more and more employers back out of the health benefit business, more and more individual consumers are shopping for health insurance these days. Yet sales have remained relatively flat The McKinsey Quarterly reports in its most recent issue. “What,” McKinsey asks, “is preventing health insurers from effectively addressing pent-up demand?

My first thought was that the answer might have something to do with the fact  that consumers are having a hard time finding insurance that offers good coverage at a price they can afford. But apparently I’m wrong. The article’s authors suggest that insurers just don’t know how to advertise their product: “Our research suggests that a primary barrier is [insurers’]  belief that consumers make economically rational decisions about health benefits. It’s a misguided view. Faced with more choice, complexity, and financial exposure for their health care in an increasingly uncertain world, what consumers are really seeking is peace of mind.”

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Spinning Health Care Reform: Why Liberals Shouldn’t Learn to “Frame” Issues

Frank Luntz, a master manipulator of language who helped create the rhetoric that conservatives used throughout the 1990s, is now offering Republicans advice on how to talk about health care reform.

First, they must embrace the idea: “You simply MUST be vocally and passionately on the side of REFORM,” Luntz advises in a confidential 26-page report that Politico.com obtained from Capitol Hill Republicans.

Most Americans want health care reform, and so Republicans should forget about simply opposing President Obama on this issue. But they can redefine what reform means, says Luntz, author of Words that Work: It’s Not What You Say, It’s What People Hear.

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Health Care Industry Promises to Slow Spending on Health Care

Why?

You’ve seen the headlines: “Health Care Industry Offers to Rein in Spending”; “Stakeholders to Obama: We’re Ready to Cut Costs”?

What does this mean? I think it means that the industry—and in particular the insurance industry—is afraid, very afraid that the healthcare reform train is going to leave the station without them. They’re desperate to have “a seat at the table.” 

And so they are admitting what President Obama, White House Budget Director Peter Orszag and bloggers like yours truly have been saying for more than a year: we must rein in health care spending.  Over the weekend, the Wall Street Journal announced that the president would be receiving a letter signed by leaders of of Pharma, Advamed (device manufacturers), the American Medical Association (doctors), the American Hospital Association, America's Health Insurance Plans, and the Service Employees International Unions.  In that letter, the signers pledge “to do our part to achieve your Administration’s goal of decreasing the annual health care spending growth rate” by 1.5 percent a year, “saving $2 trillion or more . . .  we are developing consensus proposals to reduce the rate of increase in future health and insurance costs through changes made in all sectors of the health care system."  Today the president announced the industry’s promise.

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A Mother’s Day Present That Only a Blogger Would Love

Blog-bioethics reports that drug giant Merck has gone into the publishing business, creating a fake “peer-reviewed” medical journal to tout its products. (Hat-tip to reader and son Michael Klotz for calling my attention to this story yesterday—an unexpected Mother’s Day gift).

Summer Johnson writes: “It's a safe guess that somewhere at Merck today someone is going through the meeting minutes of the day that the hair-brained scheme for the Australasian Journal of Bone and Joint Medicine was launched, and that everyone who was in the room is now going to be fired. [ I’m afraid Johnson may be little optimistic about how Merck makes firing decisions—mm]

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Provider Backlash

Fifteen years ago, insurers were trying to put a brake on healthcare costs by “managing care”—which often meant saying “no” to patients. Too often, insurers denied coverage for care that patients needed. Then came the backlash against managed care, and insurers relented.  They began to say “yes” to more treatments, and passed the cost along to customers in the form of higher premiums, co-pays and deductibles. 

More recently, insurers have begun trying to save money by shifting their focus from patients to doctors. Increasingly, insurers have been delaying payments to physicians, and, doctors say, insurers are underpaying for many services. Physicians are now fighting back, bringing lawsuits against insurers. Doctors often complain that we live in a terribly litigious society. Now, they are hiring the lawyers. Are the suits justified?

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