In a New York Times Op Ed, Leonard Rubenstein and Brig. Gen. [ret] Stephen Xenakis discuss the contrast between the investigation of the torture lawyers and the lack of any investigation of the torture physicians and psychologists:
Doctors Without Morals
By Leonard S. Rubenstein and Stephen N. Xenakis
After five years of investigation, the Justice Department has released its findings regarding the government lawyers who authorized waterboarding and other forms of torture during the interrogation of suspected terrorists at Guantánamo Bay and elsewhere. The report’s conclusion, that the lawyers exercised poor judgment but were not guilty of professional misconduct, is questionable at best. Still, the review reflects a commitment to a transparent investigation of professional behavior.
In contrast, the government doctors and psychologists who participated in and authorized the torture of detainees have escaped discipline, accountability or even internal investigation.
It is hardly news that medical staff at the C.I.A. and the Pentagon played a critical role in developing and carrying out torture procedures. Psychologists and at least one doctor designed or recommended coercive interrogation methods including sleep deprivation, stress positions, isolation and waterboarding. The military’s Behavioral Science Consultation Teams evaluated detainees, consulted their medical records to ascertain vulnerabilities and advised interrogators when to push harder for intelligence information.
Psychologists designed a program for new arrivals at Guantánamo that kept them in isolation to “enhance and exploit” their “disorientation and disorganization.” Medical officials monitored interrogations and ordered medical interventions so they could continue even when the detainee was in obvious distress. In one case, an interrogation log obtained by Time magazine shows, a medical corpsman ordered intravenous fluids to be administered to a dehydrated detainee even as loud music was played to deprive him of sleep.
When the C.I.A.’s inspector general challenged these “enhanced interrogation” methods, the agency’s Office of Medical Services was brought in to determine, in consultation with the Justice Department, whether the techniques inflicted severe mental pain or suffering, the legal definition of torture. Once again, doctors played a critical role, providing professional opinions that no severe pain or suffering was being inflicted.
According to Justice Department memos released last year, the medical service opined that sleep deprivation up to 180 hours didn’t qualify as torture. It determined that confinement in a dark, small space for 18 hours a day was acceptable. It said detainees could be exposed to cold air or hosed down with cold water for up to two-thirds of the time it takes for hypothermia to set in. And it advised that placing a detainee in handcuffs attached by a chain to a ceiling, then forcing him to stand with his feet shackled to a bolt in the floor, “does not result in significant pain for the subject.”
The service did allow that waterboarding could be dangerous, and that the experience of feeling unable to breathe is extremely frightening. But it noted that the C.I.A. had limited its use to 12 applications over two sessions within 24 hours, and to five days in any 30-day period. As a result, the lawyers noted the office’s “professional judgment that the use of the waterboard on a healthy individual subject to these limitations would be ‘medically acceptable.’”
The medical basis for these opinions was nonexistent. The Office of Medical Services cited no studies of individuals who had been subjected to these techniques. Its sources included a wilderness medical manual, the National Institute of Mental Health Web site and guidelines from the World Health Organization.
The only medical source cited by the service was a book by Dr. James Horne, a sleep expert at Loughborough University in Britain; when Dr. Horne learned that his book had been used as a reference, he said the C.I.A. had distorted his findings and misrepresented his research, and that its conclusions on sleep deprivation were nonsense.
Dr. Horne had used healthy volunteers who were subject to no other stresses and could withdraw at any time, while C.I.A. and Pentagon interrogators used a broad array of stresses in combination on the detainees. Sleep deprivation, he said, mixed with pain-inducing positioning, intimidation and a host of other stresses, would probably exhaust the body’s defense mechanisms, cause physical collapse and worsen existing illness. And that doesn’t begin to acknowledge the dire psychological consequences.
The shabbiness of the medical judgments, though, pales in comparison to the ethical breaches by the doctors and psychologists involved. Health professionals have a responsibility extending well beyond nonparticipation in torture; the historic maxim is, after all, “First do no harm.” These health professionals did the polar opposite.
Nevertheless, no agency — not the Pentagon, the C.I.A., state licensing boards or professional medical societies — has initiated any action to investigate, much less discipline, these individuals. They have ignored the gross and appalling violations by medical personnel. This is an unconscionable disservice to the thousands of ethical doctors and psychologists in the country’s service. It is not too late to begin investigations. They should start now.
*************
Leonard S. Rubenstein is a visiting scholar at the Johns Hopkins Bloomberg School of Public Health. Stephen N. Xenakis is a psychiatrist and a retired Army brigadier general.
March 1st, 2010
A couple of years ago science writer Gary Taubes published Good Calories, Bad Calories, which argued that the conventional view that obesity was due to overeating was inconsistent with the evidence was likely false. Yaubes argued, rather, that it was more likely, and more consistent with the evidence, that carbohydrates in the diet were the problem. He also argued that the evidence that saturated fats were the cause of heart disease was extremely weak. He then went on to argue that many other conditions may be associated with increased carbohydrate consumption.
I am not a medical doctor, a biochemist, not nutrition expert. But I am a researcher and methodologist. From that perspective, I was extremely impressed with the quality of his argument. He convinced me that his argument was a very serious and important one.
As a researcher and methodologist, I know that we never trust people, especially in medicine and the human sciences, who have discovered that received belief is wrong. It is all too easy to become convinced by good rhetoric. Therefore, I sought out critiques of his work. At least at the time, a few months after the book came out, most critiques I could find were hatchet jobs. In one instance an author claimed that Taubes misquoted him. Taubes, however, produced the entire email from this researcher in which his meaning was clear. But Taubes went further. He showed that he had sent a followup email to this researcher asking if he really meant to say what Taubes interpreted him to say. The researcher was unambiguous in reioterating the correctness of Taubes’ interpretation.
Other critiques simply reiterated received wisdom on the value of low fat, high carbohydrate diets, with no real presentation of evidence, and essentially accused Taubes of being a danger to society. When I saw the quality of these “critiques,” I figured he likely has such a command of the facts that few were willing to challenge him at that level.
Taubes recently summarized his argument regarding obesity at the Dartmouth-Hitchcock Medical Center in a lecture: Why we gain weight. Judging from the questions, he received a very sympathetic and open-minded response. Perhaps at least parts of medicine are finally ready to take seriously this evidence-based challenge to received wisdom.
Watching the lecture, I was again reminded of the power of his argument and his mastery of a vast amount of evidence. He concludes. “I’m not trying to convince that it’s true. I’m trying to convince you that it’s worth taking seriously.” In that spirit, I recommend the lecture, and the book, very highly.
Watch it here. Do not take Taubes’ position to be the truth. But do try and encourage experts in relevant fields to seriously engage with it. Even if wrong, the science can only advance by taking this sophisticated argument seriously.
January 9th, 2010
One of the most popular academics supporting the Senate-Obama health plan has apparently failed to disclose his $297,600 contract contract with the Department of Health and Human Services. From emptywheel. As pointed out below, he is a major source for claims that taxing “expensive” health plans is effective policy:
Jonathan Gruber Failed to Disclose His $297,600 Contract with HHS
By emptwheel
MIT health economist Jonathan Gruber has been the go-to source that all the health care bill apologists point to to defend otherwise dubious arguments. But he has consistently failed to disclose that he has had a sole-source contract with the Department of Health and Human Services since June 19, 2009 to consult on the “President’s health reform proposal.”
He is one source for the claim that the excise tax will result in raises for workers (though his underlying study is in-apt to the excise tax question). He is the basis for the argument that the Senate bill reduces families’ risk–even if it remains totally unaffordable. Even Politico stenographer Mike Allen points to Gruber’s research.
But none of the references to Gruber I’ve seen have revealed that Gruber has a $297,600 contract with HHS to produce,
a technical memorandum on the estimated changes in health insurance coverage and associated costs and impacts to the government under alternative specifications of health system reform. The requirement includes developing estimates of various health reform proposals on health insurance coverage and cost. The alternative specifications to be considered will be derived from the President’s health reform proposal. [my emphasis]
(h/t Mote Dai)
The President’s health reform proposal? But I thought this was the Senate’s health reform proposal?!?!? (wink!)
Now, HHS says they had to put Dr. Gruber in charge of evaluating health care reform proposals because he’s got,
a proven micro-simulation model with the flexibility to ascertain the distribution of changes in health care spending and public and private sector health care costs due to a large variety of changes in health insurance benefit design, public program eligibility criteria, and tax policy.
Even assuming that Gruber is the only one in the world who can run these simulations, don’t you think it’s rather, um, dubious that the guy evaluating the heath care reform–for $300,000–is also the package’s single biggest champion?
And no one has been transparent about this contract?
January 8th, 2010
From Norway comes news of a simple, but effective, solution to the problem of Methicillin-resistant Staphylococcus aureus (MRSA) or “superbugs” that, as they spread, pose extreme dangers to us and our healthcare system. In the US and other countries, a visit to the hospital means worrying about exposure to MRSAs. There are 19,000 MRSA deaths in the US every year. But not in Norway.
The reason: Norwegians stopped taking so many drugs….
Norway’s model is surprisingly straightforward.
• Norwegian doctors prescribe fewer antibiotics than any other country, so people do not have a chance to develop resistance to them.
• Patients with MRSA are isolated and medical staff who test positive stay at home.
• Doctors track each case of MRSA by its individual strain, interviewing patients about where they’ve been and who they’ve been with, testing anyone who has been in contact with them.
They allow minor illnesses to take their course:
“We don’t throw antibiotics at every person with a fever. We tell them to hang on, wait and see, and we give them a Tylenol to feel better,” says Haug.
However, Norwegian society has a crucial difference that allows them to wait. They have a social democracy:
All workers are paid on days they, or their children, stay home sick.
Can you imagine such a radical idea in the US?
Acting reasonably also pays off in reduced costs:
Norway responded swiftly to initial MRSA outbreaks in the 1980s by cutting antibiotic use. Thus while they got ahead of the infection, the rest of the world fell behind.
In Norway, MRSA has accounted for less than 1 percent of staph infections for years. That compares to 80 percent in Japan, the world leader in MRSA; 44 percent in Israel; and 38 percent in Greece.
In the U.S., cases have soared and MRSA cost $6 billion last year. Rates have gone up from 2 percent in 1974 to 63 percent in 2004. And in the United Kingdom, they rose from about 2 percent in the early 1990s to about 45 percent, although an aggressive control program is now starting to work.
Alas, Norway is not separate from the rest of the world. It’s success may not last:
But Elstrom [Norway's MRSA control director] worries about the bacteria slipping in through other countries. Last year almost every diagnosed case in Norway came from someone who had been abroad.
“So far we’ve managed to contain it, but if we lose this, it will be a huge problem,” he said. “To be very depressing about it, we might in some years be in a situation where MRSA is so endemic that we have to stop doing advanced surgeries, things like organ transplants, if we can’t prevent infections. In the worst case scenario we are back to 1913, before we had antibiotics.”
Fortunately, Norway’s success is replicable elsewhere:
But can Norway’s program really work elsewhere?
The answer lies in the busy laboratory of an aging little public hospital about 100 miles outside of London. It’s here that microbiologist Dr. Lynne Liebowitz got tired of seeing the stunningly low Nordic MRSA rates while facing her own burgeoning cases.
So she turned Queen Elizabeth Hospital in Kings Lynn into a petri dish, asking doctors to almost completely stop using two antibiotics known for provoking MRSA infections.
One month later, the results were in: MRSA rates were tumbling. And they’ve continued to plummet. Five years ago, the hospital had 47 MRSA bloodstream infections. This year they’ve had one.
“I was shocked, shocked,” says Liebowitz, bouncing onto her toes and grinning as colleagues nearby drip blood onto slides and peer through microscopes in the hospital laboratory.
When word spread of her success, Liebowitz’s phone began to ring. So far she has replicated her experiment at four other hospitals, all with the same dramatic results.
“It’s really very upsetting that some patients are dying from infections which could be prevented,” she says. “It’s wrong.”
Around the world, various medical providers have also successfully adapted Norway’s program with encouraging results. A medical center in Billings, Mont., cut MRSA infections by 89 percent by increasing screening, isolating patients and making all staff — not just doctors — responsible for increasing hygiene.
In Japan, with its cutting-edge technology and modern hospitals, about 17,000 people die from MRSA every year.
Dr. Satoshi Hori, chief infection control doctor at Juntendo University Hospital in Tokyo, says doctors overprescribe antibiotics because they are given financial incentives to push drugs on patients.
Hori now limits antibiotics only to patients who really need them and screens and isolates high-risk patients. So far his hospital has cut the number of MRSA cases by two-thirds.
In 2001, the CDC approached a Veterans Affairs hospital in Pittsburgh about conducting a small test program. It started in one unit, and within four years, the entire hospital was screening everyone who came through the door for MRSA. The result: an 80 percent decrease in MRSA infections. The program has now been expanded to all 153 VA hospitals, resulting in a 50 percent drop in MRSA bloodstream infections, said Dr. Robert Muder, chief of infectious diseases at the VA Pittsburgh Healthcare System.
“It’s kind of a no-brainer,” he said. “You save people pain, you save people the work of taking care of them, you save money, you save lives and you can export what you learn to other hospital-acquired infections.”
Pittsburgh’s program has prompted all other major hospital-acquired infections to plummet as well, saving roughly $1 million a year.
“So, how do you pay for it?” Muder asked. “Well, we just don’t pay for MRSA infections, that’s all.”
Will this approach catch on?
Meanwhile, the Norwegian experience is another reminder that, in healthcare, less is not always worse. If only the breast cancer “advocates” who came out so strongly against the reasonable new recommendations of the US Prevention Task Force that not all women between 40 to 50 need to be screened and that, for many other, biannual screening is enough had understood this lesson.
January 3rd, 2010
NPR recently had an amazing story by Alix Spiegel of how pharmaceutical company Merck help turn a research term, osteopenia, into a diagnosis “treated,” often ineffectively, by Merck’s drug Fosamax. The story involves the creation of osteopenia, a supposed subthreshold version of osteoporosis or low bone density. I also involves the systematic dissemination of inexpensive “diagnostic” machines for the new disorder that, however, fail to assess bone density where most breaks occur, that is, where it really matters. It involves Merck funding a number of organizations to lobby for the Medicare law to be changed, allowing doctors to be reimbursed for using these new machines of questionable utility. And it involves Merck selling a lot of Fosamax to women with the new “disorder” and making a lot of money. And it involves questions as to whether Fosamax is actually helpful, or may even be harmful, in these women who a few years ago were only experiencing normal aging. It also involves a lack of any plans to conduct the long-term follow-up studies necessary to determine if this treatment is helping, useless, or harmful.
This is a story that tells us so much about what is wrong with our healthcare system. Questionable diagnoses created and treatments administered to make money for large corporations. Alas, the recent reactions to the changed breast cancer screening guidelines suggest that once a constituency of doctors, drug dealers companies, and advocacy groups sees “benefits” from a new prevention approach, it will be extremely difficult to change.
Read or listen to the story here.
January 1st, 2010
Antony Lerman, writing in the Guardian, calls upon the Israeli Medical Association to investigate reports that Israeli physicians are complicit in torture. The World Medical Association should also stop its double standard and investigate reports of Israeli abuse, just as they responded to reported abuses by Iran:
Israel’s doctors must allay torture fears
Allegations of Israeli doctors colluding in the torture of Palestinians must be investigated
By Antony Lerman
One of the disturbing features of the persistent use of torture by many countries in conflict situations around the world is the role some doctors play in condoning it. The World Medical Association (WMA), which “promot[es] the highest possible standards of medical ethics, [and] provides ethical guidance to physicians”, is crystal clear on this practice. Its 1975 Tokyo declaration states unequivocally that “physicians shall not countenance, condone or participate in the practice of torture or other forms of cruel, inhuman or degrading procedures, and in all situations, including armed conflict and civil conflict”. True to its principles, in October, in response to reports about the possible collusion of doctors in the abuse of prisoners in Israeli and World Medical , the WMA passed a unanimous motion at its annual meeting in Delhi urging national medical associations to speak out in support of the rights of patients and doctors there. But is the WMA being selective in its condemnations?
The specific problem of doctors’ complicity in the torture of detainees in the Middle East was raised at an international patients’ rights conference in Turkey in November. In a presentation she made, Dr Ruchama Marton, head of Physicians for Human Rights-Israel (PHR-I), called for the WMA to play a central role in establishing a network “to voice complaints and provide assistance to those who are willing to struggle against torture”. National medical associations and human rights organisations should work together “to campaign against torture in general and against the participation of physicians in torture procedures”. In saying this, Marton was thinking about what some regard as the very unsatisfactory situation in Israel.
Evidence has been produced by the Public Committee Against Torture in Israel (PCATI) and PHR-I of doctors examining interrogated Palestinians before, during or after torture without documenting, reporting or resisting, and by providing medical documents and information to the bodies responsible for the torturing. These are all expressly prohibited under WMA and Israel Medical Association (IMA) guidelines, as is even the presence of a doctor where there is torture.
These allegations have never been seriously investigated by the IMA, despite persistent urging by PHR-I as part of its long struggle against the use of torture and its bringing of the issue to the attention of the WMA. In the summer the IMA cut ties with the human rights body, accusing it of fomenting antisemitism. Dr Yoram Blachar, the chairman of the IMA, wrote in a letter that “the outrageous situation is that PHR’s activity serves as fertile ground for antisemitism, anti-Israelism and anti-Zionism”.
In May, a letter sent to the WMA council through the chairman, Dr Edward Hill, signed by 725 doctors from 43 countries, and supported by PHR-I, requested that the WMA investigate the IMA for failing to conform to its code on the absolute prohibition of doctors participating in and condoning torture. And it called for the immediate resignation of the then president of the WMA, Blachar. In November, Dr Derek Summerfield of the Institute of Psychiatry at the University of London, convenor of the group who signed the May letter, wrote to the new WMA president, Dr Dana Hanson, on behalf of the lead signatory Professor Alan Meyers of Boston University, and again pressed for action to investigate the IMA. And he also referred to the apparent discrepancy between the treatment of reports of collusion in torture in Iran and in Israel. At the end of October, Meyers spoke to WMA council chair Dr Edward Hill and was told that the WMA would neither be responding to nor commenting on the May letter. So far, that stance seems remain in place.
The current situation is deeply unsatisfactory. Even though Israel’s supreme court in 1999 finally ruled that methods of torture used at that time by the security forces were illegal, a loophole was left for interrogators who tortured in “ticking bomb” situations, which ultimately allowed old forms of torture to creep back in by the mid-2000s, as a 2007 report by PCATI showed. So there is good reason to be seriously concerned about the use of torture today.
It is important to recognise that torture would not be possible without the support and safety net of doctors and that doctors are key in exposing and stopping the practice. Israel therefore needs to do two things. First, allegations that Israeli doctors colluded in torture must be confronted and thoroughly investigated. Otherwise, this ongoing affair can only damage the reputation of the vast majority of doctors in Israel, many of whom belong to PHR-I, who will have no truck whatsoever with torture and who assiduously apply their principles of medical ethics equally to all who come into their care, irrespective of national, ethnic or religious origin.
Second, PHR-I proposals for guidelines to help doctors identify torture and for legislation that would make it obligatory to report suspicion of torture and protect whistleblowers – measures that would protect doctors’ independence and make it much harder for interrogators to use torture – must be adopted by the IMA and the government.
No double standards are being applied to Israel here. By implementing the proposals, Israel would simply be conforming to WMA guidelines – and doing at least one thing that would help repair its international position.
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December 23rd, 2009
Here is a letter sent by a Tallahassee, Florida orthopedic surgeon to Washington Post columnist David Broder responding to Broder’s recent columns on the healthcare reform effort. The letter responds to interesting recent arguments of New Yorker writer and Harvard physician Atul Gawande on strategies for reducing healthcare cost:
December 11, 2009
Mr. David Broder
Washington Post Writers Group
1150 15th Street NW
Washington, DC 20071
Dear Mr. Broder,
I read with interest your column titled “Health Care Brings Freshman Senators to the Forefront” in today’s edition of the Tallahassee Democrat. I agree cost control is the key issue in health reform and has not been addressed in current congressional efforts. The output from Congress seems focused mostly on what is politically possible and increasingly on what can be supported by 60 votes, not true reform.
The mainstream media seems to have bought into the notion that, since the Republicans are trying to block reform and perhaps make health reform “Obama’s Waterloo,” the House and Senate output should be supported. Although allowing for deep flaws in the legislation, there is the feeling that incremental steps toward a better system are good. You and the excellent writer you reference, Dr. Atul Gawande, have apparently bought into this mindset. Allow me to disagree.
Gawande, in his latest article in The New Yorker titled “Testing, testing,” speaks of small-scale pilot projects in the proposed legislation with hope they will show the way toward cost savings.
Yet we already have pilot projects all over the world that have met with dramatic success: nearly every other developed country has universal coverage with higher citizen satisfaction and far higher medical outcomes at roughly half the per-capita cost as U.S. health care. Half the cost.
Why do we need new pilot projects? We have the knowledge that the only two successful health care models in these countries are either (1) highly regulated nonprofit insurers who sell health policies as an inducement to the purchase of profitable property, fire and auto insurance, or (2) some version of single payer.
We know no country utilizes a system like the model Congress is proposing and that none like it has ever been successful. Eight prior state efforts using this model all failed, usually within a few years. Massachusetts, currently starting its third year with a similar model, is not able to control costs, and has the most expensive health insurance in the world. This is the model for what Congress has proposed.
Medicare for All is criticized for being a “government takeover.” Really, we have entrusted health care to private insurance long enough to know that their business model of avoiding the sick, then dumping those who do need care rather than spreading the risk as insurance is supposed to do, does not work. Medicare has a 92 percent enrollee satisfaction rate. Private insurance cannot approach that.
Critics also charge that Medicare is bankrupt. What do you expect when the funding is provided by a dwindling collection of payroll taxes from fewer and fewer workers to support current Medicare enrollees who are swelling in numbers? Funding Medicare with a 2 percent or 3 percent progressive income tax would be the answer – an amount that would certainly be less than what most people pay today for premiums, co-pays, deductibles, uncovered services and other out-of-pocket health care costs.
The individual mandate to have insurance, as proposed by the House, is an effort to avoid adverse risk selection, which occurs when those who are currently young and healthy wait to purchase insurance until they get sick. Insurance obviously works best with the largest possible risk pool and that is why health savings accounts and skimpy coverage for different groups are bad ideas. What would work best is every American covered in the same risk pool. We could have comprehensive coverage, all with the same policy as every member of Congress – truly egalitarian – for what we currently pay in health care in this country now: $2.4 trillion annually.
Gawande mentions the benefits of improved information about what works, comparative effectiveness, and the problem of overutilization (which he headlined in his previous New Yorker article). Yet look what instant information would be available if we had single payer: instant data on comparative effectiveness, overutilization, and disease outbreaks anywhere in the country.
Gawande has also written about a Texas border town, McAllen, with high utilization and cost. His information was obtained through Medicare data, which is the best nationwide health care data we have available. Single payer would give us such high-quality information instantly for the entire nation, not just the Medicare population.
Gawande also speaks of the need for tort reform, of which there is essentially none in current congressional proposals. If we had truly universal comprehensive, egalitarian Medicare for All, we would eliminate the cost of future medical expenses from all personal injury lawsuits, not just Med-Mal. This is a major component of economic damages in personal injury lawsuits.
Current congressional proposals retain the main low-hanging fruit for cost cutting and reward it: the wasteful administrative expense, marketing cost, profits of the for-profit insurance industry. To the current 31 percent administrative waste in the system, Congress proposes to add additional bureaucracy and a czar so we are likely to reach 35 percent overhead and waste. That figure, the highest in the world almost by a factor of two, could be lowered for a saving of $400 billion a year within our current budget, with the savings used to cover every one of us without raising costs.
The additional opportunity to sensibly manage our nation’s health budget with the inevitable rationing decisions necessary in the future, with global budgeting and so on, would also stem from a single-payer system.
Now one last word on true reform: if we moved away from fee-for-service reimbursement for physicians and instead provided incentives for them take salaried positions, like those in the Veterans Administration and the U.S. military (along with those at the Mayo Clinic), there would likely be huge additional savings. Socialized medicine? No. By and large, you’d still private physicians working in private hospitals.
Under a single-payer arrangement, patients would have more free choice of physician and hospital than we have now. Every American would have the choice to go to the Mayo Clinic, so the competition would surely result in improvements for all facilities and caregivers.
I read what you write and what Dr. Gawande writes with interest, but in this case I strongly disagree. Congress needs to start over on health reform, and this time it needs to compare single-payer Medicare for All with other options. I guarantee you that single payer will win hands down.
Sincerely,
Ray Bellamy, M.D.
Dr. Ray Bellamy is an orthopedic surgeon in Tallahassee, Fla.
December 16th, 2009
Firedoglake is requesting signatures on the following petition to President Obama:
Sign our Petition to President Obama:
“Harry Reid might not be able to make corrupt Senate Democrats work on behalf of the American people, but you certainly can. Make good on your campaign promises and don’t let corrupt Members of Congress and the private insurance industry get in the way of the needs of millions of Americans. If health care reform continues with a compromised public option, we’ll know you failed to do everything in your power to ensure affordable access and coverage for those who need it most.”
[FDL continues:] During his campaign, President Obama gave us his word: “…when I’m President, we’re going to make drug and insurance companies compete for their customers just like every other business in America.” If he signs a health care bill with a triggered public option, he’ll be turning his back on a promise to his voters. Will Obama let the interests of the private insurance industry seal the fate of millions of desperate Americans? Or will he stand up for the nation’s most vulnerable citizens and pass a real public option?
Go here to sign.
December 9th, 2009
We have writeup here repeatedly about the failures of US health professionals to act to stop or reveal US torture. Rather, they chose tho aid it. Now out of Iran comes a tragic story reminding us that some health professionals do choose to act in the face of government abuse, even at the risk of their lives. Doctor Ramin Pourandarjani, who revealed the torture of jailed protesters the spring’s election theft protests, has apparently been poisoned:
Pourandarjani was a doctor at Kahrizak, a prison on Tehran’s outskirts where hundreds of opposition protesters were taken after being arrested in the crackdown following June’s disputed presidential elections. The facility became so notorious that it was ordered shut down by Iran’s supreme leader as reports of abuse and torture became an embarrassment to the clerical rulers and security forces.
Pourandarjani testified before a parliamentary committee and reportedly told the committee members that one young protester he treated died from heavy torture.
The young physician died from an overdose of propranolol in a delivery salad, Mr. Dowlatabadi said Tuesday. Propranolol is used to treat high blood pressure, rapid heart rate and tremors, and can be lethal in high doses.
Sadly, in the far less dangerous environment here, we have no comparable US health professional heroes.
December 3rd, 2009
I have come across an important article from the British Medical Journal that discusses one of the major gaps in what has come to be called Evidence-Based Medicine. Such a gap is a major scandal for the field of medicine:
Parachute use to prevent death and major trauma related to gravitational challenge: Systematic review of randomised controlled trials
Gordon C S Smith, professor1, Jill P Pell, consultant2
1 Department of Obstetrics and Gynaecology, Cambridge University, Cambridge CB2 2QQ, 2 Department of Public Health, Greater Glasgow NHS Board, Glasgow G3 8YU
Correspondence to: G C S Smith gcss2@cam.ac.uk
Abstract
Objectives To determine whether parachutes are effective in preventing major trauma related to gravitational challenge.
Design Systematic review of randomised controlled trials.
Data sources: Medline, Web of Science, Embase, and the Cochrane Library databases; appropriate internet sites and citation lists.
Study selection: Studies showing the effects of using a parachute during free fall.
Main outcome measure Death or major trauma, defined as an injury severity score > 15.
Results We were unable to identify any randomised controlled trials of parachute intervention.
Conclusions As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.
November 25th, 2009