Perspectives: Health Care Sabotage; Patient-Centered Cancer Research; And Quality Nursing Home Care
Editorial writers focus on these health topics and others.
The Hill:
When My Former Colleagues In Congress Attack Health Care, They Attack Me
Like many Members of Congress, I thought I knew health care. Until I got sick. Just over a year ago, I shared my story about my personal fight for my right to health care while my former Republican colleagues were doing everything in their power to take it away. It’s not a secret: I have multiple sclerosis, an autoimmune disease that attacks the central nervous system. It is a chronic and expensive disease. Every time the GOP attacks the health care of working families, I hear them loudly and clearly because they put my life at risk. (Former Rep. Donna Edwards, 10/18)
Boston Globe:
Looking To The Future Of Patient-Centered Cancer Research And Treatment
Over the past 40 years, cancer research has seen revolutionary discoveries — about genes, targeted drugs, and immune therapies — that have already had dramatic effects for some patients.But to speed progress toward better therapies, we need another kind of revolution: We need to enable cancer patients to become active partners in research. (Reed Jobs and Eric S. Lander, 10/18)
The Hill:
We Should Give Long-Term Care Residents The Quality Care They Need And Deserve
Nursing homes face constant criticism. Most recently, nursing homes have been consistently questioned and scrutinized for the amount of therapy provided to the people for whom we provide care. Some say it is too much therapy, others too little. Now critics are using a recent study in the, “Journal of the American Medical Directors Association (JAMDA)” to go one step further by accusing nursing homes of inappropriately providing increasingly intense levels of rehabilitation to long-stay residents nearing the end of life. (Mark Parkinson, 10/18)
JAMA:
Clinician-Patient Discussions Of Successful CPR—The Vegetable Clause
“Well, I wouldn’t want to be a vegetable.” This statement, which a colleague has termed the vegetable clause, is one that I have heard countless times from patients when the topic of cardiopulmonary resuscitation (CPR) is raised. Often made to an admitting resident during an overnight encounter, the vegetable clause is interpreted to mean that the patient would not want life-sustaining treatment, specifically CPR. This results in the placement of a do-not-resuscitate (DNR) order. However, when I meet these patients soon after admission, it sometimes becomes clear that attempting CPR is consistent with their values and goals but that they would not desire prolongation of life were they to sustain severe neurologic deficits. (Anthony C. Breu, 10/18)
JAMA:
Cervical Cancer Screening—Moving From The Value Of Evidence To The Evidence Of Value
Widespread implementation of cytology-based screening programs has resulted in marked declines in cervical cancer incidence and mortality in the United States. Nonetheless, an estimated 13 240 women will be diagnosed with cervical cancer in 2018, and 4170 will die from the disease. It is likely that a sizable proportion of these women will not have been appropriately screened. (George F. Sawaya, 10/18)
New England Journal of Medicine:
The Supreme Court’s Crisis Pregnancy Center Case — Implications For Health Law
States frequently compel health professionals and commercial entities to disclose information relevant to patient or consumer decision making. For many years, such laws were presumed to be constitutional, despite the First Amendment’s protection of free speech. But after the Supreme Court’s decision in National Institute of Family and Life Advocates v. Becerra (NIFLA) in late June 2018,1 the status of such laws is an open question. (Wendy E. Parmet, Micah L. Berman, and Jason A. Smith, 10/18)
New England Journal of Medicine:
Abortion 'Reversal' — Legislating Without Evidence
Women up to 10 weeks pregnant who are having a medication abortion generally take one dose of mifepristone, which blocks the progesterone receptor, followed within 48 hours by a dose of misoprostol, a prostaglandin that causes cervical dilation and uterine contractions, leading to expulsion of the pregnancy tissue. Four states (Arkansas, Idaho, South Dakota, and Utah) require abortion providers to tell their patients about treatment that may reverse the effect of mifepristone if they change their mind after starting a medication abortion. So-called abortion reversal involves administering repeated doses of progesterone. Since 2017, other states have proposed similar bills and the California Board of Registered Nursing approved a course on medication-abortion reversal for continuing-education credit. This trend is troubling because of the lack of medical evidence demonstrating the safety and efficacy of the treatment; laws promoting it essentially encourage women to participate in an unmonitored research experiment. (Daniel Grossman and Kari White, 10/18)
New England Journal of Medicine:
'Transparency' As Mask? The EPA’s Proposed Rule On Scientific Data
The Environmental Protection Agency proposes excluding from consideration in setting environmental standards any studies whose raw, individual-level data are not publicly available. Its actions seem to be an attack on the use of science in environmental policy. (Joel Schwartz, 10/18)
