End-of-Life Health Care - NYTimes.com

End-of-Life Health Care - NYTimes.com

Fortunately, advance planning for end-of-life decisions has been going on for years and is continuing to spread despite the demagogy on the issue in 2009. There is good evidence that, done properly, it can greatly increase the likelihood that patients will get the care they really want. And, as a secondary benefit, their choices may help reduce the cost of health care as well.

Many people sign living wills that specify the care they want as death nears and powers of attorney that authorize relatives or trusted surrogates to make decisions if they become incapacitated. Those standard devices have been greatly improved in recent years by adding medical orders signed by a doctor — known as Physician Orders for Life Sustaining Treatment, or POLST — to ensure that a patient’s wishes are followed, and not misplaced or too vague for family members to be sure what a comatose patient would want.

Fifteen states, including New York, have already enacted laws or regulations to authorize use of these forms. Similar efforts are under development in another 28 states. The laws generally allow medical institutions to decide whether to offer the forms and always allow patients and families to decide voluntarily whether to use them.

With these physician orders, the doctor, or in some states a nurse practitioner or physician assistant, leads conversations with patients, family members and surrogates to determine whether a patient with advanced illness wants aggressive life-sustaining treatment, a limited intervention or simply palliative or hospice care.

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The Long Con: Mail-order conservatism | Rick Perlstein | The Baffler

The Long Con: Mail-order conservatism | Rick Perlstein | The Baffler

Ever wonder why right wing talk sponsors are so loyal?

In 2007, I signed on to the email lists of several influential magazines on the right, among them Townhall, which operates under the auspices of evangelical Stuart Epperson’s Salem Communications; Newsmax, the organ more responsible than any other for drumming up the hysteria that culminated in the impeachment of Bill Clinton; and Human Events, one of Ronald Reagan’s favorite publications. The exercise turned out to be far more revealing than I expected. Via the battery of promotional appeals that overran my email inbox, I mainlined a right-wing id that was invisible to readers who encounter conservative opinion at face value.

Subscriber lists to ideological organs are pure gold to the third-party interests who rent them as catchments for potential customers. Who better suits a marketing strategy than a group that voluntarily organizes itself according to their most passionately shared beliefs? That’s why, for instance, the other day I (and probably you) got an advertisement by way of liberal magazine The American Prospect seeking donations to Mercy Corps, a charity that helps starving children in the Third World. But back when I was getting emails every day from Newsmax and Townhall, the come-ons were a little bit different.

Dear Reader, I’m going to tell you something, but you must promise to keep it quiet. You have to understand that the “elite”would not be at all happy with me if they knew what I was about to tell you. That’s why we have to tread carefully. You see, while most people are paying attention to the stock market, the banks, brokerages and big institutions have their money somewhere else . . . [in] what I call the hidden money mountain . . . All you have to know is the insider’s code (which I’ll tell you) and you could make an extra $6,000 every single month.

Soon after reading that, I learned of the“23-Cent Heart Miracle,” the one “Washington, the medical industry, and drug companies REFUSE to tell you about.” (Why would they? They’d just be leaving money on the table: “I was scheduled for open heart surgery when I read about your product,” read one of the testimonials. “I started taking it and now six months have passed and I haven’t had open-heart surgery.”) Then came news of the oilfield in the placenta.

“Dear NewsMax Reader,” this appeal began, leaving no doubt that whatever trust that publication had built with its followers was being rented out wholesale. “Please find below a special message from our sponsor, James Davidson, Editor of Outside the Box. He has some important information to share with you.”

Here’s the information in question: “If you have shied away from profiting from the immense promise of stem cells to treat disease because of moral concern over extracting stem cells from fetal tissue, pay close attention. You can now invest with a clear conscience. An Israeli entrepreneur, Zami Aberman, has discovered‘an oilfield in the placenta.’ His little company, Pluristem Life Systems (OTCBB: PLRS) has made a discovery which is potentially more valuable than Prudhoe Bay.”

Davidson concluded by proposing the lucky investor purchase a position of 83,000 shares of PLRS for the low, low price of twelve cents each. If you act now, Davidson explained, your $10,000 outlay “could bring you a profit of more than a quarter of a million dollars.”

Not long after I let the magic of the placenta-based oilfield sink in, I got another pitch, this one courtesy of the webmasters handling the Human Events mailing list and headed “The Trouble with Get-Rich-Quick Schemes.” Perhaps I’m a little gullible myself; for a couple of seconds, I believed the esteemed Reagan-era policy handbook might be sending out a useful consumer advisory to its readers, an investigative guide to the phony get-rich-quick schemes caroming around the right-leaning opinion-sphere. But that hasty assumption proved sadly mistaken, presuming as it did that the proprietors of outfits likeHuman Events respect their readers. Instead, this was a come-on for something called“INSTANT INTERNET INCOME”—the chance at last to “put an end to your financial worries . . . permanently erase your debts . . . pay cash for the things you want . . . create a secure, enjoyable retirement for yourself . . . give your family the abundant lifestyle they so richly deserve.”

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Hurricane Sandy: beware of America's disaster capitalists | Naomi Klein | Comment is free | The Guardian

Hurricane Sandy: beware of America's disaster capitalists | Naomi Klein | Comment is free | The Guardian

The prize for shameless disaster capitalism, however, surely goes to rightwing economist Russell S Sobel, writing in a New York Times online forum. Sobel suggested that, in hard-hit areas, Federal Emergency Management Agency (Fema) should create "free-trade zones – in which all normal regulations, licensing and taxes [are] suspended". This corporate free-for-all would, apparently, "better provide the goods and services victims need".

Yes, that's right: this catastrophe, very likely created by climate change – a crisis born of the colossal regulatory failure to prevent corporations from treating the atmosphere as their open sewer – is just one more opportunity for further deregulation. And the fact that this storm has demonstrated that poor and working-class people are far more vulnerable to the climate crisis shows that this is clearly the right moment to strip those people of what few labour protections they have left, as well as to privatise the meagre public services available to them. Most of all, when faced with an extraordinarily costly crisis born of corporate greed, hand out tax holidays to corporations.

The flurry of attempts to use Sandy's destructive power as a cash grab is just the latest chapter in the very long story I have called the The Shock Doctrine. And it is but the tiniest glimpse into the ways large corporations are seeking to reap enormous profits from climate chaos.

One example: between 2008 and 2010, at least 261 patents were filed or issued relating to "climate-ready" crops – seeds supposedly able to withstand extreme conditions such as droughts and floods; of these patents close to 80% were controlled by just six agribusiness giants, including Monsanto and Syngenta. With history as our teacher, we know that small farmers will go into debt trying to buy these new miracle seeds, and that many will lose their land.

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What do top hospitals have in common? Not as much as you think.

What do top hospitals have in common? Not as much as you think.

Researchers at the Atlas looked at how the top 23 academic medical centers, as ranked by U.S. News and World Report, provide care to their patients. Their results show huge variations in how the very best hospitals care for their sickest patients.

A patient at New York Presbyterian Hospital can expect to spend 20 days in the hospital during the last six months of life. The average Mayo Clinic patient would have 10 days in the hospital over the same time span.

At the University of Utah, the average patient sees 20 doctors during the last six months of life. At the Cedars-Sinai Hospital in California, that number is 73 physicians.

A patient at UCLA’s Ronald Reagan Hospital is three times as likely to have a fall or injury while in the hospital than one at Cedars Sinai, also in Los Angeles.

“We know these differences cannot be explained by the prevalence of diseases,” Goodman says. “Yes, populations differ. Those are small differences we see compared to the dramatic differences in care.”

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