@criticalthud
Yeah, I've been accused of that, but I blame that on the "arguing on the internet" aspect of things, rather than my actual mindset. For instance, as much as I talk up Medical Science, I still don't trust doctors, and in the last 10 years, have only visited to A) get a Physical Examination required by a job, B) get a prescription for a PT, C) Get innoculated for one of the bird/swine flu, as I had been sick for a week after spending a weekend at a "Gamer Convention" (PAX), where there were many confirmed cases.

But, while I don't trust doctors, I actively campaign against "Alternative Medicine", as I've seen many people hurt by it. I've seen one person poison themselves after getting food poisoning, because "like cures like", and I've had one friend commit suicide after they were convinced that the anti-psychotic medicine they were taking wasn't "natural", and quit it.

Whenever I think of alternative medicine practitioners and their criticism of Proper Medicine, I have one quote that sticks in my head, courtesy of The Big Lebowski:
"You're not wrong, Walter. You're just an asshole"

Sure, Medical Science can be improved. But you can't improve it by removing the science. You improve it by removing the politics. Remove the kickbacks from big pharma. Remove the groveling and begging for research funds. Remove the Actual Politics of Insurance and Medicare and Medicaid and VA Benefits. Remove the Actual Politics of the 'War on Drugs".

Those are the problems in our current medical community. But rather than attempting to solve the actual problems that we all agree on, most naturopaths are just treating the symptoms... working on the edges of society, and contributing to the distrust of the individual doctors, rather than the overhaul of the entire system.

And there are certainly many types of naturopaths. Of those that I've met (my wife spent three years in a "Traditional Western Herbalism" school, so I've met quite a few), most have problems differentiating between an idea and a fact. An unsettling amount believed that herbalism is effective because the ancient aliens that brought us to earth also brought us a dramatic and intelligent plant-system which was created to diagnose and treat all of our illnesses.

They believe that through meditation, they are able to connect to this awareness, and this awareness is what will tell them what to give their patients.


It's not the individuals I have a problem with, it's their poor education that I have a problem with. Some NPs can overcome the disadvantage of their environment that de-values scientific method and fact-gathering. Many MDs can overcome the disadvantage of years of de-valuing their own intuition.

But acknowledging the similarities between the two ignores the actual harm that is caused by alternative medicine. Alternative medicine shares the same risks as Proper Medicine, with the same chances of mis-treatment.... but it removes any chance of surgery or active treatment to cure issues. It removes the huge base of shared understanding, and replaces it with a very small base of folklore that has been accumulated through "give the patient this plant, if they don't die, it must have cured them".

It sure seems to me that currently, unfettered "capitalism" is in full swing in the health care industry and what the administration of health care facilities truly fear and lobby so furiously against is the standardization of health care costs based on real world supply and demand, not prices conjured out of thin air from some mysterious Chargemaster grimoire.

The health care industry has no incentive to change the current model. Why would they? Could a CEO or executive board of a hospital get traction for disrupting the current status quo when it is so obscenely profitable? I think the answer is obvious that there will be no systemic changes from within the health care industry which leaves just one possible source for market correction: government regulation.

Leaving aside the argument about whether Medicare is more efficiently administered than private health care and actually costs far less money (it is), don't you think it would be a good thing to have a watch dog organization whose sole purpose is to analyze the "Chargemaster" and make the health care industry actually accountable to the free market?

It sure seems like "Chargemaster" is just a new word for that time tested practice of free marketeers since the Boss Tweed days: price fixing. Anti-trust law actually helps create a true free market and we are in desperate, desperate need of it in the medical industry.

Sounds like they're headed in the direction Australia did in 1996, with a ban on semi-automatic rifles and all semi-automatic and pump-action shotguns. Though without a gun-buy back and destruction scheme, it would be pretty useless.

The Australian government raised $500m (through a one-off increase in the Medicare levy) for the scheme, which led to the destruction of 631,000 firearms (mostly semi-auto .22 rimfires, semi-automatic shotguns and pump-action shotguns).

Roughly 80% of Australians supported the action by the government; main opposers being sporting shooters and farmers.

Comment hidden because you are ignoring dag. (show it anyway)

We thought about time limits- honestly, I just don't want to touch it. Powepoints are like Medicare, the 3rd rail of Sift politics.

False. First of all, the top 10% aren't rich, most of them are middle class. Second of all, the top 10% don't pay 70% of "the tax" per your own link they pay that high a percentage of the INCOME tax. What percentage of the payroll tax (40% of federal revenue, and equal in magnitude to income tax) do they pay? If we count their capital gains as income, what's their effective tax rate? How about if we count all taxes (e.g. sales), and break down the effective tax rate?

I'm fine with cutting spending, so long as the spending getting cut in lieu of tax increases comes entirely from the spending funded by the income tax which you are apparently complaining is too progressive. That means slashing the defense budget exclusively because frankly that is the only significant contributor to the deficit paid out of the general fund (other than interest on your party's debt, much of which is owed to the Social Security fund). Medicare and Social Security are both financed by FICA which is not the unfair tax you seem so concerned about.

Any dollar cut from Social Security and Medicare should be repaid by a dollar of payroll tax cuts, not income tax cuts.

if any video deserved the dark tag this would be it.
not too far off on the child-support deal either.
the courts do not care how or where you get the money,their basic philosophy is "fuck you..pay me".

and the money you do pay does not count toward any form of government subsistence either.
so no food stamps,medicare,medicaid...nothing..fuck you..pay me.

you are responsible for daycare,even though she has government subsidized,so she can go to work but you cant afford the insurance on your 15 yr old car.
that sucks buddy but fuck you..pay me.

she finds out you are moonlighting as a teacher at night school and hauls you into court where the judge promptly takes 100% of your earnings from that second job siting the "needs of the children" where-as you were just trying to make grocery money.
life is unfair...fuck you..pay me.

your visitation is revoked because she complained that your studio flat was in a "bad neighborhood" but refuses to honor the 2 hrs a week your are allowed by court order to see your son.who then turns around and tries to have your parental rights taken due to "negligence".
and all you get for all your letters to the judge is a "cease and desist" order.
fuck you...pay me.

every week a certain amount is collected from my check and every month it is sent to tallahasee and then distributed to an undisclosed recipient.like clockwork this money has never failed to make its rounds to a once young boy who will soon be graduating high school.

i am awaiting the day for a knock on my door to be greeted by a face i once knew many years ago.a round a cherubic face and he will say: thanks for nothing...fuck you dad.
*quality

This kind of thing drives me nuts. During the election, the Republicans were talking about Medicare for current retirees. Now they are talking about Medicare for future retirees.

I am no fan of the Republicans. I find them mostly distasteful. But this is just as distasteful to me. It is intellectually dishonest.

IF YOU THOUGHT HEALTH CARE WAS EXPENSIVE BEFORE, WAIT UNTIL OBAMARXCARE MAKES IT FREE!


Although some of the "fiscal cliff" taxes can be avoided through a deal made in Congress, new ObamaCare taxes are guaranteed to kick in on January 1, amounting to $268 billion tax hike.

The Obamacare Medical Device Tax – a $20 billion tax increase: Medical device manufacturers employ 409,000 people in 12,000 plants across the country. Obamacare imposes a new 2.3 percent excise tax on gross sales – even if the company does not earn a profit in a given year. In addition to killing small business jobs and impacting research and development budgets, this will increase the cost of your health care – making everything from pacemakers to prosthetics more expensive.

The Obamacare “Special Needs Kids Tax” – a $13 billion tax increase: The 30-35 million Americans who use a Flexible Spending Account (FSA) at work to pay for their family’s basic medical needs will face a new government cap of $2,500 (currently the accounts are unlimited under federal law, though employers are allowed to set a cap).

There is one group of FSA owners for whom this new cap will be particularly cruel and onerous: parents of special needs children. There are several million families with special needs children in the United States, and many of them use FSAs to pay for special needs education. Tuition rates at one leading school that teaches special needs children in Washington, D.C. (National Child Research Center) can easily exceed $14,000 per year. Under tax rules, FSA dollars can be used to pay for this type of special needs education. This Obamacare tax provision will limit the options available to these families.

The Obamacare Surtax on Investment Income – a $123 billion tax increase: This is a new, 3.8 percentage point surtax on investment income earned in households making at least $250,000 ($200,000 single). This would result in the following top tax rates on investment income:


The Obamacare “Haircut” for Medical Itemized Deductions – a $15.2 billion tax increase: Currently, those Americans facing high medical expenses are allowed a deduction to the extent that those expenses exceed 7.5 percent of adjusted gross income (AGI). This tax increase imposes a threshold of 10 percent of AGI. By limiting this deduction, Obamacare widens the net of taxable income for the sickest Americans. This tax provision will most harm near retirees and those with modest incomes but high medical bills.

The Obamacare Medicare Payroll Tax Hike --an $86.8 billion tax increase: The Medicare payroll tax is currently 2.9 percent on all wages and self-employment profits. Under this tax hike, wages and profits exceeding $200,000 ($250,000 in the case of married couples) will face a 3.8 percent rate instead. This is a direct marginal income tax hike on small business owners, who are liable for self-employment tax in most cases.

Not only does this tax increase costs on companies, it also increases costs on hospitals, doctors and people in need of medical treatment that requires medical devices to be used. As a consequence of this, biomedical or medical device engineering firms are already laying off workers who develop crucial medical products due to the "unforeseen" costs, or in other words, the costs of ObamaCare. Not to mention, the more money these companies pay to the government, the less money they have to invest in research and development.

With this new medical device tax, students who pay large sums of money to get degrees in the field of biomedical engineering, just like doctors, will no longer see the benefits of going into the field and therefore, we will have a shortage of engineers developing new medical device technology. The medical device tax is a death sentence for American medical innovation.

OWN IT, LIBS!

Lv,

QM

http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?pagewanted=all

One October afternoon three years ago while I was visiting my parents, my mother made a request I dreaded and longed to fulfill. She had just poured me a cup of Earl Grey from her Japanese iron teapot, shaped like a little pumpkin; outside, two cardinals splashed in the birdbath in the weak Connecticut sunlight. Her white hair was gathered at the nape of her neck, and her voice was low. “Please help me get Jeff’s pacemaker turned off,” she said, using my father’s first name. I nodded, and my heart knocked.
Related

Upstairs, my 85-year-old father, Jeffrey, a retired Wesleyan University professor who suffered from dementia, lay napping in what was once their shared bedroom. Sewn into a hump of skin and muscle below his right clavicle was the pacemaker that helped his heart outlive his brain. The size of a pocket watch, it had kept his heart beating rhythmically for nearly five years. Its battery was expected to last five more.

After tea, I knew, my mother would help him from his narrow bed with its mattress encased in waterproof plastic. She would take him to the toilet, change his diaper and lead him tottering to the couch, where he would sit mutely for hours, pretending to read Joyce Carol Oates, the book falling in his lap as he stared out the window.

I don’t like describing what dementia did to my father — and indirectly to my mother — without telling you first that my parents loved each other, and I loved them. That my mother, Valerie, could stain a deck and sew an evening dress from a photo in Vogue and thought of my father as her best friend. That my father had never given up easily on anything.

Born in South Africa, he lost his left arm in World War II, but built floor-to-ceiling bookcases for our living room; earned a Ph.D. from Oxford; coached rugby; and with my two brothers as crew, sailed his beloved Rhodes 19 on Long Island Sound. When I was a child, he woke me, chortling, with his gloss on a verse from “The Rubaiyat of Omar Khayyam”: “Awake, my little one! Before life’s liquor in its cup be dry!” At bedtime he tucked me in, quoting “Hamlet” : “May flights of angels sing thee to thy rest!”

Now I would look at him and think of Anton Chekhov, who died of tuberculosis in 1904. “Whenever there is someone in a family who has long been ill, and hopelessly ill,” he wrote, “there come painful moments when all timidly, secretly, at the bottom of their hearts long for his death.” A century later, my mother and I had come to long for the machine in my father’s chest to fail.

Until 2001, my two brothers and I — all living in California — assumed that our parents would enjoy long, robust old ages capped by some brief, undefined final illness. Thanks to their own healthful habits and a panoply of medical advances — vaccines, antibiotics, airport defibrillators, 911 networks and the like — they weren’t likely to die prematurely of the pneumonias, influenzas and heart attacks that decimated previous generations. They walked every day. My mother practiced yoga. My father was writing a history of his birthplace, a small South African town.

In short, they were seemingly among the lucky ones for whom the American medical system, despite its fragmentation, inequity and waste, works quite well. Medicare and supplemental insurance paid for their specialists and their trusted Middletown internist, the lean, bespectacled Robert Fales, who, like them, was skeptical of medical overdoing. “I bonded with your parents, and you don’t bond with everybody,” he once told me. “It’s easier to understand someone if they just tell it like it is from their heart and their soul.”

They were also stoics and religious agnostics. They signed living wills and durable power-of-attorney documents for health care. My mother, who watched friends die slowly of cancer, had an underlined copy of the Hemlock Society’s “Final Exit” in her bookcase. Even so, I watched them lose control of their lives to a set of perverse financial incentives — for cardiologists, hospitals and especially the manufacturers of advanced medical devices — skewed to promote maximum treatment. At a point hard to precisely define, they stopped being beneficiaries of the war on sudden death and became its victims.

Things took their first unexpected turn on Nov. 13, 2001, when my father — then 79, pacemakerless and seemingly healthy — collapsed on my parents’ kitchen floor in Middletown, making burbling sounds. He had suffered a stroke.

He came home six weeks later permanently incapable of completing a sentence. But as I’ve said, he didn’t give up easily, and he doggedly learned again how to fasten his belt; to peck out sentences on his computer; to walk alone, one foot dragging, to the university pool for water aerobics. He never again put on a shirt without help or looked at the book he had been writing. One day he haltingly told my mother, “I don’t know who I am anymore.”

His stroke devastated two lives. The day before, my mother was an upper-middle-class housewife who practiced calligraphy in her spare time. Afterward, she was one of tens of millions of people in America, most of them women, who help care for an older family member.

Their numbers grow each day. Thanks to advanced medical technologies, elderly people now survive repeated health crises that once killed them, and so the “oldest old” have become the nation’s most rapidly growing age group. Nearly a third of Americans over 85 have dementia (a condition whose prevalence rises in direct relationship to longevity). Half need help with at least one practical, life-sustaining activity, like getting dressed or making breakfast. Even though a capable woman was hired to give my dad showers, my 77-year-old mother found herself on duty more than 80 hours a week. Her blood pressure rose and her weight fell. On a routine visit to Dr. Fales, she burst into tears. She was put on sleeping pills and antidepressants.

My father said he came to believe that she would have been better off if he had died. “She’d have weeped the weep of a widow,” he told me in his garbled, poststroke speech, on a walk we took together in the fall of 2002. “And then she would have been all right.” It was hard to tell which of them was suffering more.

As we shuffled through the fallen leaves that day, I thought of my father’s father, Ernest Butler. He was 79 when he died in 1965, before pacemakers, implanted cardiac defibrillators, stents and replacement heart valves routinely staved off death among the very old. After completing some long-unfinished chairs, he cleaned his woodshop, had a heart attack and died two days later in a plain hospital bed. As I held my dad’s soft, mottled hand, I vainly wished him a similar merciful death.

A few days before Christmas that year, after a vigorous session of water exercises, my father developed a painful inguinal (intestinal) hernia. My mother took him to Fales, who sent them to a local surgeon, who sent them to a cardiologist for a preoperative clearance. After an electrocardiogram recorded my father’s slow heartbeat — a longstanding and symptomless condition not uncommon in the very old — the cardiologist, John Rogan, refused to clear my dad for surgery unless he received a pacemaker.

Without the device, Dr. Rogan told me later, my father could have died from cardiac arrest during surgery or perhaps within a few months. It was the second time Rogan had seen my father. The first time, about a year before, he recommended the device for the same slow heartbeat. That time, my then-competent and prestroke father expressed extreme reluctance, on the advice of Fales, who considered it overtreatment.

My father’s medical conservatism, I have since learned, is not unusual. According to an analysis by the Dartmouth Atlas medical-research group, patients are far more likely than their doctors to reject aggressive treatments when fully informed of pros, cons and alternatives — information, one study suggests, that nearly half of patients say they don’t get. And although many doctors assume that people want to extend their lives, many do not. In a 1997 study in The Journal of the American Geriatrics Society, 30 percent of seriously ill people surveyed in a hospital said they would “rather die” than live permanently in a nursing home. In a 2008 study in The Journal of the American College of Cardiology, 28 percent of patients with advanced heart failure said they would trade one day of excellent health for another two years in their current state.

When Rogan suggested the pacemaker for the second time, my father was too stroke-damaged to discuss, and perhaps even to weigh, his trade­offs. The decision fell to my mother — anxious to relieve my father’s pain, exhausted with caregiving, deferential to doctors and no expert on high-tech medicine. She said yes. One of the most important medical decisions of my father’s life was over in minutes. Dr. Fales was notified by fax.

Fales loved my parents, knew their suffering close at hand, continued to oppose a pacemaker and wasn’t alarmed by death. If he had had the chance to sit down with my parents, he could have explained that the pacemaker’s battery would last 10 years and asked whether my father wanted to live to be 89 in his nearly mute and dependent state. He could have discussed the option of using a temporary external pacemaker that, I later learned, could have seen my dad safely through surgery. But my mother never consulted Fales. And the system would have effectively penalized him if she had. Medicare would have paid him a standard office-visit rate of $54 for what would undoubtedly have been a long meeting — and nothing for phone calls to work out a plan with Rogan and the surgeon.

Medicare has made minor improvements since then, and in the House version of the health care reform bill debated last year, much better payments for such conversations were included. But after the provision was distorted as reimbursement for “death panels,” it was dropped. In my father’s case, there was only a brief informed-consent process, covering the boilerplate risks of minor surgery, handled by the general surgeon.

I believe that my father’s doctors did their best within a compartmentalized and time-pressured medical system. But in the absence of any other guiding hand, there is no doubt that economics helped shape the wider context in which doctors made decisions. Had we been at the Mayo Clinic — where doctors are salaried, medical records are electronically organized and care is coordinated by a single doctor — things might have turned out differently. But Middletown is part of the fee-for-service medical economy. Doctors peddle their wares on a piecework basis; communication among them is haphazard; thinking is often short term; nobody makes money when medical interventions are declined; and nobody is in charge except the marketplace.

And so on Jan. 2, 2003, at Middlesex Hospital, the surgeon implanted my father’s pacemaker using local anesthetic. Medicare paid him $461 and the hospital a flat fee of about $12,000, of which an estimated $7,500 went to St. Jude Medical, the maker of the device. The hernia was fixed a few days later.

It was a case study in what primary-care doctors have long bemoaned: that Medicare rewards doctors far better for doing procedures than for assessing whether they should be done at all. The incentives for overtreatment continue, said Dr. Ted Epperly, the board chairman of the American Academy of Family Physicians, because those who profit from them — specialists, hospitals, drug companies and the medical-device manufacturers — spend money lobbying Congress and the public to keep it that way.

Last year, doctors, hospitals, drug companies, medical-equipment manufacturers and other medical professionals spent $545 million on lobbying, according to the Center for Responsive Politics. This may help explain why researchers estimate that 20 to 30 percent of Medicare’s $510 billion budget goes for unnecessary tests and treatment. Why cost-containment received short shrift in health care reform. Why physicians like Fales net an average of $173,000 a year, while noninvasive cardiologists like Rogan net about $419,000.

The system rewarded nobody for saying “no” or even “wait” — not even my frugal, intelligent, Consumer-Reports-reading mother. Medicare and supplemental insurance covered almost every penny of my father’s pacemaker. My mother was given more government-mandated consumer information when she bought a new Camry a year later.

And so my father’s electronically managed heart — now requiring frequent monitoring, paid by Medicare — became part of the $24 billion worldwide cardiac-device industry and an indirect subsidizer of the fiscal health of American hospitals. The profit margins that manufacturers earn on cardiac devices is close to 30 percent. Cardiac procedures and diagnostics generate about 20 percent of hospital revenues and 30 percent of profits.

Shortly after New Year’s 2003, my mother belatedly called and told me about the operations, which went off without a hitch. She didn’t call earlier, she said, because she didn’t want to worry me. My heart sank, but I said nothing. It is one thing to silently hope that your beloved father’s heart might fail. It is another to actively abet his death.

The pacemaker bought my parents two years of limbo, two of purgatory and two of hell. At first they soldiered on, with my father no better and no worse. My mother reread Jon Kabat-Zinn’s “Full Catastrophe Living,” bought a self-help book on patience and rose each morning to meditate.

In 2005, the age-related degeneration that had slowed my father’s heart attacked his eyes, lungs, bladder and bowels. Clots as narrow as a single human hair lodged in tiny blood vessels in his brain, killing clusters of neurons by depriving them of oxygen. Long partly deaf, he began losing his sight to wet macular degeneration, requiring ocular injections that cost nearly $2,000 each. A few months later, he forgot his way home from the university pool. He grew incontinent. He was collapsing physically, like an ancient, shored-up house.

In the summer of 2006, he fell in the driveway and suffered a brain hemorrhage. Not long afterward, he spent a full weekend compulsively brushing and rebrushing his teeth. “The Jeff I married . . . is no longer the same person,” my mother wrote in the journal a social worker had suggested she keep. “My life is in ruins. This is horrible, and I have lasted for five years.” His pacemaker kept on ticking.

When bioethicists debate life-extending technologies, the effects on people like my mother rarely enter the calculus. But a 2007 Ohio State University study of the DNA of family caregivers of people with Alzheimer’s disease showed that the ends of their chromosomes, called telomeres, had degraded enough to reflect a four-to-eight-year shortening of lifespan. By that reckoning, every year that the pacemaker gave my irreparably damaged father took from my then-vigorous mother an equal year.

When my mother was upset, she meditated or cleaned house. When I was upset, I Googled. In 2006, I discovered that pacemakers could be deactivated without surgery. Nurses, doctors and even device salesmen had done so, usually at deathbeds. A white ceramic device, like a TV remote and shaped like the wands that children use to blow bubbles, could be placed around the hump on my father’s chest. Press a few buttons and the electrical pulses that ran down the leads to his heart would slow until they were no longer effective. My father’s heart, I learned, would probably not stop. It would just return to its old, slow rhythm. If he was lucky, he might suffer cardiac arrest and die within weeks, perhaps in his sleep. If he was unlucky, he might linger painfully for months while his lagging heart failed to suffuse his vital organs with sufficient oxygenated blood.

If we did nothing, his pacemaker would not stop for years. Like the tireless charmed brooms in Disney’s “Fantasia,” it would prompt my father’s heart to beat after he became too demented to speak, sit up or eat. It would keep his heart pulsing after he drew his last breath. If he was buried, it would send signals to his dead heart in the coffin. If he was cremated, it would have to be cut from his chest first, to prevent it from exploding and damaging the walls or hurting an attendant.

On the Internet, I discovered that the pacemaker — somewhat like the ventilator, defibrillator and feeding tube — was first an exotic, stopgap device, used to carry a handful of patients through a brief medical crisis. Then it morphed into a battery-powered, implantable and routine treatment. When Medicare approved the pacemaker for reimbursement in 1966, the market exploded. Today pacemakers are implanted annually in more than 400,000 Americans, about 80 percent of whom are over 65. According to calculations by the Dartmouth Atlas research group using Medicare data, nearly a fifth of new recipients who receive pacemakers annually — 76,000 — are over 80. The typical patient with a cardiac device today is an elderly person suffering from at least one other severe chronic illness.

Over the years, as technology has improved, the battery life of these devices lengthened. The list of heart conditions for which they are recommended has grown. In 1984, the treatment guidelines from the American College of Cardiology declared that pacemakers were strongly recommended as “indicated” or mildly approved as “reasonable” for 56 heart conditions and “not indicated” for 31 more. By 2008, the list for which they were strongly or mildly recommended expanded to 88, with most of the increase in the lukewarm “reasonable” category.

The research backing the expansion of diagnoses was weak. Over all, only 5 percent of the positive recommendations were supported by research from multiple double-blind randomized studies, the gold standard of evidence-based medicine. And 58 percent were based on no studies at all, only a “consensus of expert opinion.” Of the 17 cardiologists who wrote the 2008 guidelines, 11 received financing from cardiac-device makers or worked at institutions receiving it. Seven, due to the extent of their financial connections, were recused from voting on the guidelines they helped write.

This pattern — a paucity of scientific support and a plethora of industry connections — holds across almost all cardiac treatments, according to the cardiologist Pierluigi Tricoci of Duke University’s Clinical Research Institute. Last year in The Journal of the American Medical Association, Tricoci and his co-authors wrote that only 11 percent of 2,700 widely used cardiac-treatment guidelines were based on that gold standard. Most were based only on expert opinion.

Experts are as vulnerable to conflicts of interest as researchers are, the authors warned, because “expert clinicians are also those who are likely to receive honoraria, speakers bureau [fees], consulting fees or research support from industry.” They called the current cardiac-research agenda “strongly influenced by industry’s natural desire to introduce new products.”

Perhaps it’s no surprise that I also discovered others puzzling over cardiologists who recommended pacemakers for relatives with advanced dementia. “78-year-old mother-in-law has dementia; severe short-term memory issues,” read an Internet post by “soninlaw” on Elderhope.com, a caregivers’ site, in 2007. “On a routine trip to her cardiologist, doctor decides she needs a pacemaker. . . . Anyone have a similar encounter?”

By the summer of 2007, my dad had forgotten the purpose of a dinner napkin and had to be coached to remove his slippers before he tried to put on his shoes. After a lifetime of promoting my father’s health, my mother reversed course. On a routine visit, she asked Rogan to deactivate the pacemaker. “It was hard,” she later told me. “I was doing for Jeff what I would have wanted Jeff to do for me.” Rogan soon made it clear he was morally opposed. “It would have been like putting a pillow over your father’s head,” he later told me.

Not long afterward, my mother declined additional medical tests and refused to put my father on a new anti-dementia drug and a blood thinner with troublesome side effects. “I take responsibility for whatever,” she wrote in her journal that summer. “Enough of all this overkill! It’s killing me! Talk about quality of life — what about mine?”

Then came the autumn day when she asked for my help, and I said yes. I told myself that we were simply trying to undo a terrible medical mistake. I reminded myself that my dad had rejected a pacemaker when his faculties were intact. I imagined, as a bioethicist had suggested, having a 15-minute conversation with my independent, predementia father in which I saw him shaking his head in horror over any further extension of what was not a “life,” but a prolonged and attenuated dying. None of it helped. I knew that once he died, I would dream of him and miss his mute, loving smiles. I wanted to melt into the arms of the father I once had and ask him to handle this. Instead, I felt as if I were signing on as his executioner and that I had no choice.

Over the next five months, my mother and I learned many things. We were told, by the Hemlock Society’s successor, Compassion and Choices, that as my father’s medical proxy, my mother had the legal right to ask for the withdrawal of any treatment and that the pacemaker was, in theory at least, a form of medical treatment. We learned that although my father’s living will requested no life support if he were comatose or dying, it said nothing about dementia and did not define a pacemaker as life support. We learned that if we called 911, emergency medical technicians would not honor my father’s do-not-resuscitate order unless he wore a state-issued orange hospital bracelet. We also learned that no cardiology association had given its members clear guidance on when, or whether, deactivating pacemakers was ethical.

(Last month that changed. The Heart Rhythm Society and the American Heart Association issued guidelines declaring that patients or their legal surrogates have the moral and legal right to request the withdrawal of any medical treatment, including an implanted cardiac device. It said that deactivating a pacemaker was neither euthanasia nor assisted suicide, and that a doctor could not be compelled to do so in violation of his moral values. In such cases, it continued, doctors “cannot abandon the patient but should involve a colleague who is willing to carry out the procedure.” This came, of course, too late for us.)

In the spring of 2008, things got even worse. My father took to roaring like a lion at his caregivers. At home in California, I searched the Internet for a sympathetic cardiologist and a caregiver to put my Dad to bed at night. My frayed mother began to shout at him, and their nighttime scenes were heartbreaking and frightening. An Alzheimer’s Association support-group leader suggested that my brothers and I fly out together and institutionalize my father. This leader did not know my mother’s formidable will and had never heard her speak about her wedding vows or her love.

Meanwhile my father drifted into what nurses call “the dwindles”: not sick enough to qualify for hospice care, but sick enough to never get better. He fell repeatedly at night and my mother could not pick him up. Finally, he was weak enough to qualify for palliative care, and a team of nurses and social workers visited the house. His chest grew wheezy. My mother did not request antibiotics. In mid-April 2008, he was taken by ambulance to Middlesex Hospital’s hospice wing, suffering from pneumonia.

Pneumonia was once called “the old man’s friend” for its promise of an easy death. That’s not what I saw when I flew in. On morphine, unreachable, his eyes shut, my beloved father was breathing as hard and regularly as a machine.

My mother sat holding his hand, weeping and begging for forgiveness for her impatience. She sat by him in agony. She beseeched his doctors and nurses to increase his morphine dose and to turn off the pacemaker. It was a weekend, and the doctor on call at Rogan’s cardiology practice refused authorization, saying that my father “might die immediately.” And so came five days of hard labor. My mother and I stayed by him in shifts, while his breathing became increasingly ragged and his feet slowly started to turn blue. I began drafting an appeal to the hospital ethics committee. My brothers flew in.

On a Tuesday afternoon, with my mother at his side, my father stopped breathing. A hospice nurse hung a blue light on the outside of his hospital door. Inside his chest, his pacemaker was still quietly pulsing.

After his memorial service in the Wesleyan University chapel, I carried a box from the crematory into the woods of an old convent where he and I often walked. It was late April, overcast and cold. By the side of a stream, I opened the box, scooped out a handful of ashes and threw them into the swirling water. There were some curious spiraled metal wires, perhaps the leads of his pacemaker, mixed with the white dust and pieces of bone.

A year later, I took my mother to meet a heart surgeon in a windowless treatment room at Brigham and Women’s Hospital in Boston. She was 84, with two leaking heart valves. Her cardiologist had recommended open-heart surgery, and I was hoping to find a less invasive approach. When the surgeon asked us why we were there, my mother said, “To ask questions.” She was no longer a trusting and deferential patient. Like me, she no longer saw doctors — perhaps with the exception of Fales — as healers or her fiduciaries. They were now skilled technicians with their own agendas. But I couldn’t help feeling that something precious — our old faith in a doctor’s calling, perhaps, or in a healing that is more than a financial transaction or a reflexive fixing of broken parts — had been lost.

The surgeon was forthright: without open-heart surgery, there was a 50-50 chance my mother would die within two years. If she survived the operation, she would probably live to be 90. And the risks? He shrugged. Months of recovery. A 5 percent chance of stroke. Some possibility, he acknowledged at my prompting, of postoperative cognitive decline. (More than half of heart-bypass patients suffer at least a 20 percent reduction in mental function.) My mother lifted her trouser leg to reveal an anklet of orange plastic: her do-not-resuscitate bracelet. The doctor recoiled. No, he would not operate with that bracelet in place. It would not be fair to his team. She would be revived if she collapsed. “If I have a stroke,” my mother said, nearly in tears, “I want you to let me go.” What about a minor stroke, he said — a little weakness on one side?

I kept my mouth shut. I was there to get her the information she needed and to support whatever decision she made. If she emerged from surgery intellectually damaged, I would bring her to a nursing home in California and try to care for her the way she had cared for my father at such cost to her own health. The thought terrified me.

The doctor sent her up a floor for an echocardiogram. A half-hour later, my mother came back to the waiting room and put on her black coat. “No,” she said brightly, with the clarity of purpose she had shown when she asked me to have the pacemaker deactivated. “I will not do it.”

She spent the spring and summer arranging house repairs, thinning out my father’s bookcases and throwing out the files he collected so lovingly for the book he never finished writing. She told someone that she didn’t want to leave a mess for her kids. Her chest pain worsened, and her breathlessness grew severe. “I’m aching to garden,” she wrote in her journal. “But so it goes. ACCEPT ACCEPT ACCEPT.”

Last August, she had a heart attack and returned home under hospice care. One evening a month later, another heart attack. One of my brothers followed her ambulance to the hospice wing where we had sat for days by my father’s bed. The next morning, she took off her silver earrings and told the nurses she wanted to stop eating and drinking, that she wanted to die and never go home. Death came to her an hour later, while my brother was on the phone to me in California — almost as mercifully as it had come to my paternal grandfather. She was continent and lucid to her end.

A week later, at the same crematory near Long Island Sound, my brothers and I watched through a plate-glass window as a cardboard box containing her body, dressed in a scarlet silk ao dai she had sewn herself, slid into the flames. The next day, the undertaker delivered a plastic box to the house where, for 45 of their 61 years together, my parents had loved and looked after each other, humanly and imperfectly. There were no bits of metal mixed with the fine white powder and the small pieces of her bones.

Katy Butler lives in Mill Valley, Calif., and teaches memoir writing at the Esalen Institute in Big Sur.

>> ^bobknight33:

Single payer system will drive up costs and inefficiencies. What these guys are doing is a good thing. Putting up prices and letting you decide.

If Coke was the only drink in to have then they would no no issue to set the price high. As soon as a competitor shows up and delivers a comparable product at a lesser price the true price of the product will be discovered.

>> ^Yogi:

>> ^bobknight33:
Obamacare is not driving out the cost of healthcare for this group. Capitalism is.
from the text above:
The major cause of exploding U.S. heath care costs is the third-party payer system, a text-book concept in which A buys goods or services from B that are paid for by C. Because private insurance companies or the government generally pick up most of the tab for medical services, patients don't have the normal incentive to seek out value.
The Government gave us the third party payer system during WWII. Government is at fault.

Patients shouldn't have to "Seek out value." They're busy, usually being sick, or trying to work while being sick. It shouldn't be a for profit industry, everyone should have healthcare it should be a single payer system.



Medicare is extremely efficient, the only thing that makes it cost more money and be inefficient is that it has to deal with the current healthcare system. Also we have examples of other industrial countries systems which are way WAY more efficient than ours and produce better outcomes for it's patients overall.

It's absolutely pathetic where were ranked in health worldwide, we should be doing better.

>> ^Yogi:

>> ^coolhund:
>> ^Yogi:
>> ^coolhund:
If Romney is elected, I will loose all my respect for America.
How anyone can vote someone like Romney after 8 years of Bush, is beyond any of my understanding and tolerance.

So where are you from just wondering? I just can't let this pass. Obama is worse than Bush. I'll say it again...OBAMA IS WORSE THAN BUSH. The only reason why the World...and that is intellectuals and leaders not the population but the only reason why they like Obama better than Bush is because Obama is NICER about being a fucking evil bastard. Bush just said straight up, we don't care what you think. Obama says with a smile that it doesn't matter what you think.
Obama is continuing and expanding the murderous policies from under Bush he's just being nicer about it.

Im from Baghdad and lost my whole family to Bush. Will you now shut up? WTF is that kind of stupid question?
Seriously, I actually supported Bush the first legislation and most of his second. But I learned from my mistakes, and that mistake is huge and something I feel really bad about, because so many people told me that I was wrong before and then I got it in the face when he admitted the Iraq war was a lie and several other unbelievable corruption stuff under his watch, outgoing from republicans. This guy started so much shit, that will haunt us for hundreds of years, and of course Obama cant do shit about it, with the republican obstructionists in the congress. However you see how he tries it, and how he tries to please the republicans at least a little, so they dont block the other 25% of the stuff he actually was able to change. Just look for how long he fought for something essential like Medicare, that many other western countries, WHICH ARE NOT SOCIALISTS, have had implemented for decades and have it working fine.
As I said, Obama is actually trying a lot to make things better, but the president is no dictator. Just look at the republican lies, that were so successful that even democrats believe them now. And people like you who have no clue about politics actually believe republicans claiming Obama is so bad, while THEY are blocking everything he does.
Dont get me wrong, Obama did a lot of crap by himself too, just like every other president before, but to say he is WORSE than Bush... lol... seriously?

Noam Chomsky says he's worse than Bush, has written and presented the evidence that he's worse than Bush. The Most Important Intellectual and US Critic says that Obama is worse than Bush. Go read what he wrote, I can't convince you here.


I would actually believe it, if I watched too much Fox News and believed that there was no economic crash right before Obama went to office and I was blind and stupid enough to not see that other countries dont fare better (not even Germany) and have very similar changes to that what republicans try to blame on Obama.
I just saw some idiot video on Youtube where someone compared the gas prices from right before Obama went to office to where they are now, of course telling that it will rise and rise much higher with ONLY Obama in office. That under Bush they were actually much higher and dropped to such low numbers before Obama due to a massive economic crisis, was left out.

I understand the right wing propaganda very well. As I said, my thoughts were similar some time ago.

>> ^coolhund:

>> ^Yogi:
>> ^coolhund:
If Romney is elected, I will loose all my respect for America.
How anyone can vote someone like Romney after 8 years of Bush, is beyond any of my understanding and tolerance.

So where are you from just wondering? I just can't let this pass. Obama is worse than Bush. I'll say it again...OBAMA IS WORSE THAN BUSH. The only reason why the World...and that is intellectuals and leaders not the population but the only reason why they like Obama better than Bush is because Obama is NICER about being a fucking evil bastard. Bush just said straight up, we don't care what you think. Obama says with a smile that it doesn't matter what you think.
Obama is continuing and expanding the murderous policies from under Bush he's just being nicer about it.

Im from Baghdad and lost my whole family to Bush. Will you now shut up? WTF is that kind of stupid question?
Seriously, I actually supported Bush the first legislation and most of his second. But I learned from my mistakes, and that mistake is huge and something I feel really bad about, because so many people told me that I was wrong before and then I got it in the face when he admitted the Iraq war was a lie and several other unbelievable corruption stuff under his watch, outgoing from republicans. This guy started so much shit, that will haunt us for hundreds of years, and of course Obama cant do shit about it, with the republican obstructionists in the congress. However you see how he tries it, and how he tries to please the republicans at least a little, so they dont block the other 25% of the stuff he actually was able to change. Just look for how long he fought for something essential like Medicare, that many other western countries, WHICH ARE NOT SOCIALISTS, have had implemented for decades and have it working fine.
As I said, Obama is actually trying a lot to make things better, but the president is no dictator. Just look at the republican lies, that were so successful that even democrats believe them now. And people like you who have no clue about politics actually believe republicans claiming Obama is so bad, while THEY are blocking everything he does.
Dont get me wrong, Obama did a lot of crap by himself too, just like every other president before, but to say he is WORSE than Bush... lol... seriously?


Noam Chomsky says he's worse than Bush, has written and presented the evidence that he's worse than Bush. The Most Important Intellectual and US Critic says that Obama is worse than Bush. Go read what he wrote, I can't convince you here.

>> ^Yogi:

>> ^coolhund:
If Romney is elected, I will loose all my respect for America.
How anyone can vote someone like Romney after 8 years of Bush, is beyond any of my understanding and tolerance.

So where are you from just wondering? I just can't let this pass. Obama is worse than Bush. I'll say it again...OBAMA IS WORSE THAN BUSH. The only reason why the World...and that is intellectuals and leaders not the population but the only reason why they like Obama better than Bush is because Obama is NICER about being a fucking evil bastard. Bush just said straight up, we don't care what you think. Obama says with a smile that it doesn't matter what you think.
Obama is continuing and expanding the murderous policies from under Bush he's just being nicer about it.


Im from Baghdad and lost my whole family to Bush. Will you now shut up? WTF is that kind of stupid question?

Seriously, I actually supported Bush the first legislation and most of his second. But I learned from my mistakes, and that mistake is huge and something I feel really bad about, because so many people told me that I was wrong before and then I got it in the face when he admitted the Iraq war was a lie and several other unbelievable corruption stuff under his watch, outgoing from republicans. This guy started so much shit, that will haunt us for hundreds of years, and of course Obama cant do shit about it, with the republican obstructionists in the congress. However you see how he tries it, and how he tries to please the republicans at least a little, so they dont block the other 25% of the stuff he actually was able to change. Just look for how long he fought for something essential like Medicare, that many other western countries, WHICH ARE NOT SOCIALISTS, have had implemented for decades and have it working fine.

As I said, Obama is actually trying a lot to make things better, but the president is no dictator. Just look at the republican lies, that were so successful that even democrats believe them now. And people like you who have no clue about politics actually believe republicans claiming Obama is so bad, while THEY are blocking everything he does.
Dont get me wrong, Obama did a lot of crap by himself too, just like every other president before, but to say he is WORSE than Bush... lol... seriously?

@bareboards2

I'm also glad that we can discuss these issues like reasonable people. I apologize if I've come off as unreasonable in the past. The truth is that I'm always willing to talk things out.

I've heard the rhetoric about death panels from both sides; I just haven't put in the effort to separate fact from fiction. Now that I've looked into it, this is what I've found. What you're describing (end of life consultations) is not the same thing as what are now being called death panels in Obamacare. Yes, it is true that the provision you are speaking about was demonized by republicans and ultimately removed from Medicare. I'm actually not sure how I feel about it, because it is a form of assisted suicide, and it could be abused. Some seniors may feel pressured into forgoing care, just as you hear of some people receiving substandard care because they are organ donors.

http://www.lifesitenews.com/news/dad-rescues-brain-dead-son-from-doctors-wishing-to-harvest-his-organs-boy-r

In any case, the conversation has evolved, and we are no longer talking about these end of life consultations when we are talking about death panels. The death panel in Obamacare is an unelected board of 15 "health care experts" (the Independent Payment Advisory Board, or IPAB) who will make critical decisions on what services within Medicare are financially viable, and which aren't. Here is a quote from President Obama in the first debate acknowledging this:

"It — when Gov. Romney talks about this board, for example, unelected board that we’ve created, what this is, is a group of health care experts, doctors, et cetera, to figure out, how can we reduce the cost of care in the system overall?” Obama said.

“Now, so what this board does is basically identifies best practices and says, let’s use the purchasing power of Medicare and Medicaid to help to institutionalize all these good things that we do,” Obama added.

This is also acknowledged by a senior adviser to Obama:

"WE need death panels. Well, maybe not death panels, exactly, but unless we start allocating health care resources more prudently — rationing, by its proper name — the exploding cost of Medicare will swamp the federal budget."

http://www.nytimes.com/2012/09/17/opinion/health-care-reform-beyond-obamacare.html?_r=2

So call it death panels, or rationing, the principle is still the same. The recommendations this board makes will become law unless it is overridden by a 2/3's majority vote in congress. Here is a good example of how this type of legislative oversight is making health care "better" (penalizing hospitals for readmitting patients within 30 days):

"Beginning Monday, the hospitals will receive lower reimbursements on Medicare claims filed with the government for each admitted patient. Over the year, the total amount of those reductions will vary from $1.2 million for MedStar Washington Hospital Center in Northwest Washington, the region’s largest private hospital, to about $12,000 for Reston Hospital Center in Virginia. Of 16 hospitals in the District and Northern Virginia, all but three will get paid less."

"Some of the hardest-hit facilities are inner-city hospitals that tend to treat sicker, poorer patients. These patients sometimes end up being readmitted because they have a harder time getting medication and follow-up doctors’ appointments, often because they lack transportation, hospital officials said.

“Not only do we have the very sick patients, they also have very significant social needs,” said Kamaljit Sethi, who heads quality and safety at Providence Hospital in Northeast, where officials estimate they will lose about $320,000 in the coming year."

http://www.washingtonpost.com/national/health-science/hospitals-in-dc-va-to-lose-millions-from-medicare/2012/09/30/2fe0f96c-08ca-11e2-afff-d6c7f20a83b
f_story.html

What this means is that patients with the greatest needs will lose the most services, because the hospitals will no longer be able to serve them because of this penalty. This outcome could turn out to be deadly for thousands of people, ultimately, all in the name of efficiency. This is a perfect illustration as to why Government should have as little power over your health care as possible. Here is testimony from the front lines:

" Today while working my shift in the emergency room, an old lady was brought in very sick and in fact near death. I did my usual workup and evaluation and attempted to administer life saving treatment. It was my plan to admit this woman to the hospital. I found out a little later that this same woman had been a patient here just slightly more than 2 weeks ago with a DIFFERENT DIAGNOSIS. I was told that if this woman was admitted, the hospital would not be paid.

The new Medicare rule now is that if the same Medicare patient is re-admitted to the hospital within 30 days, the hospital will not be paid. When they first started this nonsense they said this only applied to patients with the same diagnosis. Now they have "expanded" the rule to include re-admissions for any reason. So if you're in the hospital for pneumonia, and 3 weeks later, you break your leg.......too bad. Medicare will not pay the hospital to fix your leg."

http://grouchatrighttruth.blogspot.com/2012/10/death-panels-are-here.html

This is completely outrageous, I think you will be forced to agree. Personally, I think we need to have a national conversation about this issue, and both sides need to come together to hammer out this issue. Obamacare is clearly not ready for primetime, and as it stands it is going to hurt people.

As far as your other comments, I'm not limiting myself to any particular news source. I am a political independent and I will share with you that I won't be voting for either candidate this year. I will still participate in the local elections but I cannot vote for either candidate in good conscience. While I am socially and fiscally conservative on many issues, I am liberal on others, such as helping the poor, the environment (within reason), and immigration. I don't fit into a polical cookie cutter and I don't automatically support a candidate because they give God lip service.

shinyblurry, no, that is not "basically" what I am saying. But there is no need to go on with this.

Thank you for a non-inflammatory exchange, however much we did not change each others position.

FYI -- the "death panels" are nothing more than an advanced health directive. Everyone should have an advanced health directive -- I have one that I signed when I created my will. Medicare was going to pay for patients to sit with their care providers, BEFORE they got sick, and go through the choices offered by a standard, normal, common sense advanced health directive. Do you want a feeding tube? What extraordinary measures do you want taken on your behalf if you are unable to make decisions?

A hospital in the Midwest made it their policy for all patients to have one and the benefits that I mentioned were dccumented there over time. The most telling was the peace of mind of the family -- that they knew beyond a shadow of a doubt that these were the wishes of their aged parents, because the questions were asked BEFORE they got so sick they couldn't answer.

Medicare was going to include the consultation as a reimbursable expense under Medicare, rather than do it for free and not get paid for providing good care.

If that sounds like good common sense to you, you might ask yourself why you didn't know these very simple facts about "death panels" when they were in the news so much. Who labelled the process with such an inflammatory phrase? What was gained from that phrase?

And how much heartache, worry, and the coin of the realm has been wasted because these simple facts weren't shared with you from your news source?

And yes, the idea of "death panels" was first put forward by some Republicans. None of whom defended it when other Republicans threw it under the bus for political points.