Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

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/pdf/acc-aha-2005-guideline-update-for-the-diagnosis-and-4hik65ngbe.pdf

ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

In 1974 an article appeared in Science magazine with the dry-sounding title “Judgment Under Uncertainty: Heuristics and Biases” by a pair of psychologists who were not well known outside their discipline of decision theory. In it Amos Tversky and Daniel Kahneman introduced the world to Prospect Theory, which mapped out how humans actually behave when faced with decisions about gains and losses, in contrast to how economists assumed that people behave. Prospect Theory turned Economics on its head by demonstrating through a series of ingenious experiments that people are much more concerned with losses than they are with gains, and that framing a choice from one perspective or the other will result in decisions that are exactly the opposite of each other, even if the outcomes are monetarily the same. Prospect Theory led cognitive psychology in a new direction that began to uncover other human biases in thinking that are probably not learned but are part of our brain’s wiring.

Thinking fast and slow.

ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure).

Mariell Jessup, MD, FACC, FAHA, Chair [*][1]

William T. Abraham, MD, FACC, FAHA[†][2]

Donald E. Casey, MD, MPH, MBA[‡][3]

Arthur M. Feldman, MD, PhD, FACC, FAHA[§][4]

Gary S. Francis, MD, FACC, FAHA[§][4]

Theodore G. Ganiats, MD[∥][5]

Marvin A. Konstam, MD, FACC[¶][6]

Donna M.

/pdf/2009-focused-update-incorporated-into-the-acc-aha-2005-3z9lhvyqwq.pdf

2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation

Background:Quality reporting is increasingly used as a tool to encourage health systems, hospitals, and their practitioners to deliver the greatest health benefit. However, quality reporting systems may have unintended negative consequences, such as inadvertently encouraging “cherry-picking” by inadequately adjusting for patients who are challenging to take care of, or underpowering to reliably detect meaningful differences in care. There have been no reports seeking to identify a minimum level of accuracy that ought to be viewed as a prerequisite for quality reporting.Method:Using a decision analytic model, we seek to delineate minimal standards for quality measures to meet, using the simplest assumptions to illustrate what those standards may be.Results:We find that even under assumptions regarding optimal performance of the quality reporting system (sensitivity and specificity of 1), we can identify a minimal level of accuracy required for the quality reporting system to “do no harm”: the increase in h...

https://journals.sagepub.com/doi/pdf/10.1177/2050312114523425

Who is watching the watchmen: Is quality reporting ever harmful?

While all reproductive‐aged individuals with cancer should be offered fertility preservation (FP) counseling, there is little guidance over offers to adolescent and young adults (AYA) with terminal diagnoses, especially when considering posthumous assisted reproduction (PAR). The Enriching Communication skills for Health professionals in Oncofertility (ECHO/ENRICH) trains Allied Health Professionals (AHPs) to improve communication with AYAs with cancer. Little is known about AHPs' role in assisting in FP and PAR decisions.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/cam4.5345

Perspectives surrounding fertility preservation and posthumous reproduction for adolescent and young adults with terminal cancer: Survey of allied health professionals

I am often asked what is the single most important issue that needs to be resolved in order to insure that health care reform moves forward in America. The answer is actually quite simple. If the key reason to reform the health care system is to extend health insurance coverage to the tens of millions of Americans who have none, then all those promoting reform but especially President Obama must drive home the ethical position that health care is a right. 

As the current debate over health reform shows, those who oppose change argue that health reform cannot work because reform is not practical due to “the details.” A larger load of baloney masquerading as an argument is hard to imagine.

Health reform is not in the details. Think I am wrong? How far did we get this summer wallowing around in claims about co-ops, public plans, death panels, rationing, and cost savings? 

Health reform is in the ethics. It will only occur if those who favor it can win the fight to recognize a right to health care. If health care is recognized as a right, then the details of how to achieve affordable health insurance reform will follow. If it is not, then efforts to move reform forward will simply die under the weight of nitpicking, fear-mongering, sloganeering, and the invocation of details as obstructions to change.

Only critics looking for some way to derail reform give a hoot about details. Details are the place reform goes to die. No one at a town meeting or in Congress was ever motivated to worry about health reform solely by getting the details. If health care is not acknowledged as a right, then no amount of detail will ever move health reform forward.

No nation on earth has ever reformed its health care system by asking the public to wallow around in the details of health reform. Canada, Britain, France, Spain, Singapore, Taiwan, Germany, Switzerland, Australia, New Zealand, and the rest of the list of our economic peer nations that have universal health care coverage did not assemble their finest numbers crunchers and pencil pushers and send them into the front lines of the battle to sell reform. Each nation secured agreement that health care is a right and then and only then moved on to figure out how to guarantee that right to all citizens.

In some societies, health care is seen as a right because it has been earned. The British National Health Service was created in response to the British public having endured the Nazi blitz for many awful years. Some societies see health care as a right because a healthy workforce means a stronger economy. That was the basis for health care reform in Germany and Singapore. And in some nations, health care is seen as a right because of the ethical belief that a community should look after its own. Switzerland, Canada, Australia, France, Taiwan, New Zealand, and many other nations have grounded their right to health care in this idea of social solidarity.

America is not likely to buy any of these arguments. But there is a foundation for rights that every American understands — equality of opportunity.

Our nation loves the free market. But you cannot compete in the free market unless you can see, hear, move, chew, think, communicate, and breathe. Health care is essential to being able to do these things. We must make sure that each one of us has minimal insurance coverage so every one can compete and flourish in a free society if we are really a nation that takes equality of opportunity seriously. Once that commitment is made, then and only then do the details become important, because then and only then are arguments over the details carried out in good faith to try and achieve the agreed-upon goal of expanding health insurance coverage.

True, access to health care and having health insurance are not the same thing. But without universal basic health insurance coverage, access to health care is sporadic, inefficient, and hugely expensive. The road to health reform goes right through the acknowledgement that health care is a right. Those favoring reform need to say so and need to understand the basis for why it is true. Those who oppose reform should have to answer why they believe health care is not a right rather then using a false concern about the details to bog reform down.

Right to reform

Of mice and men: the human sciences and the humanities.

We read Patel’s article with distress verging on disbelief.1 Although flu is unlikely to have serious sequelae in healthy non-pregnant healthcare workers, unvaccinated workers can and do transmit the virus to their co-workers, adversely affecting the workforce. They also infect patients, including elderly people, immunocompromised patients, pregnant women, and very young children (who …

Arthur L. Caplan

Papers

Who is watching the watchmen: Is quality reporting ever harmful?

Perspectives surrounding fertility preservation and posthumous reproduction for adolescent and young adults with terminal cancer: Survey of allied health professionals

Right to reform

Of mice and men: the human sciences and the humanities.

Doctors choosing not to be vaccinated is choosing to do harm.