A new study by the Dana-Farber Cancer Institute shows that people who are most religious are also most likely to want aggressive medical care at the end of their lives.
The researchers asked about 350 terminally ill cancer patients around the country how they coped with illness and prepared for death. Then they tracked their medical care. Dana-Farber’s Holly Prigerson says she was surprised to find that very religious patients often wanted intensive life-saving treatments such as mechanical ventilation.
“You would think people who are more spiritual and religious would put their faith in God and let things happen naturally,” says Prigerson, who is director of the Center for Psycho-oncology and Palliative Care Research at Dana Farber, as well as an associate professor of psychiatry at Harvard Medical School. “But the most religious people are often the people who are saying, ‘Do everything mechanical possible to keep me alive for as long as possible.’ “
Prigerson says one reason could be that the patients expected a miracle. She also says doctors should respect those wishes, but should also inform patients that aggressive end-of-life care can significantly worsen quality of life.
The study appears in today’s issue of the Journal of the American Medical Association.
An interview about the study with Prigerson, ethicist Father Ed Vacek of Boston College, and WBUR’s Morning Edition host Bob Oakes can be heard at http://www.wbur.org/news/2009/83719_20090318.asp.
Our recent presidential election was a stirring reminder of the power of the ballot box. Pending federal legislation on the Employee Free Choice Act (EFCA) threatens that basic democratic value and could significantly change labor relations in the United States.
In Massachusetts, hospital workers have always acted independently around unionizing; some hospital employees have chosen unions, while others have not. Our state’s hospitals value employees as essential contributors to a quality healthcare system, and have a long history of collaborating with their employees – union and non-union – to provide the quality care for which the Commonwealth is nationally known.
The existing National Labor Relations Act (NLRA) is intended to protect a worker’s individual right to decide whether or not to unionize through a democratic election process free from harassment, threats, or intimidation from either employer or union.
Under EFCA, the decision whether or not to unionize would no longer be made via a democratic voting process. Read more…
George Fountas of Salem refused to tell the state whether he had health insurance in 2007 and was assessed a $219 penalty. Fountas argued, among other things, that the law is an illegal taking of property, is cruel and unusual punishment and requires self-incrimination. But a Superior Court judge found in favor of the Department of Revenue and dismissed the suit. Bob Bliss is the department’s spokesman.
“Clearly the court felt that the law’s been properly drafted and implemented and there weren’t any constitutional issues with moving forward on it and we’re obviously glad to have that opinion.”
Fountas calls the ruling bogus and says the state has violated additional rights by dismissing the suit and keeping his personal tax exemption. He says he will appeal and hopes to force the state to dismiss the individual mandate and associated penalities.
Martha Bebinger
As we reported last week, Governors Patrick and Douglas are co-leading one of five regional health care forums that will follow the health care summit in Washington, D.C. last week. Here’s a statement from Becky Deusser, a spokeswoman for Governor Patrick:
“The availability and affordability of health care is a serious issue facing millions of Americans, and Governor Patrick supports President Obama’s effort to engage all of us in the conversation to help define both problems and solutions within the health care system. Successful health care reform in Massachusetts has become a national model – with more than 98 percent of residents covered by health insurance. The Governor looks forward to joining the discussion on how best to make quality health care available to all Americans, while containing skyrocketing costs.”
And here are some details:
The forum is at the Davis Center at the University of Vermont in Burlington on Tuesday, the 17th, from 1-2:30pm.
Read more…
State public health officials have approved some of the country’s strictest rules regarding gifts and payments to doctors from pharmaceutical and medical device companies.
The regulations are meant to prevent drug and medical device firms from having too much influence over health care providers. They ban companies from giving gifts to doctors ranging from museum tickets to promotional pens. And they require firms to disclose any payments above $50 to doctors for marketing activities.
“We’re very happy that we’ll be shedding some light on these potential conflicts of interest,” said Georgia Maheras of the nonprofit group Health Care for All, “so that we can make sure that patients can find out what their doctors are doing and make sure they’re getting the care that they need.”
Corporate critics say the rules are an unfair burden to the biopharmaceutical industry.
The Bay State is among the nation’s leaders in the way it serves mental health patients…or at least it was until recently. The National Alliance on Mental Illness gave Massachusetts a “B” on its new nationwide report card; that’s better than the last survey three years ago when the state received a “C-”. Department of Mental Health Commissioner Barbarba Leadholm says Massachusetts was one of only six states to receive a “B”. No state received an “A”.
“We are very pleased that NAMI recognizes the strides that the Department of Mental Health and Massachusetts has made in its public mental health system.
But the head of NAMI’s Massachusetts chapter, Laurie Martinelli, fears the grade may no longer be accurate.
“If the study were done today, it would be a much different picture because the report card does not take into account the massive cuts that the dept of mental health has had over the last several months.”
Martinelli says millions of dollars in budget cuts are threatening progress made in recent years with the passage of a children’s mental health bill and an improved mental health parity law.
Frannie Carr
Martha Bebinger
Talking to your doctor about how much intensive care you want at the end of life is associated with a more peaceful death and significant savings.
Researchers at Dana-Farber Cancer Institute asked 603 cancer patients whether they had talked to their doctor about the care they would like to receive if they were dying. They found that patients who did not discuss their wishes were more likely to go on a ventilator or have other agressive procedures, experienced more physical and mental pain and did not live longer than patients who did talk about a care plan with their physician. The study’s senior author, Holly Prigerson, says a moderate increase in such conversations could save $76 million a year just among cancer patients.
“So it’s an unusual circumstance of a win win. When there are cost savings, it’s usually associated with some pain. Here, its literally the opposite, there’s more palliative, better quality of life, with lower costs.”
The study is in the latest issue of Archives of Internal Medicine.
Martha Bebinger
Lost amid the recent news of changes underway at Cambridge Health Alliance was a more important discussion about the long-term sustainability of our public hospital system and how governments can partner with health care institutions to safeguard critical medical access to those most in need.
While it is human nature to focus on what is lost during times of great change, behind the ambitious plan to reconfigure Cambridge Health Alliance is a broad collaborative strategy and story of self-determination that needs to be further explored.
Cambridge Health Alliance plays an important role in our region’s health care system by providing quality services, particularly to low-income residents. It is a safety-net hospital in the truest sense. For months, the Patrick Administration and the hospital have been working together to develop a shared understanding of the essential health care services to the diverse communities Cambridge Health Alliance serves, the limits of our resources, and how we can work together to ensure the hospital system’s future.
The comprehensive reconfiguration recently approved by the CHA Board of Trustees last month reflects a thoughtful, clinically-driven approach to preserving health care access and quality for its patients and communities given the need to respond to today’s financial challenges. Read more…
Healthcare Reform forum at whitehouse.gov
You can watch the live webcast here.
Here’s the list of participants and breakout sessions: Read more…
Senator Ted Kennedy is back in Washington for the first of President Obama’s health care forums. He’s one of about 50 members of Congress who have what some Capitol Hill insiders say is the hottest ticket in town. Kennedy has returned from Florida for this event, meetings with staff and colleagues and a belated birthday celebration at the Kennedy Center. White House aides say President Obama plans at least six health care forums that will bring together providers, consumers, insurers, business leaders and members of Congress to talk about rising health care costs and the need to expand coverage. The President has asked Governors Deval Patrick and Jim Douglas to co-lead the third forum in Vermont later this month. Massachusetts and Vermont are in the midst of statewide efforts to cover the uninsured and improve the quality of health care. The event on March 17th, planned for Burlington, will look at how the experience of these two states might translate to a national health reform plan.
Martha Bebinger
Update – press release with more details:
THE WHITE HOUSE
Office of the Press Secretary
FOR IMMEDIATE RELEASE
March 6, 2009
Building on Thursday’s White House Forum on Health Care Reform, President Obama Announces Series of Regional White House Forums to be Held Across Country
California, Iowa, Michigan, North Carolina and Vermont to host regional forums to continue discussion about bringing down health care costs, expanding coverage for all Americans
WASHINGTON, DC – Building on Thursday’s White House Forum on Health Care Reform, President Obama announced a series of Regional White House Forums on Health Reform that will bring the conversation about health care reform directly to communities across the country. In keeping with the Obama administration’s commitment to a transparent, accountable government, the forums will be an opportunity for Americans from all over the country to voice their concerns and ideas about reforming our health care system.
“Health care reform is a fiscal imperative,” President Obama said. “Skyrocketing health care costs are draining our federal budget, undermining our long-term economic prosperity and devastating American families. The time for reform is now and these regional forums are some of the key first steps toward breaking the stalemate we have been stuck in for far too long. The forums will bring together diverse groups of people all over the country who have a stake in reforming our health care system and ask them to put forward their best ideas about how we bring down costs and expand coverage for American families.”
The Regional White House Forums on Health Care Reform will be hosted by the states’ Governors and will include participants ranging from doctors to patients to providers to policy experts. They will be open conversations with everyday Americans, local, state and federal elected officials – both Democrat and Republican — and senior Obama administration officials. The events will begin with a video recorded by the President, a summary of the findings from the Health Care Community Discussions that took place in December, and an overview of the discussion that took place at the White House Forum on Health Reform.
The meetings in California, Iowa, Michigan, North Carolina and Vermont will take place in March and early April. Further logistical information about the forums is forthcoming.