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Friday, May 20 2016

Full Issue

Viewpoints: Doctors And Gun Violence; In Funding Scrum, Lawmakers Pit One Virus Against Another

A selection of opinions on health care from around the country.

Doctors often ask their patients about risky behaviors like smoking, drinking or riding in cars without seat belts. But they may be too reticent when it comes to one potential threat to their patients鈥 health: firearms. A doctor should certainly ask a patient about gun access if he or she expresses suicidal or violent intent, write Garen J. Wintemute, Marian E. Betz and Megan L. Ranney in a recent paper in Annals of Internal Medicine. But firearm screening may also be appropriate for patients with certain risk factors for gun violence, like alcohol abuse or a history of violent acts, and for children and older people with cognitive impairments. (Anna North, 5/19)

In a nation with more than 30,000 annual deaths from gunfire, and more than 70,000 injuries, promoting the safe storage and handling of guns is an obvious task for public health professionals. At least, it should be. (5/19)

On June 21, 2016, the full 11th Circuit Court of Appeals will hear arguments in Wollschlaeger v. Governor of Florida, which challenges a Florida law regulating physicians鈥 speech related to patients鈥 gun ownership. A decision by the court on the merits will most likely have broad implications both for states鈥 ability to regulate physicians鈥 speech and physicians鈥 efforts to protect patients from firearm-related injuries, which in 2014 in the United States, included more than 33,000 deaths, most of which (21,334) were suicides. (Wendy E. Parmet, Jason A. Smith and Matthew J. Miller, 5/18)

Nobody should be surprised when the present House of Representatives, dominated by penurious reactionaries, produces a stingy response to a danger that calls for compassionate largess. But for sheer fecklessness it鈥檚 hard to top the House鈥檚 response this week to the Zika virus. The salient feature is that in providing money to fight one health menace, it steals from other funds meant to fight an even more dangerous threat 鈥 the Ebola virus. (5/19)

In 2009, for the first time in decades, Democrats occupied the White House and held majorities in both houses of Congress. Still, they wanted to secure broad, bipartisan support for health reform legislation. Among their compromises was the creation of insurance exchanges where Americans could purchase private insurance, frequently with help from taxpayers. (5/19)

Maybe the revolution got started just a little too late. For decades, Bernie Sanders has been advocating for national health insurance. During his improbable ascent to national prominence over the past year, his desire to provide every American with publicly funded insurance has defined his Democratic presidential primary contest with Hillary Clinton. Although he campaigned on other issues as well 鈥 Wall Street, free college and the war in Iraq 鈥 his most ambitious goal has been replacing today's patchwork health-insurance system with one run by the government. (Max Ehrenfreund, 5/19)

No one really expects this year鈥檚 presidential campaign to be decided on issues. But in fact, we are heading toward a new record for vacuousness. To see how far we鈥檝e drifted from any connection with the real world, consider just one issue: health-care reform. (Michael Tanner, 5/18)

Failing to respond to difficult questions seems to have been a kind of corporate policy at Theranos -- and for a long time it seemed to pay off. Even when company executives did talk to journalists, they could be 鈥渆xasperatingly opaque,鈥 my friend Roger Parloff wrote in a December mea culpa about the laudatory Fortune cover story he wrote on Holmes and Theranos in 2014. If nothing else, he wrote, he wished he had included more of Holmes鈥檚 answers-that-weren鈥檛-really answers in his original article. (Justin Fox, 5/19)

The Food and Drug Administration has decided it is going to update its definition of what constitutes 鈥渉ealthy鈥 food. Under the current definition 鈥 set in the 1990s when fat was a four-letter word 鈥 companies can鈥檛 market avocados, walnuts, or salmon as healthy because they contain more than three grams of fat per serving. It doesn鈥檛 matter that the fat consists mainly of nourishing monounsaturated fatty acids. Sugary breakfast cereals and Pop-Tarts do squeak into the healthy category, however. (Roxanne Sukol, 5/19)

The drug industry blames the Food and Drug Administration for driving up the research and development costs of new drugs, stifling innovation, and interfering with the sainted mandate to bring cures to suffering medical patients. The nation's public research agencies, especially the National Institutes of Health, complain they're starved for money. Put those together, and you get the elements of what drug industry watchdog Ed Silverman calls a "grand bargain": Congress will step up funding for the NIH in return for a loosening of regulatory standards at the FDA. Silverman thinks this is an offer the American public should refuse. He's right. (Michael Hiltzik, 5/19)

If you have ever been admitted to a teaching hospital, you鈥檝e probably encountered a medical student in your midst. You might wonder: Is this student actually here to help me, or am I a guinea pig here to help them learn? While the presence of budding doctors may make some patients uneasy, these students often grapple with their own anxieties about the transition out of the classroom and into the hospital room. (Andi Shahu, 5/19)

As an emergency-room nurse in southwest Wisconsin, I sometimes received patients who had been sexually assaulted 鈥 and I was expected to help conduct an exam to collect and preserve DNA evidence, though I didn鈥檛 have the appropriate training. I would try to make sense out of the rape kit: a cardboard box packed with numerous envelopes holding a mess of long-handled swabs and slides. Instructions were printed on both sides of a sheet in type so small I could barely read it. Often, the doctor on call was as uncertain about what to do as I was and had only 10 or 15 minutes before needing to return to other emergency department duties. I felt inadequate to meet my patients鈥 needs. And I was always worried: 鈥淲hat if I mess something up in the rape kit and ruin her court case?鈥 (Terri Slapak-Fugate, 5/19)

Death doesn't scare me because we're spiritual beings. It's just that I'm quite fond of my life and don't want it to end. My biggest fear is losing my ability to care for myself during my last days or weeks with colon cancer. It is good that I have the support of my husband, children and family to soon have the legal option to complete the official paperwork required to obtain aid-in-dying medication. I recently spoke to my oncologist, who is also fully supportive of my end-of-life decision. (Kristy Allan, 5/19)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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