We Must Do Better
July 16, 2012
Everybody is expressing opinions about the US Supreme Court’s various written opinions regarding the Patient Protection and Affordable Care Act of 2010.
However, my mind goes back to the heated debate the previous year, to a passage about this topic in a July 13, 2009 Businessweek column co-authored by Benjamin E. Sasse, US Secretary of Health and Human Services from 2007 until taking a teaching position at the University of Texas in Austin in 2009, and Kerry N. Weems, an independent consultant who previously served 28 years in federal government, most recently as the head of Medicare and Medicaid.
Sasse and Weems wrote: “. . . passionate certainty that things are broken is not the same as dispassionate clarity about how to fix them.” They were critical of people on both sides of the health care debate who were “still campaigning on the issue when what’s needed is a detailed conversation.”
What bothered Sasse and Weems on July 13, 2009, seven months into President Obama’s first term, has only gotten worse on July 13, 2012, four months prior to the next election. Many are campaigning – on health care, as well as the economy, the environment, education and every other pressing issue of our times and our children’s times – but few are truly leading on those issues.
Borrowing from the title of Bill Bradley’s latest book, which he borrowed from Abraham Lincoln’s second inaugural address, "we can all do better." In fact, we not only can, we must. It’s a matter of will more than it is of wisdom.
Cardiac Screening
October 31, 2014
Sudden death among 12 to 25-year-olds is “a low event rate occurrence.”
“There is insufficient information to support the view that ECGs in asymptomatic young people for cardiac disease is appropriate or possible on a national basis for the United States, in competitive athletics or in the general population.”
“At present, there is no mechanism available in the United States to effectively create national programs of such magnitude, whether limited to athletics or including the wider population of all young people.”
“There is insufficient evidence that particularly large-scale/mass screening initiatives are feasible or cost effective within the current US healthcare infrastructure . . .”
“The ECG . . . cannot be regarded as an ideal or effective test when applied to large healthy populations.”
“An additional, but unresolved, ethical issue concerns whether students who voluntarily engage in competitive athletic programs should have advantage of cardiovascular screening, while others who choose not to be involved in such activities (but may be at the same or similar risk) are in effect excluded from the same opportunity.”
The AHA’s Sept. 14 AHA writing group “does not believe the available data support significant public health benefit from using the 12-lead ECG as a universal screening tool. The writing group, however, does endorse the widespread dissemination of automated external defibrillators which are effective in saving young lives on the athletic field and elsewhere.”