Longer looks: The frustrations of academic medicine; Small business owners fear health law changes; A doctor struggles to save his mother

Dec 7 2012

Every week Shefali S. Kulkarni selects interesting reading from around the Web.

The New York Times: Small Employers Weigh Impact Of Providing Health Insurance
Like many franchisees, Robert U. Mayfield, who owns five Dairy Queens in and around Austin, Tex., is always eager to expand and -; no surprise -; has had his eyes on opening a sixth DQ. But he said concerns about the new federal health care law had persuaded him to hold off. ... Mr. Mayfield, who has 99 employees, said he was worried he would face penalties of $40,000 or more because he did not offer health insurance to many of his full-time workers ... Most employers, even small businesses, already offer health insurance, and the federal law is not expected to have a significant impact on what they do over the next year or so. But businesses that rely heavily on low-income workers, many of whom do not make enough to afford their share of the cost of the insurance premiums, are being forced to rethink their business models (Reed Abelson and Steven Greenhouse, 11/30).

The Weekly Standard: The Sebelius Coverup
Many states are wisely signaling that they aren't interested in doing the Obama administration's bidding on Obamacare. As a result, many if not most of Obamacare's insurance exchanges -; the heart of the beast -; will have to be set up and run by the Obama administration at the federal level. ... The Obama administration's congressional allies botched the drafting of this aspect of the health care overhaul, as the plain language of Obamacare doesn't empower federal exchanges to distribute taxpayer-funded subsidies to individuals; it empowers only state-based exchanges to distribute the subsidies. ... Moreover, the Department of Health and Human Services (HHS) is lagging behind in developing the federal exchanges (Jeffrey H. Anderson, 12/5).

The New Republic: The Legal Crusade to Undermine Obamacare-;and Rewrite History
Can one very determined libertarian and one very distorted version of history keep millions of people from getting health insurance? We're about to find out. The determined libertarian is Michael Cannon of the Cato Institute. He was among the most vocal opponents of the Affordable Care Act, ... Cannon and [Jonathan] Adler, along with the state of Oklahoma and others embracing this cause, argue that the federal government lacks authority to offer those subsidies. ... Not too many legal experts seem to think the lawsuit has merit. ... [Samuel Bagenstos, a professor at the University of Michigan and a widely respected expert on constitutional law]  says Cannon and Adler are reading the statute in an unusually pinched way. ... Clearly, Bagenstos says, the Senate bill's architects wanted these substitute exchanges to be fully functional, complete with subsidies (Jonathan Cohn, 12/5).

Health Affairs: As She Lay Dying: How I Fought To Stop Medical Errors From Killing My Mom
Back when I was training to become an emergency physician, I'd worry about the day I'd be involved in a medical error. It seemed inevitable. With land mines everywhere-;the possibilities of missed diagnoses, delayed treatments, miscommunication-;it felt like almost anything could lead to catastrophe. I imagined attending the in-house case review afterward, chastened as my hospital colleagues dissected my decisions. Yet I also thought-;and hoped-;that something positive would come from the process, that lessons from an error would sharpen my clinical skills and improve care in the hospital. But when I was entangled in my first medical error, I played an unexpected role: I was a thirty-three-year-old son trying to save my mom's life (Johnathan R. Welch, December 2012).

The New York Times: Sharing The Pain Of Women In Medicine
I recently learned that a doctor friend had seriously considered quitting her job at her medical school to go into private practice. As long as I have known her, she has talked about her love for teaching new doctors and conducting research while still caring for patients. Nonetheless, I wasn't surprised to hear the reason she wanted to leave. "I got tired of being a woman in academic medicine," she said. ... What surprised me, however, was what finally persuaded her to stay. When she described her situation to some male colleagues, they listened attentively, then began relaying their frustrations with how little support they got from superiors. "It's hard being a woman here, but I concluded it's not that great for anyone else either," she said. Sadly, her assessment seems to be correct (Dr. Pauline W. Chen, 11/29).

American Medical News: The South Responds To Its Surging HIV Epidemic
Laurie Dill, MD, has HIV-positive patients who were forced to eat off paper plates because their families feared they would spread the disease. Some were kicked out of their homes when they disclosed their status. ... The attitudes toward HIV/AIDS that she sees now in Alabama were what many physicians saw in the early days of the epidemic. In many places, fears of contracting AIDS have lessened due to education about the disease and how it's transmitted. But in parts of the South, the stigma remains a serious problem. It prohibits people from getting tested, receiving timely medical care, and getting emotional and mental support. ... The South is in the grips of an epidemic, which few people paid attention to until recently (Christine S. Moyer, 12/3). 

The Oregonian: With Seniors' Help, OHSU Researchers Use Technology To Track The Aging Process
Every time Trudy Rice or her husband comes in the front door, it's recorded. ... The data captured by motion detectors installed at the retired couple's Northeast home flows to electronic charts at Oregon Health & Science University, allowing researchers to discern their patterns. ... In the future, a doctor or family member with access to the data may be able to notice changes before they become problems. A falter in Trudy Rice's walking speed, as measured by four sensors mounted on the ceiling from the front door to the living room wall, may indicate the onset of Alzheimer's disease. ... Research at the Oregon Center for Aging and Technology, or ORCATECH, a program at OHSU, indicates sensors, smartphones, computer links and other technology hold great promise for maintaining older adults' quality of life (Eric Mortenson, 12/1).

Men's Journal: The Military's Billion-Dollar Pill Problem
Suffering under the unfathomable strain caused by two extended wars and some of the most intense fighting in our nation's history, the suicide rate among active duty soldiers and veterans is at an all-time high – prompting Secretary of Defense Leon Panetta to dub it "an epidemic." The U.S. military has spent more than a billion dollars on psychiatric drugs as part of the effort to help combat the problem. The most commonly prescribed drugs to treat Post Traumatic Stress Disorder (and also as sleep aids) are anti-depressants and a class of anti-psychotics that includes Seroqel. The tragically ironic issue, however, is that with many of these drugs, some of the possible side effects include suicidal urges (December 2012).

The World/The Pulitzer Center: Cancer's New Battleground -; the Developing World
America has waged war on cancer for more than forty years, but in developing countries the fight has barely begun. In this radio and online series, we meet patients, doctors, and public health advocates on the front lines. What political, cultural, and logistical obstacles make tackling cancer so difficult across most of the globe? (Joanne Silberner, 12/3).