Medical Decisions

In yet another attempt to kill legislation to give unmarried couples medical decision-making rights, Del. Donald H. Dwyer Jr. took the unusual preliminary step yesterday of trying to repeal the measure through a voter referendum. Dwyer, an Anne Arundel County Republican, said he filed petition requests with the Maryland State Board of Elections and attorney general's office. "I'm prepared to fight this every step of the way," said Dwyer of the bill, which would be effective July 1. Under Maryland election law, Dwyer would need to collect 51,195 signatures by June 30 of this year to get the question on the 2006 ballot, said Donna Duncan, director of the election management division of the Board of Elections.

It's a name only a policy wonk could love: comparative effectiveness research. But get ready to hear a lot about it; it could save your rights as a patient - and maybe even your life. If opponents have their way, it could be the bogeyman that brings down health care reform. Using false and misleading scare tactics, Conservatives for Patients Rights, a group opposed to comprehensive health care reform, announced last week a $1 million ad attacking comparative effectiveness. However, an emerging consensus of strange bedfellows - from insurance companies to the Institute of Medicine to patients rights advocates - all support making a national investment in research to compare the effectiveness of drugs, devices and diagnostic procedures, and sharing the information that results with physicians and patients.

A BILL that would require health insurers to give patients the right to appeal unfavorable decisions on coverage would not entirely correct the imbalance of power that characterizes many of these situations. But it would be an important step in the right direction, and we urge its passage -- provided that insurers bear some of the costs.Health insurers, especially health maintenance organizations and other managed care groups, have profited handsomely on their ability to control spiraling costs for medical care.

WASHINGTON - Medical researchers and politicians are tiptoeing into an area of health care that makes some Americans uncomfortable, even angry, and it has nothing to do with such hot-button issues as cloning and stem-cell research. This time, the idea is to press doctors and patients to use particular drugs and treatments in order to save money. On the surface, it seems simple enough: Billions of dollars could be saved if everyone adopted the regimens that research showed were best and most cost-effective - which, experts say, happens far less often than most patients think.

YOUR MARCH 20 editorial, "Curbing the power of HMOs," contained a number of factual errors. The most blatant one was your assertion that "medical decisions are made not by physicians . . . but by bean-counters. . . ."I have been a sole practitioner for 25 years in Columbia. My specialty is family practice and I belong to several HMOs (over two-thirds of my patients are members of HMOs).I have never been told how to practice medicine by any HMO.I have been given practice guidelines on selected diseases (like asthma and heart failure)

High-tech medical treatment goes more often to private-pay patients than to people with public insurance or no insurance, according to a new study that found that how a person pays for his medical care may influence the kind of care he gets.The finding, to be published today in the Journal of the American Medical Association, may seem self-evident but, in fact, undercuts what many believe is a basic tenet of medicine -- that a person's care is dictated simply by the state of his health."The finding is alarming because I think the health care system is assumed to be set up in such a way that medical decisions are made on the basis of ... the clinical characteristics of patients," said Joel Weissman, an instructor in health policy at Harvard Medical School and a co-author of the paper.

A former chief of Howard County General Hospital's medical staff is suing the hospital and three doctors for at least $80 million, alleging that "bad blood" and racism -- rather than questionable medical decisions -- led to the suspension last year of his privileges at the facility.In a federal lawsuit filed Monday, Dr. Kline A. Price Jr. -- a black gynecologist who claims to be Columbia's first private doctor and is the brother of National Urban League President Hugh B. Price -- lists a host of alleged medical miscues performed at the Columbia hospital by white physicians that were not punished.

It's a name only a policy wonk could love: comparative effectiveness research. But get ready to hear a lot about it; it could save your rights as a patient - and maybe even your life. If opponents have their way, it could be the bogeyman that brings down health care reform. Using false and misleading scare tactics, Conservatives for Patients Rights, a group opposed to comprehensive health care reform, announced last week a $1 million ad attacking comparative effectiveness. However, an emerging consensus of strange bedfellows - from insurance companies to the Institute of Medicine to patients rights advocates - all support making a national investment in research to compare the effectiveness of drugs, devices and diagnostic procedures, and sharing the information that results with physicians and patients.

'TC She is a 92-year-old woman -- anybody's mother, anybody's patient.Because of bad circulation, she developed a foot ulcer, for which surgeons offered two choices: Amputating the foot in a fairly simple surgical procedure, or a more complicated bypass operation to save her foot by grafting other blood vessels onto the decayed area.Her chances of walking were limited either way because of her severe arthritis. But her family wanted to save her foot. So she chose the bypass, and at first things went well.

HMO regulations raise many more questionsIn a March 12 letter, "HMOs seen in need of more regulations," Steve Shearer supports legislation making physician administrators in health maintenance organizations accountable for their medical policy decisions.He references a March 5 article, "Stronger oversight of HMOs sought," that detailed current legislative efforts to micromanage health care in this state. I say such efforts are Band-Aids. We need a tourniquet.State and federal legislation created the problem.

Maryland military veterans will get tax breaks worth up to $400 a year under a bill Gov. Robert L. Ehrlich Jr. signed into law yesterday. The governor also gave his blessing to measures designed to crack down on underage drunken driving and to allow unmarried couples -- including gays -- to make medical decisions for each other. But the big winners in yesterday's bill signing ceremony were veterans, always a politically popular constituency, who saw more than a half-dozen measures to honor and assist them win final approval in this election year.

When Nancy Welsh's breast cancer was diagnosed in June 2004, she and her husband began a lengthy process of interviewing physicians for her treatment. As the Laurel couple visited the offices of various oncologists, radiation specialists and plastic surgeons, they took careful notes, not only about the procedures being recommended but about the physicians' attitudes and office settings. They paid attention to which doctors took cell phone calls in the middle of their conversations or talked down to them, and who had outdated technology or dirty bathrooms.

Gov. Robert L. Ehrlich Jr. has staked out a middle ground on gay rights by signing two measures and vetoing two others. But rather than ducking controversy, he's left himself the task of finding compromise on the touchiest issue of the four - whether same-sex couples should have the same right to make medical decisions for each other that married couples do. The question stirs passions on both sides, with proponents saying that denying gays the right...

The legislative session may have ended, but a battle over several bills critics say further gay rights is reaching an elevated pitch. Conservative and Christian groups are mounting a widespread effort - using e-mails and Web sites with often-fiery rhetoric - against four bills they charge promote the gay agenda. "Pray that God's will be done and that all the churches rise up against these bills," says an e-mail distributed to members of the Christian Coalition of Maryland. The bills passed the Senate and House of Delegates this session and are awaiting action - or inaction - from Gov. Robert L. Ehrlich Jr. before becoming law. Tres Kerns, executive director of VoteMarriage.

In yet another attempt to kill legislation to give unmarried couples medical decision-making rights, Del. Donald H. Dwyer Jr. took the unusual preliminary step yesterday of trying to repeal the measure through a voter referendum. Dwyer, an Anne Arundel County Republican, said he filed petition requests with the Maryland State Board of Elections and attorney general's office. "I'm prepared to fight this every step of the way," said Dwyer of the bill, which would be effective July 1. Under Maryland election law, Dwyer would need to collect 51,195 signatures by June 30 of this year to get the question on the 2006 ballot, said Donna Duncan, director of the election management division of the Board of Elections.

The Maryland General Assembly concluded its 90-day session last night riven by the same partisan feuding in which it began, with a divisive plan to spend state money on embryonic stem-cell research dying under the threat of a Senate filibuster that never came to pass. The political jockeying between Republican Gov. Robert L. Ehrlich Jr. and a Democrat-controlled legislature intensified in the third year of the governor's term and looks to continue through the next election. With confetti dropping inside the State House at midnight, Democratic leaders said they had done right by working Marylanders this year, increasing the state's minimum wage to $6.15 an hour and by imposing a tax on large corporations - effectively just Wal-Mart - that do not spend a prescribed percentage of payroll on employee health benefits.

MOST OF US might never have heard of Terri Schiavo if she had put her medical wishes in writing. Now she has become a household name after Congress and the president entered the legal battle to prolong her life against her husband's insistence that she would have preferred to die rather than live with severe brain damage. The emotional case in Florida has many people across the country scrambling to get documents in place to spell out their wishes on life-sustaining treatment. The documents can go a long way toward helping family members who must make hard choices on behalf of loved ones who are unable to speak for themselves.

A clear majority of elderly Americans oppose the use of life-sustaining medical technologies to prolong their lives, but most have neither signed living wills nor appointed someone to act on their behalf, two new studies indicate.A study of 103 residents at a Rockville nursing home reported that most of them did not want their lives extended by the use of respirators or feeding tubes.Ninety percent of the residents said that if necessary, they would choose a relative to make their health-care decisions for them.

The Maryland General Assembly concluded its 90-day session last night riven by the same partisan feuding in which it began, with a divisive plan to spend state money on embryonic stem-cell research dying under the threat of a Senate filibuster that never came to pass. The political jockeying between Republican Gov. Robert L. Ehrlich Jr. and a Democrat-controlled legislature intensified in the third year of the governor's term and looks to continue through the next election. With confetti dropping inside the State House at midnight, Democratic leaders said they had done right by working Marylanders this year, increasing the state's minimum wage to $6.15 an hour and by imposing a tax on large corporations - effectively just Wal-Mart - that do not spend a prescribed percentage of payroll on employee health benefits.

MOST OF US might never have heard of Terri Schiavo if she had put her medical wishes in writing. Now she has become a household name after Congress and the president entered the legal battle to prolong her life against her husband's insistence that she would have preferred to die rather than live with severe brain damage. The emotional case in Florida has many people across the country scrambling to get documents in place to spell out their wishes on life-sustaining treatment. The documents can go a long way toward helping family members who must make hard choices on behalf of loved ones who are unable to speak for themselves.