Viewpoints: Doctor-led frugality; George will on his son's life with Down syndrome; Facebook spurs organ donors

Los Angeles Times: Healthcare: The Testing Glut
In case you missed it, a recommendation came out last month that physicians cut back on using 45 common tests and treatments. ... Most doctors will agree with the recommendations on the list. But the problem of overuse is less one of bad doctors (although there are a few); the problem is more one of good doctors working in a bad system. ... But we have to start somewhere -; and this list is a good start. Now it needs to be extended (H. Gilbert Welch, 5/2).

Boston Globe: Doctors Should Take Responsibility For Cutting Unnecessary Procedures
The best hope for achieving significant savings in medical costs is through the elimination of unnecessary or duplicative procedures, which waste hundreds of billions of dollars a year. Government attempts to set boundaries inevitably run into cries of "death panels" and rationing, along with prideful reactions from many doctors, who assert the right to test patients as they see fit. But so many factors complicate that decision -; from patients' demands to doctors' financial interests and fear of lawsuits -; that a system without limits is untenable. It's also unhealthy, in the sense that some patients are exposed to unnecessary risks. That's why it's welcome that the medical profession -; encompassing the people best qualified to set guidelines -; is starting to take responsibility (5/3).

New England Journal of Medicine: From An Ethics Of Rationing To An Ethics Of Waste Avoidance
Whereas the "R word" is a proverbial third rail in politics, ethicists rush in where politicians fear to tread. The ethics of rationing begins with two considerations. First, rationing occurs simply because resources are finite and someone must decide who gets what. Second, rationing is therefore inevitable; if we avoid explicit rationing, we will resort to implicit and perhaps unfair rationing methods. ... Will U.S. physicians rise to the occasion, committing ourselves to protecting our patients from harm while ensuring affordable care for the near future? (Dr. Howard Brody, 5/2).

New England Journal of Medicine: Beyond the "R Word"? Medicine's New Frugality 
Useless care, critics note, is easy to spot after the fact; it's much more difficult to recognize at the moment of clinical decision. ... Even if we could eventually eliminate that waste, we would merely postpone the reckoning. ... Democrats and Republicans must come together to tell Americans that we can't afford all the things that medicine can achieve -; and that we must make painful choices between health care and other needs (Dr. M. Gregg Bloche, 5/2).

The New York Times: Short-Term Fixes
Federally subsidized student loan rates were bound to become an election-year fight, since Congress provided only enough money for five years of low-interest rates in 2007. Now that the rates are about to double, both Democrats and Republicans are failing to do the right thing again. The Republican proposal, passed by the House last week, is unquestionably worse than the Democrats' plan. To cover the $6 billion cost of keeping interest rates at 3.4 percent for a year, it would eliminate a farsighted fund established by the health care reform law to help states and communities prevent obesity, heart disease, diabetes, cancer and infectious diseases, among other ailments (5/2).

The Washington Post: Jon Will's Gift
When Jonathan Frederick Will was born 40 years ago -; on May 4, 1972, his father's 31st birthday -; the life expectancy for people with Down syndrome was about 20 years. That is understandable. ... Whether warehoused or just allowed to languish from lack of stimulation and attention, people with Down syndrome, not given early and continuing interventions, were generally thought to be incapable of living well, and hence usually did not live as long as they could have (George F. Will, 5/2).

Houston Chronicle: Texas Ideology Above Women's Health
In its admitted zeal to cut off all funding to Planned Parenthood, the state of Texas is making it perfectly, chillingly clear that it is willing to wreak havoc with the lives and health of low-income Texas women to achieve that goal…. The end result is that for now, ideology is trumping the Constitution. Planned Parenthood clinics that by law have no connection with providing abortion cannot give essential preventive health care and family planning services to poor women in Texas. Unintended pregnancies and abortion rates will rise, families will suffer and taxpayers will also be paying a heavy price (5/2).

Minneapolis Star Tribune: Modernize Medical Payment Systems
The answer to improving the payment system in health care is not "everyday shakedowns for payment in advance" or "high-pressure boiler-room-style" tactics…. The key is technology…. Using modern technology to improve the patient experience by providing transparency at the point of service and to eliminate multiple, confusing billing statements will go a long way to helping providers remain focused on giving care (Brian Beutner, 5/2).

San Francisco Chronicle: The E-Record Cost-Saving Myth
Researchers from Harvard University and the City University of New York have cautioned that the federal government's multibillion-dollar investments in health information technology might not be the boon their proponents claim…. Of course, hospitals and doctors' offices should be free to adopt useful and cost-effective technological innovations. But government mandates that they do so distort incentives -- and could end up doing more harm than good. By trying to speed the adoption of HIT, the government might slow it down -- and cost taxpayers a lot of money in the process (Sally C. Pipes, 5/3).

The Seattle Times: The Affordable Care Act Is Health-Care Justice For All
As a nurse, I'm worried that we're losing sight of a much more essential issue: health-care coverage saves lives…. We are making measurable steps toward improving patient safety and quality of care. This is not the time to dismantle or repeal this law (Diane Sosne, 5/2).

San Jose Mercury News: Facebook Organ Donor Registry Takes It To New Level
Facebook just went from being mostly a fun pastime -- sometimes even a time waster -- to a lifesaver. And "friending" takes on a whole new meaning. The social media site's intrinsic value soared this week with the numbers on California's organ donor registry, which by Wednesday was reported to have grown by 5,000 percent (yes, that's three zeros) after Facebook launched its organ donor initiative (5/2).

New England Journal of Medicine: Freedom From The Tyranny of Choice -; Teaching The End-of-Life Conversation 
[T]he typical approach to discussing resuscitation status has evolved from a paternalistic one to one in which patients and their families are often asked to choose from a bewildering array of medical possibilities. To rectify a perceived violation of patients' autonomy, health care institutions now require physicians to involve patients and families in these decisions. But ... the few studies that have assessed residents' ability to lead end-of-life conversations indicate that they're not being taught this critical skill (Drs. Daniela Lamas and Lisa Rosenbaum, 5/3).