Monday, December 12, 2005

In Vitro Meat

In Vitro Meat

In Vitro Meat

By RAIZEL ROBIN, New York Times Magazine, December 11, 2005

In July, scientists at the University of Maryland announced the development of bioengineering techniques that could be used to mass-produce a new food for public consumption: meat that is grown in incubators.

The process works by taking stem cells from a biopsy of a live animal (or a piece of flesh from a slaughtered animal) and putting them in a three-dimensional growth medium - a sort of scaffolding made of proteins. Bathed in a nutritional mix of glucose, amino acids and minerals, the stem cells multiply and differentiate into muscle cells, which eventually form muscle fibers. Those fibers are then harvested for a minced-meat product.

Scientists at NASA and at several Dutch universities have been developing the technology since 2001, and in a few years' time there may be a lab-grown meat ready to market as sausages or patties. In 20 years, the scientists predict, they may be able to grow a whole beef or pork loin. A tissue engineer at the Medical University of South Carolina has even proposed a countertop device similar to a bread maker that would produce meat overnight in your kitchen.

There are still several major hurdles to clear, like figuring out a way to get stem cells to proliferate cheaply enough that meat could be mass-produced. But if in vitro meat becomes viable, the environmental and ethical consequences could be profound. The thought of beef grown in the lab may turn your stomach, but in vitro meat would avoid many of the downsides of factory farming, most notably pollution: in the United States, livestock produce 1.4 billion tons of waste each year. What's more, once a meat-cell culture exists, it could function the way a yeast or yogurt culture does, so that meat growers wouldn't need to use a new animal for each set of starter cells - and the meat industry would no longer be dependent on slaughtering animals.

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Sunday, December 11, 2005

Study Finds That Medical Research is Often Wrong

Study Finds That Medical Research is Often Wrong

Study Finds That Medical Research is Often Wrong

Associated Press, Thursday, July 14, 2005

New research highlights a frustrating fact about science: What was good for you yesterday frequently will turn out to be not so great tomorrow.

The sobering conclusion came in a review of major studies published in three influential medical journals between 1990 and 2003, including 45 highly publicized studies that initially claimed a drug or other treatment worked.

Subsequent research contradicted results of seven studies ? 16 percent ? and reported weaker results for seven others, an additional 16 percent.

That means nearly one-third of the original results did not hold up, according to the report in Wednesday's Journal of the American Medical Association.

"Contradicted and potentially exaggerated findings are not uncommon in the most visible and most influential original clinical research," said study author Dr. John Ioannidis, a researcher at the University of Ioannina in Greece.

Ioannidis examined research in the New England Journal of Medicine, JAMA and Lancet ? prominent journals whose weekly studies help feed a growing public appetite for medical news.

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Wednesday, December 07, 2005

Six Keys to Safer Hospitals

Six Keys to Safer Hospitals

Six Keys to Safer Hospitals
A set of simple precautions could prevent 100,000 needless deaths every year.

By Donald M. Berwick, M.D.
Newsweek, December 12, 2005

Sometime soon, I will need a new right knee. If all goes well, it will be quite a relief. An artificial joint can be a modern miracle, the alternative to decades of pain and hobbling. Here's the problem. Instead of helping me, health care might kill me. In 1999, the Institute of Medicine shocked the nation with an authoritative report on hospital errors. The report concluded that up to 98,000 Americans each year die in hospitals, not from the diseases that brought them there but from injuries caused by their medical care: preventable bleeding or infections, a medication mix-up, a respirator tube put in the wrong way and a lot more. I have climbed Mount Rainier five times. Each time I made that tough trek, my risk of dying was about 100 times smaller than the risk I will face on the operating table.

Even if the surgery doesn't kill me, it may still cause needless harm. The reason I need a new knee is that I have osteoarthritis?the result of a botched and unnecessary knee operation 30 years ago, when I was a naive and trusting medical student. What could go wrong this time? My postoperative pain may not be adequately controlled. I may receive the wrong dose of blood thinner, causing bleeding in my stomach. Someone may overlook the little patch of pneumonia on my routine postoperative chest X-ray, causing me to remain on a respirator in the intensive-care unit for several days. Or the hospital may fail to take steps that could prevent the pneumonia in the first place.

Fortunately, hospitals are beginning to realize that it doesn't have to be this way. On Dec. 14, 2004, the Institute for Healthcare Improvement, a nonprofit organization headquartered in Cambridge, Mass., launched the 100,000 Lives Campaign, a broad national effort to achieve the most urgent reforms. Mainstream leadership groups like the American Medical Association, the American Nurses Association and the Joint Commission on Accreditation of Healthcare Organizations immediately signed on to the campaign. Several federal agencies?including the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, the Veterans Health Administration and the Agency for Healthcare Research and Quality?pledged support as well.

We have identified six basic measures that could save as many as 100,000 lives a year if even 2,000 hospitals adopted them. It's surprising to learn that these standards aren't already the norm?but the norms may finally be changing. Nearly 3,000 American hospitals have enrolled in our 100,000 Lives Campaign over the past year, and more than half are reporting their monthly death rates so that we (and they) can track progress. That takes courage in a world where hospitals, fearing blame and lawsuits, too often feel the need to hide their mistakes.

What exactly will it take to improve the quality of care? Here are the prescriptions that we and our partners are advancing. You don't have to be a doctor to understand them.

1 PREVENT RESPIRATOR PNEUMONIA
VAPs, or ventilator-associated pneumonias, are often deadly lung infections that people on respirators can get (after surgery, for example). A few simple maneuvers, like elevating the head of the hospital bed and frequently cleaning the patient's mouth, can eliminate them. Dominican Hospital in Santa Cruz, Calif., just celebrated one full year without a single VAP?a result most doctors would have thought impossible.

2 PREVENT IV-CATHETER INFECTIONS
Central-line infections occur when bacteria contaminate catheters that deliver food and medicine intravenously. Dr. Peter Pronovost of Johns Hopkins University recently reported that 70 hospitals in Michigan, California, Iowa and Indiana cut their central-line infections by half, saving an estimated $165 million from complications to boot. How did they do it? They made it easy for doctors and nurses to wash their hands between patients, adopted simple procedures for changing the bandages around the catheters and made absolutely sure that no catheter remained in a vein even one hour longer than needed.

3 STOP SURGICAL-SITE INFECTIONS
Surgical-site infections are a major cause of complications and deaths after operations. Last year Mercy Health Center in Oklahoma City operated on 1,200 consecutive patients without a single wound infection?by adopting a series of simple preventive measures. These include giving the right antibiotics at the right time during surgery, enforcing strict hand-washing and avoiding shaving the surgery site before the operation (clipping hair avoids nicking the skin and is safer).

4 RESPOND RAPIDLY TO EARLY-WARNING SIGNALS
A nurse or visitor is often the first person to notice that a patient is in trouble. By setting up special rapid-response teams, hospitals can ensure that these critical warnings are never missed or ignored. Busy physicians may resent the false alarms, but lives are saved when hospitals take nurses' concerns seriously and respond within minutes. Australian researchers have found that rapid-response teams may be able to cut hospital death rates by 20 percent or more. The University of Pittsburgh Medical Center is testing an even more innovative way to use rapid-response teams. The staff trains patients' visiting family members to call for assistance whenever they sense trouble. The new protocol, dubbed Condition H (for "Help"), has already saved lives.

5 MAKE HEART-ATTACK CARE ABSOLUTELY RELIABLE
The scientifically correct treatments for heart attacks could save far more lives if we used them reliably. The 100,000 Lives Campaign simply asks hospitals to ensure that every patient gets every medication and treatment recommended by the American College of Cardiology and other expert bodies. These measures include aspirin and a beta blocker on arrival and a stent or clot buster promptly after admission. McLeod Regional Medical Center in Florence, S.C., has cut the death rate among its heart-attack patients from 10 per-cent (the U.S. average) to about 4 percent. All the hospital had to do was ensure 100 percent reliability.

6 STOP MEDICATION ERRORS
Medication errors kill tens of thousands of patients a year, yet many are easily prevented. One secret is to "reconcile" medications whenever patients move from one care setting to another?from hospital to home, or even from one place to another within a hospital. The reconciliation protocol assigns a doctor or nurse at every step to check and recheck: are the medicines the patient gets after the transfer exactly the ones planned before the transfer? If not, the mistake gets corrected right away.

How much difference are we making through these efforts? We don't yet know whether the campaign will save 100,000 lives in its first year. Talk is cheap; changing the culture of a hospital is hard. But I've got a stake in it. When I close my eyes on the operating table so that a surgical team can implant my shiny new pain-free titanium knee, I know exactly what I want: safe, effective care, without a single complication.

BERWICK is president and CEO of the Institute for Healthcare Improvement (ihi.org) and clinical professor of pediatrics and health-care policy at Harvard Medical School. For more information, visit health.harvard.edu/NEWSWEEK.

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Tuesday, December 06, 2005

Science and Religion at John Templeton Foundation

Science and Religion at John Templeton Foundation

"The mission of the John Templeton Foundation is to pursue new insights at the boundary between theology and science through a rigorous, open-minded and empirically focused methodology, drawing together talented representatives from a wide spectrum of fields of expertise. Using 'the humble approach,' the Foundation typically seeks to focus the methods and resources of scientific inquiry on topical areas which have spiritual and theological significance ranging across the disciplines from cosmology to healthcare. In the human sciences, the foundation supports programs, competitions, publications, and studies that promote character education and the exploration of positive values and purpose across the lifespan. It supports free enterprise education and development internationally through the Templeton Freedom Awards, new curriculum offerings, and other programs that encourage free-market principles."

Learn more about the John Templeton Foundation

Identity in an infinitely expanding universe

Identity in an infinitely expanding universe

Identity in an infinitely expanding universe
Laurance Doyle and Reed Harris
Adapted from the Christian Science Sentinel, February 3, 2004

Astrophysicist Laurance R. Doyle is a principal investigator at the SETI Institute (Search for Extraterrestrial Intelligence) in Mountain View, California. SETI?s mission is to explore and explain the nature and prevalence of life in the universe. Dr. Doyle?s peer-reviewed projects track questions such as, How many stars have planets and how many of these planets might support life? The following excerpted comments are from a recent webcast discussion on spirituality.com, moderated by spiritual healer and speaker Reed Harris.

Laurance Doyle: Where science runs into a conflict with the sacred is in not accepting a limited version of the Source?a limited version of the Creator, a limited version of Mind. You can?t convince a scientist who works with googleplexes and galaxies and accelerating universes, much less quantum probabilities, that God is a tribal god that will fight. In the scientific community, a colleague of mine said, ?You?re not trying to mix religion and science, are you?? I said, ?Oh, no, no, no. I?m trying to make religion scientific.? And he goes, ?Okay. That?s okay.? So that?s acceptable?to make things scientific.

The philosophy I have of science is that you?re doing science when you take the evidence of intelligence above the evidence of the senses. The earth used to be thought to be flat. Well, it took evidence of intelligence to say it was round, because the senses say it?s flat. Same thing with the sun going around the earth, or the earth going around the sun. Bertrand Russell, the mathematician/philosopher, once said that physics is based on the assumption that things are as they appear, and then [the physicist] proceeds to prove that things are not as they appear.

So nothing changes when you realize the earth is round, except your perspective. When you rise higher, you see that it was round all the time?During the Renaissance, suddenly the sun didn?t go around the earth; the earth started going around the sun. Nothing changed. We just discovered a deeper reality.


?The universe is huge?I mean really, really big.?


The universe is huge?I mean, really big. I was trying to get a feel for that. I thought, ?Okay, if all humanity held hands and jumped in the ocean, it would rise a tenth of an inch.? Now that?s pitiful. And you could fit a million earths inside the sun if you dropped them in. You could fit a hundred million suns inside Betelgeuse?the giant star in Orion. With ten thousand years? worth of counting, you could count all the stars in [our own] galaxy. And there are trillions of galaxies. So what good am I?

Then I started reading about the spiritual nature of man [in Science and Health with Key to the Scriptures by Mary Baker Eddy], and I thought, ?Okay, what is this saying? Maybe it?s saying my identity isn?t material. Maybe it?s saying I?m an idea. Now what good is that?? Well, suddenly I thought, ?Wait a second, if I?m an idea, I?m unique in the entire universe.? If you had the only diamond in this room, people would probably come over and see it. But if you had the only diamond in Massachusetts, people would come from all around to see it.

Now what if you had the only diamond in creation?[it would be] infinitely valuable. Well, I was thinking, ?Gosh, I?m the diamond.? And so are you?you are one of a kind in the universe. The person sitting next to you is an infinitely valuable one-of-a-kind person?.


?I started reading the universe.?


By looking at my identity as an idea, as spiritual, instead of material, I found it: ?Gosh, I?m infinitely valuable!? And you know what that did? It evaporated competition in graduate school. It gave me confidence because I could always say, ?But I?m myself.? I mean, there?s a guy smarter than I am at physics; there?s a guy who?s a better observer; there?s a guy who?s better at signal detection; this guy can calculate three times faster than I can. But I?m a Laurance, and there has never been another one, and there never will be another me as good as me.

Online question: ?What caused you to first suspect that there?s a connection between science and religion from your work in astrophysics??

Laurance: I grew up with training in metaphysics in the Christian Science Sunday School, so I had a metaphysical view of things already. But the sheer scale of things in the universe made me have to reexamine my identity. If you examine yourself as a material person, the universe is so huge, and so old, that you begin to feel negligible. So I had to look to the teachings that I grew up with in Christian Science, one of which was what Christ Jesus said: that the Creator of the universe was ?my Father.? What an idea!

I began to connect with the universal Cause itself, and that?s when I realized my spiritual nature. That?s when the spiritual nature of things made me connect. I started reading the universe. Instead of saying, ?That?s the color of this nebula? or ?That?s a planet out there,? I began to read it, like you read a book. You don?t look at wood pulp and ink, you read the ideas. The ideas flow from Mind [God]. And you can read stars, and the ideas of their grandeur flow from Mind.

Once I began reading the universe in a spiritual way, that?s when I found my connection.


?Questioning is a gift.?


In other words, it?s important to look at the blackboard and see the numbers, but you have to read them. Pretty soon, it dawns on you that there?s a Principle behind those numbers, and it?s independent of the chalk, and it?s profoundly orderly and harmonious?.

Reed Harris: What?s the difference between people for countless millennia memorizing religious dogma and your study of Christian Science?

Laurance: [Television interviewer] Bill Moyers asked Isaac Asimov, ?What?s your definition of science?? Asimov said, ?Science is when you compare your thoughts with those of the universe to see if they match.? That?s the mitigating factor in science. You can be the world?s expert, but if the data does not back it up, if you cannot demonstrate the truth of it?you have no final authority. The final authority in science is what the universe has to say about the subject.

I think that?s the difference between dogma and belief. A scientist at no point encounters the dogma, or shouldn?t [accept the dogmatic response]??I?m sorry, that?s just the mystery. You?re going to have to accept that on blind belief.? That is anathema to science. The scientific process is, question, question, question, and only truth will survive. That?s the fundamental difference between the practice of science and [religious] dogma of the past. I?m really grateful we?re in a scientific age, because the truth will survive this questioning. Questioning is a gift. It?s a present to us to determine what the truth is. I encourage questioning. Don?t believe what I?m saying, by the way, on this show. Question it, investigate it, and check it out. I wouldn?t expect anything less from a scientist.

Online question: ?What is so scientific about your Christianity??

Laurance: What?s scientific about it is that you have to work it. You have to demonstrate that the harmony that?s at the truth of Christianity is also the truth about the universe, and can affect your life?make it more healthy, more harmonious, can solve problems, international problems, as well as your own personal problems. And you can do it with scientific precision. Communing with the harmony that is the source of the universe?this infinite Mind?and realizing your identity as the creation of this harmonious Mind, restores harmony in your life. It?s experimentally verifiable. And once again, don?t take my word for it. There are experiments you can do to demonstrate this for yourself.


??science is a simple three-letter word, law.?


?I think of Christ Jesus as a scientist. I don?t believe in miracles in the sense of setting aside the laws of the universe momentarily. [Jesus] has to have had a deeper understanding of the real laws of the universe in order to have demonstrated the healing of things that quickly. He must have understood that order at the deepest level. For Christ Jesus to be the founder of Christianity, he had to have been the founder of a scientific method.

Reed: If I take a look at the word Christian or Christianity, and I boil that down?what?s left is a four-letter word, love. And if I take a look at the word science, to me, it?s about looking for something that?s repeatable, replicable, reliable?What I get when I boil down the word science is a simple three-letter word, law. So, to me, Christian Science is not so much about one religion, or one small private point of view, as it is about the Science and the law of love. Mary Baker Eddy has a very interesting [comment] about Jesus in Science and Health: ?Jesus of Nazareth was the most scientific man that ever trod the globe. He plunged beneath the material surface of things, and found the spiritual cause.?

Online question: ?Is it hard to relate to the universe in spiritual terms when you?re a scientist??

Laurance: No?Johannes Kepler was the discoverer of celestial mechanics and modern optics. He was one of the ?giants? whose shoulders Newton [said he] stood on when he did his work. So here?s Kepler, around 1602: ?God wanted to have us recognize these laws when He created us in His image, so that we should share in His own thoughts. In doing so, our knowledge is of the same kind as the divine, is unique and eternal, a reflection of the mind of God. That mankind shares in it is because man is an image of God. For these secrets are not of the kind whose research should be forbidden. Rather they are set before our eyes like a mirror so that by examining them we observe to some extent the goodness and wisdom of the Creator.? Well, I would say this guy is in a state of bliss, investigating the order of the universe, and clearly seeing a [spiritual] cause.

But that?s not just a Renaissance trait. That?s also a modern trait. The best scientists have recognized that the order has to have a source?an infinite Mind. Albert Einstein was asked his view of religion??My religion consists of a humble admiration of the illimitable superior Spirit, who reveals Himself in the slight details we are able to perceive with our frail and feeble minds. That deeply emotional conviction of the presence of a superior reasoning power which is revealed in the incomprehensible universe forms my idea of God. One thing I have learned in a long life: that all our science measured against reality is primitive and childlike. And yet, it is the most precious thing we have.??Now if that?s Einstein?s humility, any scientist [has] to at least be that humble?at least I do.


?[Scientists] are looking for the order and Principle of the universe.?


Online question: ?Does one have to use material means in order to examine scientifically??

Laurance: In order to examine scientifically, one has to use intelligence. Consciousness is what does the examining, what does the experiment - it's intelligence that is the investigative part. The idea of matter being intelligent is not valid. Once again, it's not the investigation of matter that is the scientific process. It's looking beyond that. It's looking through the matter, and resolving it into the ideas that are the substance of what is really going on.

If someone says that scientists are materialists, I would have to strongly disagree. They are not examining matter. They are looking for the order and Principle of the universe. They?re not just believing the appearance [of things]. You?re doing science when you ?plunge beneath the material surface of things, and find the spiritual cause.?

From reading what Mary Baker Eddy had to say about the nature of matter a hundred years ago, I would say that nothing that's been discovered in quantum physics in the modern age contradicts any of that. It's interesting that she talks of all being "infinite Mind and its infinite manifestation" and [of] the substantiality of ideas. I found when I thought of myself as that identity - as an idea rather than a material construct - that something landed with me there. I've been able to hold that concept of myself [in prayer] and be healed of illnesses. There's something right about that.

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Monday, December 05, 2005

Tangled Strands in Fight Over Peru Gold Mine

Tangled Strands in Fight Over Peru Gold Mine

The Cost of Gold | Treasure of Yanacocha
Tangled Strands in Fight Over Peru Gold Mine
By JANE PERLEZ and LOWELL BERGMAN, The New York Times, October 25, 2005

SAN CERILLO, Peru - The Rev. Marco Arana drove his beige pickup over the curves of a dirt road 13,000 feet high in the Andes. Spread out below lay the Yanacocha gold mine, an American-run operation of mammoth open pits and towering heaps of cyanide-laced ore. Ahead loomed the pristine green of untouched hills.

Then, an unmistakable sign that this land, too, may soon be devoured: Policemen with black masks and automatic rifles guarding workers exploring ground that the mine's owner, Newmont Mining Corporation, has deemed the next best hope.

"This is the Roman peace the company has with the people: They put in an army and say we have peace," said Father Arana as he surveyed the land where gold lies beneath the surface like tiny beads on a string.

Yanacocha is Newmont's prize possession, the most productive gold mine in the world. But if history holds one lesson, it is that where there is gold, there is conflict, and the more gold, the more conflict.

Newmont, which has pulled more than 19 million ounces of gold from these gently sloping Peruvian hills - over $7 billion worth - believes that they hold several million ounces more. But where Newmont sees a new reserve of wealth - to keep Yanacocha profitable and to stay ahead of its competitors - the local farmers and cattle grazers see sacred mountains, cradles of the water that sustains their highland lives.

The biggest issue is the one looming over every modern industrial gold mine: What happens when the ore that lured the miners here is gone?

Over 13 years, Newmont has moved mountains for gold - 30 tons of rock and earth for every ounce. By the time it is through, the company will have dug up a billion tons of earth. Much of it will be laced with acids and heavy metals.

Three years ago, after Newmont acknowledged that 36,700 fish were missing from a river contaminated by the mine, the World Bank hired an American geochemist, Ann Maest, to study the streams and canals flowing from the mine.

In the short term, she concluded, the water was safe for human use. But long term, she said in an interview, the company's own tests show that all the components are in place for the huge piles of rock to leak acids that will pollute surface and groundwater.

The only preventive, she said, would be 'perpetual treatment.'

Mr. Hinze, who was recently appointed head of Newmont's North American operations, insists that the company's plan for closing the mine will take care of long-term treatment and cleanup.

"We plan on being here a very long time," he said.

Newmont has yet to put aside money for long-term treatment, though it says it will comply with a Peruvian government requirement due to take effect in 2007. But to pay for cleanups, the company needs to keep profits high. To keep profits high, it needs to keep finding and mining more gold. Yet increasingly, the unmovable reality is that to keep mining more gold, it has to make peace with the people who will be here long after the miners leave.

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"Better Final Days " - The need for more effective care

Better Final Days

The end of life need not be filled with extreme medical costs and intensive care.

By Shannon Brownlee, Schwartz Senior Fellow, The New America Foundation
Los Angeles Times, November 26, 2005

Whenever Americans stop to think about how they want to die, most conclude that they don't want to spend their last days in a hospital bed. They don't want to be stuck in an intensive care unit unnecessarily, or hooked up to machines if they can possibly avoid it. And they do not want a lot of tests and procedures, especially painful ones, if undergoing them won't improve their chances of surviving--or at least make their passing a little easier.

But that's exactly the sort of high-tech death thousands of elderly patients with chronic illnesses are suffering, depending on which hospital they find themselves in during the last two years of life. A landmark study, published by a team of Dartmouth University researchers in the journal Health Affairs last week, looked at the care received by Medicare recipients who died in 226 California hospitals between 1999 and 2003.

The study found huge variations in the amount of care being delivered in different hospitals to similar, chronically ill patients. Let's look first at UCLA Medical Center, a hospital that is renowned for its geriatric services. The average Medicare recipient who died there spent 19 days in the hospital during the last two years of life, 11 of them in the ICU. He saw a doctor in the hospital 52 times, and Medicare paid $71,922 for his care.

At Garfield Medical Center in Monterey Park, the average patient fared worse: He spent 23 days in the hospital, saw a doctor a whopping 92 times and cost Medicare $106,254.

But if that same patient had lived instead near UC Davis, he would have been hospitalized for just over 11 days, been in the ICU for about seven days and seen one-quarter the number of doctors for a cost to Medicare of $55,323.

Did the extra care make these chronically ill patients live longer or better? Probably not, according to a previous study by the Dartmouth team. That study, published in 2003 in the Annals of Internal Medicine,/i>, concluded that Medicare patients in higher-spending regions "receive more care than those in lower-spending regions but do not have better health outcomes."

Hospitals will correctly argue that there's no way to know ahead of time which patients are likely to recover with aggressive treatment and which are in their last few months of life. And academic medical centers such as UCLA will say they provide more care because they attract sicker patients.

But are the hospitals that are spending the most any better at helping patients get well? Most patients would agree that all those days in the hospital, doctor visits and often unpleasant tests and treatments would be worth it if it actually made a difference in the quality and length of their lives. But a growing body of research suggests that it does not. And more spending does not mean that hospitals are better at delivering proven treatments, like pneumonia vaccines or beta blockers for patients admitted to the hospital with a heart attack. In fact, patients in hospitals delivering the most intensive care were often less likely to get tests and treatments that are known to work, according to the latest California study as well as previous research.

What's more, winding up in those intensive-care hospitals may actually increase a patient's chances of dying by as much as 2% to 6%. That's because hospitals, for all their power to deliver lifesaving treatments, can also be dangerous places where every drug, every treatment, every test carries the risk of error and harm.

Americans have come to believe that more healthcare equals better health. But what these studies show is that's not always true. And as anybody who has spent time in an ICU can tell you, a lot of treatment for terminal conditions can certainly make a misery of a patient's final few weeks of life.

Certainly hospitals such as Garfield and UCLA, and the doctors who work in them, generally don't think they are delivering excess care--or that they are failing to provide needed care. But doctors and hospitals are paid more for doing more, not for doing better. They often profit from giving excess care and lose money when they provide some kinds of care that really makes a difference, such as monitoring a heart failure patient once he goes home.

Those who study healthcare also note that the supply of medical resources--not how sick the patients are--often determines what care patients get. The more beds a hospital has, the more patients will be hospitalized, and the more MRI machines a hospital buys, the more scans will be ordered. And as much as Americans like being able to see their specialists, having more specialists involved can complicate care.

How can this problem be fixed? Patients and their distraught families cannot possibly be expected to decide what kind of care is appropriate. It's up to insurers, Medicare and Congress to restructure the financial incentives to make sure that good care pays.

Whenever payers begin talking about cutting costs, Americans begin worrying about rationing. It would be rationing if hospitals or insurers were to withhold effective care in order to save money. This isn't about denying elderly patients treatment that could help them; it's about not inflicting expensive treatments that aren't likely to improve or substantially prolong their lives.

Before Americans broach the topic of rationing, we ought first to make our hospitals deliver better care more efficiently. If every hospital in the country were to hit the benchmark of those that keep unneeded care down and quality up, it would reduce Medicare costs by 30%.

The Dartmouth group is working on a similar study of hospitals across the nation. Acting on its findings could go a long way toward averting the fiscal train wreck that is facing Medicare in the next 50 years, when costs are projected to rise to $2.67 trillion. It might also make the end of life a little easier for millions of Americans.

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