“Being Mortal,” flimsy conflict of interest policies, and more complications with robotic surgery: RightCare Weekly

October 9, 2014

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our health care system toward the right care for all patients.

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  • Surgeon and New Yorker staff writer Atul Gawande, MD, has been among the most influential writers and thinkers in health care for the last several years, helping to popularize ideas like “hot spotting,” surgical checklists, and the problem of spending variation in medicine. In his new book, Being Mortal, he turns to the essential question of how medicine can best serve patients at the end of their lives. The book is a powerful indictment of the medical system’s failure to talk honestly with patients about dying, understand their goals and fears, and truly care for patients rather than merely treating them.  You can read excerpts from the book at the New York TimesThe Atlantic, and Slate, and interviews with Gawande at Mother Jones, the Diane Rehm Show, the Daily Show, and Democracy Now.


  • Kudos to the American Medical Student Association for releasing its scorecard of teaching hospitals with policies that disclosed potential conflicts of interest to the public. While most hospitals had conflict of interest policies in place for researchers and clinicians, only 19 of the 204 policies examined met model criteria. For example, most policies required disclosure of conflicts within the institution, but few required public disclosure. In a HealthLeaders Media article, AMSA National President Britani Kessler, DO, conveyed that “…it is so important to AMSA to advocate on behalf of students to ensure that we retain the right to unbiased training.”

There has been increasing recognition that conflicts of interest fuel biased science and corrupt the information doctors, nurses, and students get about how to treat their patients. Paid thought leaders give speeches promoting drugs, and industry-funded trials are often tainted and subject to bias. However, some still argue that the conflict of interest problem is overblown. For example, see this argument by John LaMattina in Forbes.


  • Robotic surgery has been touted as the next step in making surgery safer and less invasive, but a new study in Obstetrics and Gynecology finds the opposite. Daniela Hernandez writes for Kaiser Health News that robotic surgeries are thousands of dollars more expensive than laparoscopic or open surgery, and complications were more common during robotic procedures. Proponents of robotic surgery claim that the devices are useful in difficult or complex surgical cases. But even if that’s the case, it doesn’t appear that their use is being limited to complex cases, and patients are paying the price – both physically and financially.



  • Registration is open for our Road to RightCare conference, March 8 – 11, 2015 in San Diego! Come share your vision of what health care should be and how to get there. Save $150 if you register by October 31, 2014. There are also scholarships for the conference available for medical and nursing students, residents, patient advocates, and community leaders – apply today!



Health care delivery system

  1. ‘The Health Care System Falls Apart When You’re A Complex Patient’ – Lisa Gillespie, Kaiser Health News
  2. A Simple Case Of Chest Pain: Sensitizing Doctors To Patients With Disabilities – Leana S. Wen, Health Affairs


Medical science

  1. The Connection Between Evidence-Based Medicine and Shared Decision Making – Tammy Hoffman, Victor Montori, and Chris Del Mar, JAMA
  2. Have we given guidelines too much power? – Margaret McCartney, BMJ
  3. The Placebo Effect Doesn’t Apply Just to Pills – Aaron Carroll, The Upshot
  4. Design Power: Patients Play Researchers in Drug Trials – Amy Dockser Marcus, Wall Street Journal


Patient safety

  1. Surgery patients report waking up during surgery but unable to let doctors know – Claire Wilson, Washington Post
  2. Medical Company May Be Falling Short of Its Patient-Safety Ideals – Marshall Allen and Annie Waldman, ProPublica
  3. Why American Babies Die – Cari Romm, The Atlantic
  4. U.S. nurses say they are unprepared to handle Ebola patients – Julie Steenhuysen, Reuters



  1. Treatment for substance use disorders may pay for itself through reduced crime rates – Adrianna McIntyre, The Incidental Economist


Global right care

  1. Dying Without Morphine – Ronald Piana, New York Times op-ed


End-of-life care

  1. Care at the End of LifeNew York Times editorial
  2. Extra Scrutiny for Hospices – Paula Span, New York Times’ New Old Age blog


Medical education

  1. Medical Schools Change How Students Prepare for Work – Delece Smith-Barrow, US News
  2. Shorter doc training not tied to worse outcomes: study – Andrew M. Seaman, Reuters


Conflicts of interest

  1. Financial Ties Between Doctors and Health Care Firms Are Detailed – Katie Thomas and Rachel Abrams, New York Times


Health care costs

  1. Healthcare Triage: Pay for Performance – Aaron Carroll, The Incidental Economist
  2. Given Choice, Parents Pick Cheaper Medical Procedure for Children – Elisabeth Rosenthal, The Upshot
  3. The Cost of Cancer Drugs – Lesley Stahl, 60 Minutes
  4. Biogen’s new MS drug to cost $62,036 a year – Robert Weisman, Boston Globe


RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.