The current debate over health reform has been intense and highly polarizing. In 2009, it was dominated by a brouhaha over death panels and talk of government rationing and domination of health care. I will begin my remarks by addressing the provisions of the health reform legislation that precipitated the talk of death panels and the like. Specifically, I will talk about the comparative effectiveness research initiative, which is at the root of the brouhaha over death panels. Then, I will explore the central question of whether comparative effectiveness research really is a contribution to true health reform and can achieve the critical goal of controlling health care costs.

Experiments demonstrate that elites can influence public opinion through framing. Yet outside laboratories or surveys, real-world constraints are likely to limit elites' ability to reshape public opinion. Additionally, it is difficult to distinguish framing from related processes empirically. This paper uses the 2009-2010 health care debate, coupled with automated content analyses of elite- and mass-level language, to study real-world framing effects. Multiple empirical tests uncover limited but real evidence of elite influence. The language Americans use to explain their opinions proves generally stable, although there is also evidence that the public adopts the language of both parties' elites symmetrically. Elite rhetoric does not appear to have strong effects on Americans' overall evaluations of health care reform, but it can influence the reasons they provide for their evaluations. Methodologically, the automated analysis of elite rhetoric and open-ended questions shows promise in distinguishing framing from other communication effects and illuminating elite-mass interactions.

When the end of life makes its inevitable appearance, people should be able to expect reliable, humane, and effective caregiving. Yet too many dying people suffer unnecessarily. While an "overtreated" dying is feared, untreated pain or emotional abandonment are equally frightening. Approaching Death reflects a wide-ranging effort to understand what we know about care at the end of life, what we have yet to learn, and what we know but do not adequately apply. It seeks to build understanding of what constitutes good care for the dying and offers recommendations to decisionmakers that address specific barriers to achieving good care. This volume offers a profile of when, where, and how Americans die. It examines the dimensions of caring at the end of life: Determining diagnosis and prognosis and communicating these to patient and family. Establishing clinical and personal goals. Matching physical, psychological, spiritual, and practical care strategies to the patient's values and circumstances. Approaching Death considers the dying experience in hospitals, nursing homes, and other settings and the role of interdisciplinary teams and managed care. It offers perspectives on quality measurement and improvement, the role of practice guidelines, cost concerns, and legal issues such as assisted suicide. The book proposes how health professionals can become better prepared to care well for those who are dying and to understand that these are not patients for whom "nothing can be done."

The New York Times bestselling author of Being Mortal and Complications reveals the surprising power of the ordinary checklist We live in a world of great and increasing complexity, where even the most expert professionals struggle to master the tasks they face. Longer training, ever more advanced technologies—neither seems to prevent grievous errors. But in a hopeful turn, acclaimed surgeon and writer Atul Gawande finds a remedy in the humblest and simplest of techniques: the checklist. First introduced decades ago by the U.S. Air Force, checklists have enabled pilots to fly aircraft of mind-boggling sophistication. Now innovative checklists are being adopted in hospitals around the world, helping doctors and nurses respond to everything from flu epidemics to avalanches. Even in the immensely complex world of surgery, a simple ninety-second variant has cut the rate of fatalities by more than a third. In riveting stories, Gawande takes us from Austria, where an emergency checklist saved a drowning victim who had spent half an hour underwater, to Michigan, where a cleanliness checklist in intensive care units virtually eliminated a type of deadly hospital infection. He explains how checklists actually work to prompt striking and immediate improvements. And he follows the checklist revolution into fields well beyond medicine, from disaster response to investment banking, skyscraper construction, and businesses of all kinds. An intellectual adventure in which lives are lost and saved and one simple idea makes a tremendous difference, The Checklist Manifesto is essential reading for anyone working to get things right.

A revealing and dramatic chronicle of the twelve months leading up to Dr. Martin Luther King, Jr.'s assassination. Martin Luther King, Jr. died in one of the most shocking assassinations the world has known, but little is remembered about the life he led in his final year. New York Times bestselling author and award-winning broadcaster Tavis Smiley recounts the final 365 days of King's life, revealing the minister's trials and tribulations -- denunciations by the press, rejection from the president, dismissal by the country's black middle class and militants, assaults on his character, ideology, and political tactics, to name a few -- all of which he had to rise above in order to lead and address the racism, poverty, and militarism that threatened to destroy our democracy. Smiley's Death of a King paints a portrait of a leader and visionary in a narrative different from all that have come before. Here is an exceptional glimpse into King's life -- one that adds both nuance and gravitas to his legacy as an American hero.

The Model Rules of Professional Conduct provides an up-to-date resource for information on legal ethics. Federal, state and local courts in all jurisdictions look to the Rules for guidance in solving lawyer malpractice cases, disciplinary actions, disqualification issues, sanctions questions and much more. In this volume, black-letter Rules of Professional Conduct are followed by numbered Comments that explain each Rule's purpose and provide suggestions for its practical application. The Rules will help you identify proper conduct in a variety of given situations, review those instances where discretionary action is possible, and define the nature of the relationship between you and your clients, colleagues and the courts.

Certainly all presidents and prime ministers have engaged in spin to a certain extent, but in the past the media - and the public - checked the extent to which our leaders were able to fudge the truth. However, President Bush has repeatedly used deception, told outright lies, and rewritten history to sell his policy agenda. And thanks to one of the most aggressive public relations teams ever assembled, he has been able to get away with it since he began his campaign. In the wake of September 11, the administration has taken its questionable conduct to a new level by attempting to intimidate critics and has tried to connect virtually every policy initiative to the war on terrorism. Bush has used the same tactics to mislead the public on a wide range of other major policy initiatives, from the environment to homeland security to Social Security - all with little scepticism from the media.

During the last 25 years, life expectancy at age 50 in the United States has been rising, but at a slower pace than in many other high-income countries, such as Japan and Australia. This difference is particularly notable given that the United States spends more on health care than any other nation. Concerned about this divergence, the National Institute on Aging asked the National Research Council to examine evidence on its possible causes. According to Explaining Divergent Levels of Longevity in High-Income Countries, the nation's history of heavy smoking is a major reason why lifespans in the United States fall short of those in many other high-income nations. Evidence suggests that current obesity levels play a substantial part as well. The book reports that lack of universal access to health care in the U.S. also has increased mortality and reduced life expectancy, though this is a less significant factor for those over age 65 because of Medicare access. For the main causes of death at older ages-cancer and cardiovascular disease-available indicators do not suggest that the U.S. health care system is failing to prevent deaths that would be averted elsewhere. In fact, cancer detection and survival appear to be better in the U.S. than in most other high-income nations, and survival rates following a heart attack also are favorable. Explaining Divergent Levels of Longevity in High-Income Countries identifies many gaps in research. For instance, while lung cancer deaths are a reliable marker of the damage from smoking, no clear-cut marker exists for obesity, physical inactivity, social integration, or other risks considered in this book. Moreover, evaluation of these risk factors is based on observational studies, which-unlike randomized controlled trials-are subject to many biases.

This groundbreaking book uncovers the hidden world of illicit physician-assisted suicide and euthanasia. Through the frank and often troubling first-hand accounts of health professionals who have been involved in assisted death, the book records for the first time this secret but real area of medical and nursing practice. Through face-to-face interviews with these "angels of death, " Roger S. Magnusson explores the social practices, relationships, and networks that constitute "underground" euthanasia. How is assisted death actually practiced within health care settings? What are the issues that surround the making of such a momentous decision? How do health care workers justify their attitudes and actions in this area? Angels of Death offers detailed answers to these questions and many others. The doctors, nurses, and therapists who were interviewed pseudonymously for this study work in the HIV/AIDS communities in the United States and Australia. Their perspectives and practices, their attitudes and feelings, illuminate the assisted death debate and expose a variety of disturbing issues, including the reality of "botched attempts, " euthanasia without consent, and unduly hasty measures to bring about death. The testimony of medical practitioners, combined with Magnusson's thoughtful assessment of the issues, will be of intense interest to both opponents and advocates of proposals to legalize euthanasia.