Three weeks ago the
9th US Circuit Court heard oral arguments in the Juliana v. the US case
filed in 2015 by 21 children who petitioned the court to require the federal government
to protect their Constitutional rights to life, liberty and the pursuit of
happiness by addressing the climate crisis. In its defense, the US argued the plaintiffs
have “no fundamental constitutional right to a stable climate system,” or a
“climate system capable of sustaining human life.”
It appears plaintiffs’ lives are in fact not protected. A recently published essay in The New England Journal of Medicine by Harvard’s Dr. Renee Salas and her colleagues concluded, “climate change is the greatest public health emergency in our time and is particularly harmful to fetuses, children and adolescents.” This is because recent reports including the US’s National Climate Assessment, the United Nations’ (UNs’) Intergovernmental Panel on Climate Change’s (IPCC’s) “Global Warming of 1.5ºC” and Lancet’s “Countdown on Human Health and Climate Change” all describe in agonizing detail rapid atmospheric warming from currently 1º Celsius to 2º Celsius within the next few decades is causing increasing flooding, wildfires, disease, starvation, forced migration and war. According to a recent Carbon Brief study, the carbon budget of a child born today will have to be one-eighth that of one born in 1950 if today’s child wants to live in a world that is less than 2º Celsius warmer.
The Juliana case along with numerous related others was decades overdue. Since Ronald Reagan, the Republican party has denied or worked to undermine the life-extinguishing effects of atmospheric warming. President Trump summarized his recent 90-minute discussion on the topic with Prince Charles by stating, “the US right now has among the cleanest climates.” (The US ranks 10th in the world in air quality.) He refused to recognize climate science stating, “I believe there’s a change in weather and I think it changes both ways.”
By RICHARD HARRIS, MD
With the 116th Congress actively discussing several healthcare topics, now is an opportune time to discuss how we can move our country to a truly value-based healthcare system that better serves patients’ needs. One of the most pressing issues affecting where and how patients access care remains the unchecked pace of hospital mergers and acquisitions. Not only are physicians like me concerned with this trend, most Americans are worried about the rate at which hospitals are purchasing independent physician practices, which they see as a threat to affordable care.
As a urologist who has fought for the rights of independent physicians for years, it is clear we can no longer allow hospitals to monopolize the conversation about care delivery, the organization of resources and the best reimbursement strategies. For too long, Americans have considered hospitals to be benevolent organizations more concerned with patient health and community service. The truth, as any informed observer of healthcare knows, is quite the contrary: hospitals are no different than any other business seeking to monopolize its service area and increase revenues. Multiple studies show that hospital consolidation in a market increases prices and reduces options for purchasers of health services, which includes self-insured businesses, insurers, government programs and individual patients.
For our patients, the increasingly rapid rate of hospital consolidation is leading to fewer and fewer options for care. Across the country, patients are less satisfied, less trusting and more concerned about the future of their healthcare than ever. In fact, a recent poll found that the majority of patients (65 percent) trust an independent physician to give them the best recommendation over those employed by hospital systems. Even worse, lesscompetition due to mergers has been shown to affect care quality. For example, Medicare beneficiaries who experienced a heart attack were more likely to die within one year of treatment if they were treated by a hospital that faced few potential competitors, compared to patients in the most competitive areas.
By JEFF GOLDSMITH (3)
For people starting out in their careers or contemplating a mid-career change, an honest conversation with a mentor can make a big difference. Mentoring seems to have gone out of fashion in a tech-driven world where nearly instantaneous feedback from wide networks of “friends’ seems to have taken the place of confidential conversation with older people. But reflecting on my own career, I can say with certainty that mentors made a huge difference. And I was lucky enough to have three of them, at different stages of my career. I am grateful to them for helping me navigate in a changing world.
As an undergraduate at Reed College in the late 1960’s, I became interested in social science research, specifically how institutions selected out types of people by their personalities and interests. While my academic work focused on classics and psychology, a research project on Reed’s brutal attrition rate (only a little more than a third of people who entered Reed as freshmen graduated in four years) that sought out the selection factors that predicted “success”, at least surviving the four years of a very intense undergraduate experience.
This work brought me in contact with Professor David Riesman at Harvard, whose 1954 book “The Lonely Crowd” made him a leading public intellectual and social critic (and landed him on the cover of Time). “Lonely Crowd” decried the erosion of individualism and the rise of the “other directed” personality in America. This work eerily presaged (by a mere fifty years) today’s obsessive internet-driven hunger for the approval of strangers. Reisman, who was then in his early 60’s, had come to Harvard, and had become a leading sociologist of higher education. I sent him my Reed research to see what he thought, and the correspondence led to a friendship that stretched over the next thirty years.