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08/23/2016

Patient, Family, and Clinician Experiences with Voluntarily Stopping Eating And Drinking (VSED)

A symposium that I edited is coming out shortly from Johns Hopkins University Press:  "Patient, Family, and Clinician Experiences with Voluntarily Stopping Eating And Drinking (VSED)." The symposium includes 15 personal narratives from those invo...

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08/22/2016

Finally increasing postdoc pay. But what about the biomedical workforce?

Postdocs in the U.S. have been earning around $40,000 for the longest time. Postdoctoral fellows and graduate students constitute the bulk of the academic biomedical research workforce. In May of this year, a new regulation on overtime pay was proposed by the U.S. Department of Labor which aimed to raise salaries (Benderley 2016). Because postdocs work more than 40 hours per week, the regulations, now approved, will raise stipends to $47,484 which is the rate for Ruth L. Kirschstein National Research Service Awards (NRSAs) but serves as the standard for stipends used by most institutions (Kuo 2016). Institutions are obligated to either raise the pay or can put in punch card systems (track their pay somehow) and pay postdocs overtime. This overall 9% increase will not be seen right away. According to the new rule, the first two years of a fellow’s salary will be significantly lower (just 0.8% increase), but at the third year, the increase would be 4% (Kuo 2016). There are more caveats. The new rule has exemptions for overtime pay and it does not apply to teachers including graduate student teaching assistants or tenured/non-tenured faculty. So those postdoc with teaching responsibilities may fall through the cracks at receiving this increase in pay. Postdocs heavily dependent on teaching, such as those in the social sciences and humanities will likely be unaffected by the stipend increase. Most commentators have been supportive of increasing postdoctoral salaries. But the question that is on everyone’s mind is how will this increase impact the biomedical workforce?

 

Several who have chimed in on this debate have claimed that the pay hike will not significantly impact the current situation. Institutions have several months to begin implementation and this should be relatively straightforward. But will we see postdocs being dropped at the 3 year mark when stipends are dramatically meant to increase? Certainly some bean counters might try and utilize caveats in the rule to not pay postdocs a better salary because they are doing some side teaching or may decide to count their hours placing in time consuming time sheet systems. Also, postdocs may be pressured to finish up after their first couple years or perhaps fewer postdocs will be hired overall. But is this a bad thing? In a seminal paper by Bruce Alberts and several prominent biomedical scientists titled Rescuing US Biomedical Research From Its Systemic Flaws (among other key papers), the authors explain that the current biomedical science environment is unsustainable and in a state of hypercompetition where postdoctoral fellowships are becoming longer and researchers may undertake multiple postdocs (Alberts et al., 2014). Additionally, it is difficult to secure Principal Investigator (professorial-type) positions and the mean age of first time R01s (NIH’s flagship grant) has increased to about 42 years from 37 in the 1980s. I am positive that according to many, raising postdoc salaries means that less NIH dollars will go to research labor and decrease the workforce which is an overall drawback. But decreasing the overall workforce might be beneficial in that the competition for professorial positions might be reduced and grant success rates could increase. Because scientists have an ethical duty to promote entry of our youth into scientific professions, this should be done with a caveat in that students should know that a scientific profession might be a long and difficult road. And in many cases, this road might not lead to the ultimate position scientists desire: a research-based academic position with decent prospects at obtaining funding. Raising postdoctoral stipends, albeit in the right direction, is just one small step into making our biomedical science workforce in the U.S. sustainable. Greater efforts are required to make career prospects for future scientists reasonable.

 

References

 

Alberts, B., Kirshchner, M.C., Tilghman, S. and Varmus, H. 2014. Rescuing US biomedical research from its systemic flaws. Proceedings of the National Academy of Sciences (USA) 11(17):5773-77.

 

Benderly, B.L. 2016. Postdoc pay to increase due to new overtime rule. Science

 

http://www.sciencemag.org/careers/2016/05/postdoc-pay-increase-due-new-overtime-rule. Last updated: August 15, 2016.

 

Kuo, M. 2016. NIH sets new postdoc stipend levels. Science http://www.sciencemag.org/careers/2016/08/nih-sets-new-postdoc-stipend-levels. Last updated: August 15, 2016.

 

 

 

 

 

 

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08/22/2016

Israel Stinson v. Children’s Hospital LA – the LASC Lawsuit

Israel Stinson was declared dead in early April 2016.  But his parents were able to continue organ support by obtaining court injunctions and stays in state and federal court.  They later transferred him to Guatemala.  He is now in Los Angeles.   

The Los Angeles Superior Court is now the 4th court to be involved in this case.  Previous rulings were issued by Placer County Superior Court, the U.S. District Court for the Eastern District of California, and the U.S. Court of Appeals for the Ninth Circuit.

On  Thursday, Israel's mother obtained an ex parte temporary restraining order against Children's Hospital LA.

An order to show cause re preliminary injunction is scheduled for September 9, 2016, at 9:30 a.m.   Any opposition is to be filed and served by Septem­ber 1, 2016, and any reply is to be filed and served by September 6, 2016.

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08/21/2016

Right before I Die – Photographic Exhibition

"Right before I Die" is a new photographic exhibition at the LA Museum of Tolerance.  The photographs show people facing serious illness along with the subject's words of wisdom and hope.  

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08/20/2016

Photo Series Captures Death and Dying in Palliative Care Unit

Western Sydney Local Health District multimedia manager Carlos Furtado recently had the privilege of photographing a day in Mt Druitt Hospital’s Supportive and Palliative Care Unit.  

With the consent of patients and families, Mr Furtado was given access to photograph the most intimate of moments when patients, families and staff were dealing head-on with the reality of dying and death.


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08/19/2016

Owning Medical Professionalism

by Jon C. Tilburt, MD & Richard R. Sharp, PhD

Discontinuity, handoffs, and shiftwork have infiltrated the fabric of healthcare. These changes, made in the name of patient safety, may have the unintended effect of reducing residency training to little more than a terrible shift job, disconnected from the professional ethos so critical to the practice of medicine.

In their piece in AJOB this month Dubov and colleagues highlight several problems with resident duty hour restrictions. They postulate that cultivating a vocabulary of personal and professional “ownership” could counteract the detrimental effects of those restrictions. Their facility with the duty-hours literature is impressive and they rightly note how duty hour restrictions may have especially deleterious effects on surgical training.…

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08/19/2016

Hastening Death by Voluntarily Stopping Eating and Drinking: Clinical, Legal, Ethical, Religious and Family Perspectives

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08/19/2016

Need to Ration ICU Access

Paul E. Marik published "The Cost of Inappropriate Care at the End of life Implications for an Aging Population" in the American Journal of Hospice and Palliative Care.

Marik presents the case of an 86-year-old female who spent almost 3 months in ICU prior to her death. The fully allocated hospital costs for this patient were estimated to $5100 per day.  That is a lot.  But the stronger argument may focus on the patients deprived of the opportunity to benefit from ICU care when this patient was there and the ICU was full.   

With the increasing age of the population and the projected increased demand for ICU beds, he reviews the benefits and burdens of admitting elderly patients to the ICU.

  • Elderly patients patients (older than 65 years) account for only 11% of the US population yet they account for 34% of health care expenditure. 
  • The disproportionate usage of health care costs by elderly patients is in striking contrast with that of other Western Nations. It is likely that these differences are largely due to variances in hospitalization and the use of high technology health care resources at the end of life. 
  • The United States has 8 times as many intensive care unit (ICU) beds per capita when compared to other Western Nations. 
  • In the United States, elderly patients currently account for 42% to 52% of ICU admissions and for almost 60% of all ICU days.
  • A disproportionate number of these ICU days are spent by elderly patients before their death. 
  • In many instances, aggressive life supportive measures serve only to prolong the patient’s death. Such treatment inflicts pain and suffering on the patient (with little prospects of gain) 

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08/19/2016

Turmoil in the Obamacare Exchanges

Here is a nice story from a NC news station explaining the turmoil in the exchanges, with Aetna pulling out of many markets. Worth a quick read. North Carolina consumers buying broadly subsidized health insurance policies on the online marketplace … Continue reading

The post Turmoil in the Obamacare Exchanges appeared first on PeterUbel.com.

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08/18/2016

How can we make the “brave new world” a campaign issue?

Wesley Smith, who, based on his writing, I consider a kindred soul in bioethics, has published an essay in First Things dated August 5, 2016, and entitled, “Brave New World Should be an Election Issue.”  In it, he quickly runs down the revolutionary changes in the very nature of humanity that appear in the offing based on biotechnological developments since the publication of Aldous Huxley’s... // Read More »

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