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Hospital cited $290 billion in waste. Both also looked at productivity losses. Kelly Kennedy, USA Today, June 1, 2011. physicians who participated in the study One in three surrogates carries a lasting emotional burden related to decisions they make on behalf of loved ones at the end of percent said fear of litigation drives many published March 1 in the Annals of Internal Medicine. Guilt and lingering “Medical liability reform is essential to doubts about whether they made the right choices can lead to anxiety, depression and “Without it, healthcare costs will continue to rise. Estimates on the costs of defensive medicine range from $60-$150 billion per rather than on the patient as a person,” Chicago’s MacClean Center for Clinical surrogate’s distress can be ameliorated not only by focusing on the patient’s expressed preferences, but also by discussing his or medications because the missed doses lead her best interests in the current clinical to emergency room visits, doctor’s visits and in-patient hospitalizations, according prescription-filling firm. A second study Copyright 2011 CHA. Permission granted to CHA-member organizations and Saint Louis University to copy and distribute for educational purposes. medical conditions. Since this information would be available early in the pregnancy, “The ultimate question for society is, American Journal of Bioethics that it is valuable?” Such testing also poses concerns “justifiable in some circumstances for parents and doctors to decide to al ow an ability to sort through and understand a infant’s life would be worth living.” Dr. appropriate decisions. Associated Press, care. “Even when burdens do seem to be disability, this is not a sufficient reason to withhold life-Saving treatments. After all, a disabled baby has a full right to life too,” medical practice are less about service than “What can one doctor or practice do?” Much could be accomplished if physicians angels”, according to Joel Levine, MD, Scanning fetal DNA from a blood test will advance that promises to greatly improve current prenatal care,” says Jamie King, associate professor at the University of Research. Physicians could say it isn’t California Hastings College of Law in San “Bringing it into practice, however, “raises significant practical, legal, ethical and prevention integral to patient care even if social chal enges,” she says. The tests few insurers as willing to pay for it. This could reveal a range of medical conditions would build trust between physicians and patients, pitting both against diseases and less against each other. Joel Levine, MD Alzheimer’s disease and a range of other Copyright 2011 CHA. Permission granted to CHA-member organizations and Saint Louis University to copy and distribute for educational purposes. Studies at Saint Louis University School Maryland is also in the front of the pack of Law contributed the following items to of health care reform pioneers. The state director, Center for Health Law Studies, supervised the contributions of health law experts, a legal aid official and former business lobbyist have been appointed to state health care initiatives. (Md. Health ‘Fast and Furious’ Opportunity – The impetus behind one of the first state-run exchange with a single-payer health care operational in 2014, but funding for the (IOM) reveals that 40 percent of hospitals Himmelstein, professor at City University are receiving exceptions to their Medicare of New York’s public health program, is legislation “an announcement of intention rather than an accomplishment”. The plan has not addressed soaring health care costs hospitals and doctors based on geographic successful system. However, if the plan is successful, it may provide a template for enough and results in wasteful spending. other states to follow as they attempt to spending and were one focus of the study. McDonald, May 26, 2011) Copyright 2011 CHA. Permission granted to CHA-member organizations and Saint Louis University to copy and distribute for educational purposes. funds to a private entity under the Bayh- cost of living and doing business in each participate in the state health exchanges, In a June ruling, the U.S. Supreme Court (Stanford University v Roche). The patent is for technology featured in a kit that identifies the level of HIV in patients’ blood. Stanford argued that it should be the sole owner of the technology because the inventor worked there at the time of Services in order for the co-ops to apply Doyle Act, a university is allowed to retain rights to research funded by federal grants. loans consist of two types: “start- up” loans and “solvency” loans. The former would be used to begin the co-op and the latter is meant to help co-ops conform to would be held by Roche. The U.S. Circuit Court of Appeals for the Federal Circuit required to pay off start-up loans in five and the U.S. Supreme Court affirmed in a 7-2 decision. Justices Breyer and Ginsburg dissented. In his dissent, Justice Breyer did may get $3.8B in loans, Indianapolis not believe that an individual could assign Business Journal, Bloomberg News, July Copyright 2011 CHA. Permission granted to CHA-member organizations and Saint Louis University to copy and distribute for educational purposes. came after the publication of a clinical trial called the Study of the Effectiveness positive patients could plan to live has Reinberg, U.S. News, June 8, 2011. the average life expectancy is 55 years. The latest Kaiser tracking poll shows that Medicine said, “We knew it was good. It because they received benefits directly or until their immune systems are devastated, received benefits. Eighty-six percent of participants reported an overall positive Unfortunately, not all groups access drugs at an early stage. Men wait longer to get previous reports from Kaiser, 70 percent coverage, 60 percent of low income kids, percent of pregnant women, 20 percent of persons with severe disabilities, and 21 HIV at birth usually spend more of their Katherine Hobson, Wall Street Journal, After concerns of an increased chance of usually within their first year of taking the debated whether to test patients for early Copyright 2011 CHA. Permission granted to CHA-member organizations and Saint Louis University to copy and distribute for educational purposes. signs of Alzheimer’s and then tell them the results, even though no cure exists. The plaques that show individuals they might absence of symptoms. Although the brain plaques suggest a patient might be developing Alzheimer’s, they may not get Scotia says that there is no data “to show outcomes.” This leaves the question of why testing is necessary at all. Another “camp” of medical experts encourages continue searching for the explanation for the patient’s symptoms. There is also an their financial and legal matters in order and possibly start a medication regimen to Copyright 2011 CHA. Permission granted to CHA-member organizations and Saint Louis University to copy and distribute for educational purposes.

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Original Research Received: August 11, 2005 Accepted after revision: March 15, 2006 Enhanced External Counterpulsation Reduces Lung/Heart Ratio at Stress in Patients with Coronary Artery Disease Chii-Ming Lee a Yen-Wen Wu a Hsiang-Yiang Jui a Ming-Fong Chen a a National Taiwan University Hospital, Taipei , Taiwan; b University of Pittsburgh, Pittsburgh, Pa. , USA Key Words

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