CIA documents reveal close involvement of physicians in developing torture techniques

I honestly just can not understand what would drive a physician to have absolutely any part in torture. Jeff had blogged about this before, but this article raised the issue again. It is just atrocious.

Article in today's NYT -

Report Shows Tight C.I.A. Control on Interrogations - NYTimes.com:

From the intro:
"A prisoner could be doused with 41-degree water but for only 20 minutes at a stretch.... another detainee repeatedly knocked out with pressure applied to the carotid artery."

"Managers, doctors and lawyers not only set the program’s parameters but dictated every facet of a detainee’s daily routine, monitoring interrogations on an hour-by-hour basis. From their Washington offices, they obsessed over the smallest details: the number of calories a prisoner consumed daily (1,500); the number of hours he could be kept in a box (eight hours for the large box, two hours for the small one); the proper time when his enforced nudity should be ended and his clothes returned."

Later in the article:

"Waterboarding might be an excruciating procedure with deep roots in the history of torture, but for the C.I.A.’s Office of Medical Services, recordkeeping for each session of near-drowning was critical. “In order to best inform future medical judgments and recommendations, it is important that every application of the waterboard be thoroughly documented,” said medical guidelines prepared for the interrogators in December 2004.

The required records, the medical supervisors said, included “how long each application (and the entire procedure) lasted, how much water was used in the process (realizing that much splashes off), how exactly the water was applied, if a seal was achieved, if the naso- or oropharynx was filled, what sort of volume was expelled, how long was the break between applications, and how the subject looked between each treatment.”

When the doctors gauged what a drenching in a cold cell might do to a prisoner, they did their research, consulting a textbook entitled “Wilderness Medicine,” in particular Chapter 6 on “accidental hypothermia,” as well as a Canadian government pamphlet, “Survival in Cold Waters,” according to footnotes.

A Cure for Doctors' Bills

Was reading this article and what struck me is how relevant many parts of the discussion are still today.

A Cure for Doctors' Bills - The Atlantic

This article is from the atlantic from 1930. As a colleague of mine said - no matter what happens over the next few months, there will always be a need for health reform for ages to come.

---

"The high costs of medical care are not only the subject of countless articles in the public prints, but are even being discussed in the inner circles of the profession...

The medical profession itself has now seen the writing on the wall. Something must be done. In Europe the drift is toward state medicine. In this country, too, there is a definite set of opinion in that direction. At the annual meeting of the American Medical Association held in Detroit in June, the retiring president of the association told the house of delegates that socialization of medicine, along lines now suggested in England, was inevitable, unless the American physicians themselves established medical centres to enable the poor and the ‘white-collar classes’ to cope with the mounting cost of living.

‘Medicine,’ he said, ‘is being besieged on every side by forces that are constantly growing stronger and stronger, and unless some defensive effort is made to break the siege, the profession must eventually capitulate, become socialized, and become employees of the State.’

Most American doctors look upon any such solution with dismay. The medical journals are full of protestations against the threatened loss of the doctor’s professional independence. State medicine is their special bête noire."

"How American Health Care Killed My Father" in The Atlantic

http://www.theatlantic.com/doc/200909/health-care

A Primer on the Details of Health Care Reform

Haven't muddled through this yet, but imagine it is similar to the KFF post from the other day comparing proposals

A Primer on the Details of Health Care Reform - NYTimes.com

Health Debate Turns Hostile at Town Hall Meetings

Health Debate Turns Hostile at Town Hall Meetings - NYTimes.com

if it is any secret, this - to my understanding - is one of the main reasons that the WH wanted to pass health care reform prior to august recess.

will be interesting to see how legislators are influenced by these mobs - which seem to be more "brooks brothers brigade" than real populist uprisings.

worrisome, for sure.

Clinical trial recruitment challenges

Recent nytimes article on challenges of clinical trial recruitment (CTR).

Forty Years' War - Lack of Study Volunteers Hobbles Cancer Fight - Series - NYTimes.com

This is a cut on the challenges of CTR that I hadn't thought of before - the factoid that a patient has to spend 196 eight hour work days over the course of five years is unbelievable - that's two months of work a year you're committed to the trial. Most of the pharma conversation is about just trying to find the patients or the step prior - clinical trial feasibility(can we even find enough patients to do this trial) - but less around the challenges to a trial participant.

Interesting piece. More thoughts soon -