Word: emanuele
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...Ezekiel Emanuel got a memorable introduction to our haphazard health-care system on his first visit to a cancer ward as a medical student. The white coats were ordering a transfusion for a teenage girl, and since shyness does not run in his family - brother Rahm is President Obama's famously foulmouthed chief of staff, brother Ari a similarly silence-deficient Hollywood agent - he interrupted to ask why. Because she had Hodgkin's disease and her platelets were below 20,000, the team explained. Emanuel still had questions: Was there evidence for that protocol? Don't some hospitals wait until...
...noted oncologist turned White House health adviser, Emanuel has spent much of his career battling the that's-what-we-do-here mentality of American medicine. "It drives me nuts - the ignorance is overwhelming," he says. "I'm a data-driven guy. I want to see evidence." It turns out that Emanuel's boss, budget director Peter Orszag, is also a data-driven guy, as is Orszag's boss, the President of the United States. They've already stuffed $1.1 billion into the stimulus bill to jump-start "comparative effectiveness research" into which treatments work best in which situations...
...visit to Rochester last month, I watched a hospice team of nurses, social workers, a chaplain and just one doctor talk about dying patients in ways that might have baffled the white coats on Emanuel's cancer ward: platelets were discussed, but so were spiritual needs, family tensions, hobbies and anything else relevant to quality of life. It sounds squishy, but Mayo patients who request palliative care have 84% lower hospital costs, 53% lower overall costs and higher satisfaction. Mayo has computerized medical records that provide instant access to patient histories, improving information-sharing, reducing pharmacy errors and eliminating...
...backlash could be nasty. The ultimate success of Obamacare might depend on a cultural change among doctors and patients, a national realization that more care isn't better care. "We've got this ethos that the best doctors do everything under the sun and rule out every zebra," Emanuel says. "And hey, they get paid more to do it. But we've got to change all that...
...choice crowd: the issue they hate talking about. Even the most powerful pro-Israel lobby, the American Israel Public Affairs Committee, which opposes public U.S. pressure on Israel, hasn't taken an explicit stance on the settlements dispute. Obama has also surrounded himself with the kind of advisers (Rahm Emanuel, Hillary Clinton and Dennis Ross) and made the kind of symbolic gestures (holding a seder at the White House and condemning Holocaust denial in Cairo) that reassure many American Jews. Historically, Israel's American supporters have used their strength in Congress to box Presidents in a corner. But when Netanyahu...