Robert Steinbrook

Health Care and the American Recovery and Reinvestment Act

On February 17, President Barack Obama signed into law a

Preferences of Homosexual Men with AIDS for Life-Sustaining Treatment

787 billion economic stimulus package. Dr. Robert Steinbrook reports on the approximately

Personally controlled online health data--the next big thing in medical care?

150 billion in new funds that are directed to health care.

IMPROVING PROTECTION FOR RESEARCH SUBJECTS

The acquired immunodeficiency syndrome (AIDS) raises questions about appropriate care for patients with this incurable and progressive disease. Although individual episodes of infection and maligna...

Artificial Feeding — Solid Ground, Not a Slippery Slope

Online repositories will allow patients to store, retrieve, manage, and share their health data. Dr. Robert Steinbrook writes that it remains uncertain whether the long-term result will be improved health care and decreased costs or simply the creation of new business opportunities.

Saying No Isn't NICE — The Travails of Britain's National Institute for Health and Clinical Excellence

In March 1996, Hoiyan Wan, a 19-year-old nursing student and a healthy volunteer in a study at the University of Rochester, died two days after undergoing bronchoscopy as part of the study. During ...

Controlling Conflict of Interest — Proposals from the Institute of Medicine

Decisions about artificial feeding arouse more controversy than those involving any other life-sustaining treatment. Because food and water are generally considered basic elements of humane care, representing love and concern for the helpless, it is often thought that they must always be provided. In a landmark decision, the Supreme Judicial Court of Massachusetts ruled that a feeding tube could be removed from a patient in a persistent vegetative state if this was consistent with his previously expressed wishes. The case of Paul E. Brophy, Sr., is part of an emerging medical and legal consensus on the withholding of artificial feeding from adult patients. The view is growing that tube and intravenous feeding should be likened to other medical interventions and not to the routine provision of nursing care or comfort. Competent patients have the right to refuse such feeding. Feeding can also be stopped incompetent patients who have earlier stated such a wish.

Financial support of continuing medical education.

Britains National Institute for Health and Clinical Excellence, known as NICE, is an independent, government-funded organization that advises the British National Health Service. Dr. Robert Steinbrook writes that NICE can be viewed as either a heartless rationing agency or an intrepid and impartial messenger for the need to set priorities in health care.

Decision making for incompetent patients by designated proxy. California's new law.

The IOMs new report on conflicts of interest, issued on April 28, is notable for the breadth and variety of its proposals, which include standardizing financial disclosures, restructuring funding for continuing medical education, and restricting industry funding for development of clinical guidelines. Dr. Robert Steinbrook reports.

Ethical Dilemmas in Caring for Patients with the Acquired Immunodeficiency Syndrome

CONTINUING MEDICAL EDUCATION (CME) IS A MULTIbillion-dollar industry. In 2006, the CME providers accredited by the Accreditation Council for Continuing Medical Education (ACCME) had a total income of