Asking the Right Right Question About Football – Why do Some NFL Players Abuse Their Partners?

The national press is buzzing after TMZ released a video of Baltimore Ravens running back Ray Rice’s barbaric assault of his then-fiancee, Janay Rice.  Much of the spotlight of the coverage shined on the NFL’s handling of the abuse, and perhaps even more time was spent yesterday questioning Ms. Rice’s decision to stay in her relationship with her husband.  These are certainly valid questions to ask, and there is something to be said about the raised “awareness” of domestic violence in the aftermath of its players deplorable acts of violence.  I would argue the discussion has been more valuable than any awareness raised by NFL teams wearing pink during breast cancer awareness month.

If we want to best-capitalize on the awareness raised by these acts of violence, however, the conversation needs to shift from harm reduction (“why did she stay?”) to harm prevention.  To illustrate: when faced with the prevalence of lung cancer, do we ask “Why does the cancer patient continue to smoke?”  Yes, to some extent, we do, but we first addressed the causal inquiry, “What causes cancer?”, and in order to prevent the next generation from becoming addicted to nicotine, millions have been invested and continue to be invested in educating the public (and particularly youth) about the harms of tobacco use, and legislative action has been taken to prevent the harms caused by tobacco use.

Domestic violence (or intimate partner violence), like lung cancer, is a public health issue.  This is not a novel or controversial statement.  According to a 2010 CDC report, one in four women and one in seven men have experienced severe physical violence by an intimate partner, and according to a 2003 report, the national costs of health services for intimate partner rape, physical assault, and stalking is nearly $4.1 billion.  The CDC’s website states:  “The goal is to stop IPV [intimate partner violence] before it begins. There is a lot to learn about how to prevent IPV.”

It is time that the health care community take the CDC’s statement seriously and work collaboratively across law, public health, and medicine to research, propose, and implement innovative solutions to this perpetual epidemic, that costs thousands of lives in the United States each year.  Unlike some other organizations aimed at addressing public health issues, organizations whose goal is to prevent domestic violence are often grossly under-funded.  Perhaps the most apropos inquiry or statement to put to the NFL, the NFL Player’s Union, or other public health institutions that agree that domestic violence prevention is important is one capture by a classic football film: “SHOW ME THE MONEY.”

[Ed. Note: This post reflects the author's views only.  It does not necessarily represent the views of the Petrie-Flom Center or the Football Players Health Study at Harvard University.]

Limits on the Physician as a Good Samaritan

As one partner at my firm puts it, “If it makes good business sense, in the health care business, it’s probably illegal.” As a practicing junior health care attorney it did not take long for me to learn this reality of the regulatory scheme I learned as a law student.   As snarky as the sentiment may seem, the restrictions on profit-sharing, referrals, and reduced-cost or free goods and services imposed by Stark and Anti-Kickback laws (while well-intended) can stifle some creative thinking in health care delivery.

What is not always as salient in the daily grind of my practice focusing on transactions and system-level compliance issues, are the ways in which the regulatory scheme can limit a physician’s acts of generosity and kindness.  Whether we think our regulations intended to align incentives with cost-effective and quality health care delivery are good, bad or otherwise, I found this article in the New York Times by Abigail Zuger to be a thought-provoking moment of pause to consider how the complex scheme plays out in the day-to-day delivery of primary care and the physician-patient relationship.

Binders of Women? Reflections on ASRM Annual Meeting Round 2

by Katie Kraschel

Mitt Romney’s anecdote about the binders of women he relied upon in selecting members of his cabinet when he was Governor has fueled criticism from feminist groups and filled my Facebook feed with a plethora of Halloween pictures featuring costumes depicting his unfortunate choice of words.  People generally have an instinctive aversion to being summarized into a page in a loosely bound, plastic-covered book.  However, this level of summary and (arguably) downright objectification happens every day when individuals peruse  IVF clinic and cryobank catalogs shopping for sperm or eggs.  And while many of us worry that a Romney win next week would result in four years of presidential leadership that is clueless and insensitive to the plight of women in the workforce, the ASRM decision to remove the experimental label from oocyte cryopreservation is likely to literally increase the number of “women in binders,” which presents a different set of concerns.

Oocyte retrieval — the process of harvesting eggs that allows a woman to place her age, weight, height, eye color, S.A.T. score, college major, baby picture and perhaps even celebrity look-a-like into a gamete catalog — has long been a topic of bioethical debate and criticism due to the risks associated with the high level of hormones involved in the process and the accompanying high level of compensation frequently offered for women’s eggs.  The likely increases in demand and number of oocytes produced presents a unique opportunity to revisit these issues and reconsider what regulations may be necessary to keep all parties involved respected and protected.

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Would you rather medical school train your PCP to have good hands or a good bedside manner?

Last week NPR covered a story highlighting how medical education is morphing in order to adapt to the unmet demand for primary care physicians driven (at least in part) by the increased access to primary care that will be ushered in under the ACA.  It may be surprising to some to learn that many of the most prestigious medical schools like Johns Hopkins and Harvard do not have a primary care program; however, as reported by NPR, medical schools may soon rethink this hole in their curriculum in the face of changing demands upon the health care system and its accompanying incentives for young physicians to enter primary care.   Mount Sinai School of Medicine is leading the way in this regard by launching a new department of family medicine in June.

Intuitively, changing the medical education system to produce more primary care physicians will further goals of the ACA by increasing access to primary care, and therefore improving overall public health and diminishing cost by decreasing emergency room care for conditions that could have been treated less expensively or avoided altogether by increasing access to preventative services.  These are the arguments we’ve heard repeatedly by the champions of the ACA and by the Obama administration, particularly through its vision for the Prevention and Public Health Fund which was intended to bolster the pipeline of primary care physicians before being gutted earlier this year.

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