Remember knocking on a door and not wondering if you need a bulletproof vest

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An off-duty New Jersey state trooper fired shots at a car with three young men inside as they were trying to drive away from his house after knocking on his door by mistake at night while looking for the house of a friend who lives next door…

The trooper told investigators he suspected the three men were trying to enter his Sparta home, 50 miles northwest of New York City, between 1:30 a.m. and 2 a.m. Sunday, according to the attorney general’s office.

Jesse Barkhorn, 18, who was in the car that night, told The Associated Press on Wednesday that they attended a party earlier and were dropping off one of them at a friend’s house. He said they mistakenly knocked on the door at the house next to their friend’s house. He said they heard a man screaming from inside and they ran back to the car.

They turned around in the cul-de-sac where the home is located and saw the man standing with his weapon pointed at them, Barkhorn said.

“At this point we’re freaking out, ‘It’s a gun. It’s a gun,'” Barkhorn said. “I was like ‘Dude, get out of here.'”

He said the driver accelerated and the man then fired at them. One of the bullets struck the car’s front tire and the driver stopped the car a short distance away.

According to officials, who didn’t release the names of those involved, two 18-year-olds and a 19-year-old went to the wrong house, knocked on the door and fled after a verbal exchange. They got in their car and drove away and the trooper fired three shots with his personal weapon when the car did not stop…

Barkhorn told the AP that after they stopped the car, one of the men fled. He was found by officers hours later.

Barkhorn said all three were taken to the Sparta police department then to state police barracks in Netcong. He said he remained in custody for more than nine hours before being released without being charged.

“It was traumatic. I really have never been in a situation like that,” Barkhorn said. “You don’t really appreciate things until you have a gun pointed at your head. It was really scary.”

Nine hours in state police custody because their cop bubba did the shooting – so it had to be the kids’ fault, right? How long does it take to establish that the cop firing at these kids was the one breaking the law?

Yes, you can be suspicious about someone turning up at your door at 2 in the morning. Maybe even you keep your piece handy if you’re a gun owner. But, if the dudes are obviously hurrying to depart, you needn’t do more than try to get their license number and call it in. You don’t start shooting up the neighborhood.

I’ve been in the same situation – with a young guy showing up at the door who ran out of gas in front of our home. Yes, I had a handgun in my pocket. No need to wave it about or even mention it. And, yes, we hunted up the gas can for our lawnmower and got enough into his car to get him close enough back to civilization to find an all-night gas station and get himself home.

Cripes! Being civilized is really easier than being paranoid.

Researchers find no benefit from chemotherapy at end of life

Chemotherapy near death failed to improve quality of life (QOL) for patients with cancer, even those who otherwise were in good health, a review of end-of-life care showed.

Quality of life near death (QOD) deteriorated in patients who had good performance status when they started chemotherapy. Palliative chemotherapy had no impact on QOL among sicker patients, Holly Prigerson, PhD,…and colleagues reported online in JAMA Oncology.

…”Thus, chemotherapy appears to contribute directly to worse QOD, presumably through adverse and toxic effects that impair the QOL of those who are initially feelling well.”

Organizations that have clinical guidelines addressing end-of-life chemotherapy, such as the American Society of Clinical Oncology (ASCO), might need to rethink their recommendations, Prigerson and colleagues added.

Even an accompanying editorial expressing some disagreement…acknowledged that “if an oncologist suspects the death of a patient in the next 6 months, the default should be no active treatment.”…

Three years ago, ASCO’s expert panel for the “Choosing Wisely” campaign identified use of chemotherapy in patients for whom no proven benefit existed as one of the most widespread, wasteful, and unnecessary practices in oncology. ASCO recommends against the use of chemotherapy for patients who have not benefited from prior therapy…

Prigerson and colleagues examined the association among ECOG performance status, chemotherapy, and QOL in the last week of life…They hypothesized that patients with good performance status would have worse QOL if they received additional chemotherapy, and that patients with poor performance status would not have an improvement in quality of life with chemotherapy…

Beyond the data, the study suggests that “equating treatment with hope is inappropriate,” Blanke and Fromme said.

“Even when oncologists communicate clearly about prognosis and are honest about the limitations of treatment, many patients feel immense pressure to continue treatment,” they said. “Patients with end-stage cancer are encouraged by friends and family to keep fighting, but the battle analogy itself can portray the dying patient as a loser and should be discouraged. Costs aside, we fell the last 6 months of life are not best spent in an oncology traetment unit or at home suffering the toxic effects of largely ineffectual therapies for the majority of patients.”

Time to turn away from the greed-centric portion of the medical-industrial complex, folks. Pay attention to the folks who say, as did these researchers, “This is a clarion call…to take the lead in curtailing the use of ineffective therapy and ensuring a focus on palliative care and relief of symptoms throughout the course of illness.

Overdue.

Climate study is scary as ever – but, James Hansen still has hope


Click to enlarge — Hurricane Isaac storm surge greater than Hurricane Katrina — Lt. Conrad H. Franz

When James Hansen speaks, climate hawks listen. Hansen was legendary during his long career as NASA’s chief climatologist for being ahead of the curve on seeing the threat of catastrophic climate change. Now he teaches at Columbia University, and he has more bad news to deliver. According to a study conducted by Hansen and 16 coauthors, being published this week in the European Geophysical Union’s open-access journal Atmospheric Chemistry and Physics, the effects of even moderate warming on sea-level rise are worse than previously believed.

Hansen and his colleagues combined analysis of the historical record with modeling and current observation and found that the rate of oceanic ice melting in Greenland and Antarctica may exceed our expectations. As InsideClimate News explains, the scientists “analyzed how an influx of cold freshwater from the planet’s melting ice sheets will disrupt the ocean’s circulation … They concluded the influx of freshwater from melting ice sheets in modern times would essentially shut down the ocean’s circulation, causing cool water to stay in the Earth’s polar regions and equatorial water to warm up even faster.”

“The cooling mechanism is cut off, so it’s melting ice shelves,” Hansen explained in an interview with Grist. “It’s a really dangerous situation where you get melting that causes more melting.”…

The bottom line, as Slate’s Eric Holthaus writes, is that “glaciers in Greenland and Antarctica will melt 10 times faster than previous consensus estimates, resulting in sea-level rise of at least 10 feet in as little as 50 years.” A sea-level rise of 10 feet would inundate parts of major cities from New York to Shanghai…

Hansen, despite his reputation for doomsaying, remains hopeful about the prospects for fending off the worst of climate change. The biggest emitting nations are not pledging to cut emissions enough to even keep warming below 2C, but Hansen says a gradually rising global carbon fee could change that. It could force emissions to drop several percentage points per year and hold us down to 1.5C in warming. To get this outcome from the messy global climate treaty process would be fantastic, but it is highly unlikely. Hansen sort of admits this, but holds out hope nonetheless.

“I don’t think it’s impossible that you could get key players to agree to the concept of an international carbon fee,” he says. “It’s not going to happen with 190 countries sitting around a table. It’s going to happen with key players negotiating directly either at Paris or in the years ahead.” Specifically, Hansen imagines that the world’s two biggest economies and biggest carbon emitters, the U.S. and China, would negotiate a carbon fee bilaterally and then use their global buying power to force all of their trading partners to join.

People who actually read and study agree. At least economists who earn a living in the world of business and finance – as well as academia. I happened to see Peter Orszag on Bloomberg Surveillance, the other morning, and he was working at advancing the Hansen solution as practical and possible. Hoping against hope that reasonable leaders of industrial nations might engage in bilateral negotiations and treaties to force the reduction in atmospheric carbon.

No, he didn’t hold out any hope for the United States offering world leadership unless anti-science conservatives were absent from both houses of Congress and the White House. Poisonally, I don’t think Americans are well-enough informed or yet free enough of medieval hobgoblins to bring about that quality of change.

Ignore conservative whiners – Medicare improves your health

In a 15-year study of older Medicare patients, Yale School of Medicine researchers saw an estimated 20% drop in mortality, about 30% fewer hospitalizations, and 40% reduction in deaths after hospitalization…

Published in the July 28 JAMA theme issue on Medicare and Medicaid at 50, the study took a comprehensive look at national trends in mortality, hospitalizations, outcomes, and expenditures from all causes from 1999 to 2013. The team, from the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital, analyzed data on 68,374,904 Medicare recipients 65 years of age or older from key demographic groups and geographic areas.

“We are in the midst of a remarkable era of improvements in health and health care in America,” said lead author Harlan M. Krumholz, M.D….co-director of the Clinical Scholars Program. “This decline represents millions of hospitalizations averted and hundreds of thousands of deaths delayed.”

“The news should give us reassurance about our current efforts, but not make us complacent. We should seek to continue our advances in technology, health behaviors and policies, and quality of care — and seek to continue this remarkable trend,” Krumholz added.

Krumholz and his team also found that the total number of hospitalizations for major surgery decreased over the course of the study. The average length of time spent in the hospital declined from 5 to 4 days, and the average inpatient costs per Medicare fee-for-service recipient declined from $3,290 to $2,801. The findings were consistent across geographic and demographic groups.

Now, imagine how much better this good news might be – if we kicked whiners and ideologues out of Congress and concentrated on solid science, best administrative practices and took as the single goal improving health and healthcare for all Americans.

That would really be good news.