Sunday, December 26, 2010

2009 Lie of the Year Redux: Palin's so-called Death Panels

In 2009, a straw man was introduced into the U.S. health care debate. Death panels invoked the specter of rationing medical procedures provided for the sick and the elderly. In the name of cost cutting, blared the phony rhetoric on talk radio and Sarah Palin's Facebook page, the Obama administration would sanction euthanasia for elders and the terminally ill under provisions of the health care bill. This would save on expensive treatments that prolong patients' lives but increase the deficit, claimed the conservative crew. However, these scare tactics were an outright lie.

A year ago, Palin's "death panel" charge was named Lie of the Year, as covered here by the Wall Street Journal:
Former Alaska GOP Gov. Sarah Palin’s Facebook allegation that the Democrats’ health-care overhaul would include “death panels” to decide whether seniors and disabled people were worthy of care was named “Lie of the Year” by fact-checkers at is the 2009 Pulitzer Prize-winning, non-partisan project of the St. Petersberg Times newspaper. Its Truth-O-MeterTM carefully evaluates the statements of political figures, pundits, and organizations and finds them to be TRUE, MOSTLY TRUE, HALF TRUE, BARELY TRUE, FALSE, or PANTS ON FIRE [as defined here].

They don't exactly give Barack Obama a free pass:

PANTS ON FIRE = The statement is not accurate and makes a ridiculous claim.

So the crowning of Palin's so-called death panels as lie of the year was not a politically motivated act.
PolitiFact's Lie of the Year: 'Death panels'

By Angie Drobnic Holan
Published on Friday, December 18th, 2009 at 5:15 p.m.

Of all the falsehoods and distortions in the political discourse this year, one stood out from the rest.

"Death panels."

The claim set political debate afire when it was made in August, raising issues from the role of government in health care to the bounds of acceptable political discussion. In a nod to the way technology has transformed politics, the statement wasn't made in an interview or a television ad. Sarah Palin posted it on her Facebook page.

Her assertion — that the government would set up boards to determine whether seniors and the disabled were worthy of care — spread through newscasts, talk shows, blogs and town hall meetings. Opponents of health care legislation said it revealed the real goals of the Democratic proposals. Advocates for health reform said it showed the depths to which their opponents would sink. Still others scratched their heads and said, "Death panels? Really?"

The editors of, the fact-checking Web site of the St. Petersburg Times, have chosen it as our inaugural "Lie of the Year."

Why is this story relevant again now?? It's because of a new article in the New York Times:
Obama Returns to End-of-Life Plan That Caused Stir

Published: December 25, 2010

WASHINGTON — When a proposal to encourage end-of-life planning touched off a political storm over “death panels,” Democrats dropped it from legislation to overhaul the health care system. But the Obama administration will achieve the same goal by regulation, starting Jan. 1.

Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.
One of the issues that has most riled the conservative commentariat is the secrecy advocated by some Democrats, such as Oregon Representative Earl Blumenauer:
After learning of the administration’s decision, Mr. Blumenauer’s office celebrated “a quiet victory,” but urged supporters not to crow about it.

“While we are very happy with the result, we won’t be shouting it from the rooftops because we aren’t out of the woods yet,” Mr. Blumenauer’s office said in an e-mail in early November to people working with him on the issue. “This regulation could be modified or reversed, especially if Republican leaders try to use this small provision to perpetuate the ‘death panel’ myth.”
I don't agree with this strategy at all. It's bound to backfire, and it already has. Instead, the logical way to counteract the ‘death panel’ myth is with evidence to the contrary. But this doesn't work with those who are already convinced otherwise (e.g, the tea party, Palin fans, etc.). Because of pre-existing cognitive biases, no amount of scientific evidence, or quotation of the actual provisions of the legislation/regulation, will change their minds.

So why bother, you say? What's the point? As a scientist, I'm not going to sit idly by while a vast swath of the American populace tries to influence personal health care decisions with their ignorance. The NYT cited a peer-reviewed study that supports the benefits of end-of-life planning: The impact of advance care planning on end of life care in elderly patients: randomised controlled trial (Detering et al., 2010; PDF). They also linked to a letter to the editor of the Journal of the American Geriatrics Society that reviewed the literature on advanced directives (Fischer et al., 2010; PDF) and concluded that ADVANCE DIRECTIVE DISCUSSIONS DO NOT LEAD TO DEATH.

Yet, the conservative pundits are trying to convince everyone that the opposite is true, without presenting a shred of evidence. Previously, I wrote about how a study in the New England Journal of Medicine (Temel et al., 2010) showed that the Limbaugh/Palin "death panels" extend the lives of terminally ill patients. This paper demonstrated that the introduction of palliative care shortly after the diagnosis of metastatic lung cancer not only improved the patients' quality of life, but also extended median survival from 8.9 months to 11.6 months:
The NEJM study enrolled 151 patients with newly diagnosed metastatic non–small-cell lung cancer. Seventy-four received standard care and 77 patients received palliative care, which included meetings with a member of the palliative care team (board-certified palliative care physicians and advanced-practice nurses). The first meeting was within 3 weeks of enrollment, and subsequent meetings were held on a monthly basis, with additional sessions at the discretion of the patient and the clinical treatment team. Patients assigned to standard care did not meet with the palliative care team (unless requested). All patients continued to receive standard oncology care for the duration of the study.

These meetings are the so-called "death panels" that would have been covered by Medicare...
Don't believe the rhetoric. The true death panels are those who want to deny health care to low-income Americans. Do they plan to pay all medical care for the uninsured out of their own pockets? If not, then who will, besides the government? Oops, looks like the anti-Obamacare crowd has just condemned them to die.

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At December 26, 2010 8:39 PM, Anonymous Brian said...

> Oops, looks like the anti-Obamacare crowd has just condemned them to die.

Please, spare us of the invective. Indifference to the well-being of the poor does not follow from opposition to the PPACA/HCERA.

Stick to the analytic and eschew the vitriolic, please -- the former is an admirably strong suit of yours, and it would be a pity to see it subsumed by the latter.

At December 29, 2010 6:38 AM, Anonymous Anonymous said...

Though "Advance Care Directives" are not the "Death Panels" which Sarah Palin claimed, and her rhetoric was typically exaggerated (as is that of all politicians at one time or another), your claim is overbroad as well. Indeed, you, Palin, the NYTimes, and the pundits on both sides are guilty of using non-sequiturs and red herrings.

Indeed, research may show that advance care directives and discussions do not lead to death, and indeed those meetings may not be tantamount to "death panels". However, any system of bureaucratic rationing of health care, public or private, must by necessity contain within it a system for deciding when care will exceed benefit. That rationing body (ie: a panel) will decide when to terminate care (ie: death).

Therefore, while Palin used a red herring to vividly demonstrate that there will be death panels, and the target of her vitriol was not a death panel. By arguing that Palin's target was not a death panel, and therefore death panels do not exist, you are denying the antecedent.


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