The Baltimore Sun from Baltimore, Maryland • A19

WEDNESDAY, OCTOBER 28, 2015 NEWS THE BALTIMORE SUN 19 The high cost of dying in America modern intensive care medicine can contribute to miraculous outcomes. ICUs now provide temporary artificial liver support, prolonged artificial circulation and perioperative care for solid organ transplantations of all lands. However, my experiences in several major medical centers have also shown me that there is a problem with ICU spending in patients that are highly likely to die in the hospital. There are a number of possible underpinnings to this problem. American medical schools teach students to treat disease above all else; there is little to no emphasis on end-of-life care, particularly in the ICU.

Likewise there is no basic education in health economics or policy. Instead most physicians simply learn "on the job" about these issues, which is suboptimal. Several policy initiatives could help to address these issues. First, the American Council on Graduate Medical Education should mandate that medical schools include education about end-of-life issues. Alternatively, state medical boards could mandate graduate medical education pertaining to the topic.

Mandatory topics should include enhanced communication, terminal pain management, advanced directives and economics of end of life care. Hospitals should also pilot programs that have mandatory case review for patients who remain in the ICU longer than 30 days. The purpose of these reviews would not be to advocate for termination of supportive care, but instead to provide a regular forum for discussing the patient's condition with the patient's primary physician, intensive care physician, palliative care physician and other stakeholders. Formalization of the process would help to ensure that a patient's advanced directives are being followed and that physicians with different backgrounds and stakes communicate effectively. Finally, physicians need enhanced education about how the legal system will treat them if they refuse to provide futile care.

There is a perception among physicians that they must provide all care that is requested by a patient's family regardless of the probability of success. In fact, the AMA code of ethics states that physicians have an obligation to transition patients to palliative care when treatments have no reasonable chance of benefit. Also, some states (Texas, for example) have statutes protecting physicians from civil and criminal prosecution when they refuse to provide futile treatment. Other states should consider similar laws. Curtailing the cost of dying in the ICU is a difficult subject, but it is inevitable if the United States plans to control health care spending.

Dr. Michael Mazzeffi (mmazzeffianes.umm.edu) is an assistant professor of anesthesiology at the University of Maryland School of Medicine; the views expressed her are his own and not affiliated with the university. By Michael Mazzeffi lthough the Affordable Care Act should be applauded for increasing access to care, assisting small businesses with coverage and emphasizing preventive care, it falls short on cost containment, with health care costs still rising along with spending per individual case. And while it has provisions in place to fight fraud, it's not expected to make much of a dent in the $750 billion or 30 percent of total health care spending that the Institute of Medicine suggests is wasted annually on unnecessary services and excessive administrative fees. Much of that "waste" may be attributed to aggressive care during the last year of life.

According to the Centers for Medicare and Medicaid Services, a quarter of Medicare spending is reserved for the 5 percent of beneficiaries who die each year. Using 30 years of Medicare data, researcher Gerald Riley showed a steady temporal increase in the number of repeat hospitalizations during a Medicare beneficiary's final year of life. Many patients die in the intensive care unit (ICU) among the costliest types of hospitalization and there is a trend toward more hospitalized patients dying in the ICU, according to a study by Brown University researcher Joan Teno, who published her work in the Journal of the American Medical Association As an ICU physician, I have seen that Politically incorrect statues provide teachable moments By Alexander E. Hooke Spain reformists are calling for the removal of any public recognition of the Surrealist master, Salvador Dali, because he was an ardent supporter of the Franco fascist regime. In the Middle East, the Taliban and ISIS destroyed ancient Buddhist statutes and sacred monuments they claim are false idols and sources of evil.

And here in the U.S., people are demanding the removal of Confederate symbols because of their links to our slave past With that in mind, a Baltimore task force has begun holding meetings to decide the fate of several renowned monuments in the city. Like their predecessors in other parts of the world, this group assumes the authority to decide which parts of our history should be displayed or concealed from fellow citizens. Such a task poses a peculiar threat to public life and civic discourse if it neglects the following: First, the statues are artistic achievements, meant to be experienced as part of the public commons rather than confined to museum rooms or warehouses of taboo items. Second, as with most sacred figures, the statues inspire reflection; they greet passersby with compelling scenes that deserve two or three looks. And third, perhaps most important, these works of art invite visitors to their own teachable moments, which educators relish as the unexpected experience that provokes curiosity and renewed insight For example, consider one of the best known statues in Baltimore the Lee and Jackson monument in Wyman Park, across from the Baltimore Museum of Art It is a stunning sculpture.

A couple of visitors from Annapolis saw it and remarked that it is the kind of statue one might find in Paris or Vienna It is the 1946 work of Laura Fraser (alert, the is etched as a among first female sculptors to achieve national fame. Imagine students, joggers, travelers or area residents on an evening stroll happening upon Fraser's creation. Surrounded by trees, amid local traffic, with distant sounds of the dog park or vendors yelling "ice cold" to commuters wanting a bottle of chilled water, they stand before this monument. They look up at the larger-than-life figures of Stonewall Jackson and Robert E. Lee on their horses and stand in awe.

Yet there is more to this artistic work than just the figures. The inscriptions surrounding this statue also draw our attention. They indicate that the scene is Jackson and Lee parting ways as they prepare for the battle of Chancellorsville. Then there are the words describing them: "great generals," "Christian soldiers," and "waged war like gentlemen." Also evident is Jackson's admission that his confidence in Lee is such that he would "follow him blindfolded." Here the teachable moment arises. With a quick check on a smartphone most people with a sense of curiosity can begin weighing some questions.

If Lee and Jackson are great generals, then why did their side lose? Christianity preaches forgiveness and loving thy neighbor, so how could these soldiers trying to kill their northern neighbors be true followers of Jesus? And what does it mean for a gendeman to wage war? Do non-gentlemanly military tactics look any different? Visitors to this remarkable sculpture might then recall visits to nearby battlefields, such as Antie-tam or Gettysburg, where they witnessed accounts and re-enactments of the massive slaughters each side enforced and suffered. Thousands of American lives lost in less than a week. The stench of burning flesh and agonizing sounds of lingering death for days seem to mock or undermine any association of a gendeman with war. These sorts of images and words present viewers of the LeeJackson statue an opportunity to learn and reflect. While no mention of slavery, the South or states' rights is mentioned at this site, viewers can readily check their electronic gadgetry and discover how these issues were part of the historical landscape.

They can also gaze at this statue to consider and ponder the endless human tragedies and paradoxes provoked by warfare. They might appreciate or dispute the extent of the wisdom, courage or loyalty embodied by those who fought and the willingness to kill or die for their side. These teachable moments can arise with many of Baltimore's monuments. Those wearing the mantle of faux sensitivity and insincere tolerance in order to demand that these statues be removed from the public commons betray considerable hubris. They assume most of us are too fragile or simple-minded to appreciate and understand these works of art on our own terms.

Alexander E. Hooke is a philosophy professor at Stevenson University. His email is ahookestevenson.edu. ALGERINA PERN ABALTIMORE SUN The Baltimore Police Department on Monday launched the Body-Worn Camera Pilot Program requiring certain officers, like the three shown here, to wear body cameras while policing. Data protection needed Police body cameras promote public safety but jeopardize privacy and cybersecurity locally, some police departments become victims of ransomware, and biometric data compromised on a national scale in the recent Office of Personnel Management data breach.

These events, along with countless others, demonstrate that personal information should be afforded a high level of security by government The data collected by police body cameras is no different than other sensitive data, and law enforcement must follow CJIS security protocols to store it The International Association of Chiefs of Police recendy released principles on protecting data recommending that "law enforcement agencies should generally store all collected data at the highest level of security, which will often be the FBI CJIS standard." This level of security will not only protect those who interact with law enforcement but also the police officers wearing the devices. With Baltimore City scheduled to begin its body camera pilot this month and Baltimore County's program due to start next year, Maryland residents must demand that the highest security and privacy protocols be in place. Since the data being collected comprise potentially sensitive information that will be utilized to help prosecute or exonerate our citizens, it is important to ensure that the strongest safeguards available are employed to protect the integrity of the judicial system I urge the Maryland Police Training Commission to require law enforcement agencies to implement the CJIS security policy when deploying body cameras. Bradley Shear, a Baltimore native who works in Bethesda, is a lawyer and advocate for stronger digital privacy and cybersecurity protections. His email is bshearshearlaw.com.

By Bradley Shear he tragic death of Freddie Gray, among other troubling events across the country, has demonstrated the need for the widespread implementation of police body cameras. However, before these devices are utilized, we must understand and plan for the significant cybersecurity and privacy risks inherent to their use. Earlier this year, Gov. Larry Hogan signed legislation that created the Commission Regarding the Implementation and Use of Body Cameras by Law Enforcement Officers to study and outline best practices for the use of body cameras in Maryland. The creation of this new commission was a welcome development The group recently released a report that provides guidance to the Maryland Police Training Commission, which is set to publish its final policy for the deployment and use of body cameras by law enforcement before Jan.

While the commission's recommendations are a step in the right direction, it was disappointing to see that they did not recommend a uniform storage and maintenance policy for all law enforcement body camera data across Maryland. In an email vote taken after the commission's Sept 1 meeting, members instead decided to leave this important policy decision up to local police departments. These cameras will collect a massive amount of data, and out of cost considerations, law enforcement agencies will most likely store it in the cloud. Rather than allowing each agency to create their own set of security policies, the commission should instead require police departments in Maryland to implement the FBI's widely accepted and trusted Criminal Justice Information Services Division Security Policy (C JIS) for body camera recordings. JIS is the strongest set of security protocols available to protect sensitive law enforcement information The CJIS security policy provides an added layer of security such as routine audits and background checks for individuals working with sensitive data Absent this requirement, significant challenges for the law enforcement community will arise along with questions about data security.

The commission's vote to forego a standardized policy is the latest in a string of decisions that have unwittingly created a patchwork of substandard cybersecurity policies, which will likely result in increased costs and further public safety issues. For example, what happens when an investigation and prosecution involve multiple departments with varying levels of data security protocols? If one police department employs CJIS, while another implements a policy that is more vulnerable to the mishandling of evidence, hacking or theft, there will be serious legal consequences. Jurors, prosecutors, police officers and the general public could question whether the recordings can be trusted. Television dramas that highlight the use of forensic science and DNA testing have given rise to a the "CSI effect" a term used to describe jurors' unrealistic expectations about technology in law enforcement and how evidence is collected and stored. Inconsistent data storage policies that do not require security protocols as stringent as CJIS will lead to unwanted questions about the taaslworthiness of the body camera footage collected by law enforcement Cybersecurity and privacy are major concerns today.

We have already seen personal records of University of Maryland students, alumni and employees hacked DOONESBURY BY GARRY TRUDEAU NO, NO, I'M PEAPY. I've JU5T60TT0 CUB TAKFCARF UNSUSPECTING WUWANT 05 TDBPEAK FVRAFBW MINUTES? tmi, this bit, 6UY. YOUR HOST OFF TANNING Mem-6o-miNP. QUIET ON THE: SET, PLEASE. THIS MJLL BE TAKE ONE OF AMERICAN CANCER SOCIETY SPOT, "COVER UP!" THE MEMORIES, Ml Ke.

the-emit SWEET MEMORIES! What Maryland thinks Would City Councilman Nick Mosby's marriage to State's Attorney Marilyn Mosby pose a conflict of interest if he is elected mayor? Yes 57 No 41 Not sure 2 (273 votes, results not scientific) NEXT POLL: Are Maryland students over-tested? Vote at baltimoresun.comvote.