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imagesA Virginia federal appeals court today announced its plan to expedite review of a health care reform case with nationally significant implications.

Virginia Attorney General Kenneth Cuccinelli brought a legal challenge against the Affordable Care Act (ACA), also known as Health Care Reform. On December 13, 2010, U.S. District Judge Henry Hudson granted summary motion to Cuccinelli. Judge Hudson agreed with the suit that the federal government cannot mandate that individuals purchase insurance or face a $695 yearly penalty, a key ACA provision set to take effect in 2014.

Both Attorney General Cuccinelli and the U.S. Justice Department requested that the court expedite review of the case. Today that expedition was granted by the Fourth Circuit.

Cuccinelli is a rising star of the right. Elected before the “Tea Party” movement existed, he has said “On the issues the Tea Party cares about, I land right in their bull’s-eye,” according to the New York Times.

Prior to his 2009 election, the Washington Post editorialized, in a piece called “Mr. Cuccinelli’s Bigotry,” that “as attorney general, he would be an embarrassment to Virginia.”

The Virginia case will be heard in May. Other states are mounting challenges to ACA. This week  North Carolina and Montana moved to join Florida, Ohio, Wisconsin, Iowa, Kansas, Wyoming and Maine in litigation against the law.

A Virginia federal appeals court today announced

Sculpture by Elizabeth Abeyta; source: http://www.hanksville.org

Sculpture by Elizabeth Abeyta; source: http://www.hanksville.org

According to today’s New York Times, many Navajo would view what happens during cardiac resuscitation as barbaric but they also believe that talking about your own death will bring it about. So, helping Navajo people to have a conversation about end-of-life choices and sign an advance directive is challenging. Times reporter Ben Daitz, MD, describes how Mitzie Begay, cross-cultural coordinator of home care for Fort Defiance Indian Hospital in Arizona, and Gina Nez, RN, Director of Nursing for the hospital, worked with staff to craft a Navajo poem that serves as the advance directive and is signed by the patient, as would happen with any advance directive. This culturally-grounded approach to crucial conversations about end of life decisions  shows us that the forms we use for advance directives may lack meaningful cultural context for many people.  The American Academy of Nursing’s policy brief on Advance Care Planning as an Urgent Public Health Concern calls for treating advance directives as more than a clerical matter and eliciting the preferences and values of the patient. But other considerations may be needed when the patient’s culture precludes such discussions. If poetry works in one culture, perhaps song or literature could help in others.

Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing

[caption id="attachment_10542" align="alignleft" width="155"] Sculpture by Elizabeth

Steve Gorelick is Professor in the Department of Film and Media Studies at Hunter College of the City University of New York.

 

photo credit/livestrong.com

photo credit/livestrong.com

Some of the most fundamental and taken for granted cultural assumptions are the hardest to question.  Why?  Because “they” said they are true.

These are the assumptions that my Mom and  Grandma used to always attribute to “they,” the mystical font of all wisdom and patron saint of unsubstantiated claims. “They”  knew what caused colds, what foods were good for you, and seemed to have genuine insider knowledge about why it was important  to wait  a half hour after eating before swimming. I remember being a happy yet stubborn 9 year-old, arguing some point with  my grandma, and instantly holding up the white flag when she was able to cite some evidence that “they” had reported. It simply didn’t matter that  the information provided by “they” came from everything from supermarket tabloids to long-departed relatives.  “They” knew what “they” was talking about!

“They” was on my mind today.

Within only several years, the problem of sports-related concussions and head trauma has become a topic of wide discussion and concern. Today on NPR’s Fresh Air, former All-Ivy league lineman, pro wrestler, Harvard graduate, and head trauma activist Chris Nowitski discussed his crusade to raise awareness about the potentially lifelong and debilitating effect of repeated head trauma. His foundation, The Sports Legacy Institute, focuses on the study of the degenerative brain disease Chronic Traumatic Encephalopathy, or CTE, a condition caused by repetitive concussive and sub-concussive brain injuries.

Listening to the interview reminded me of two things: First, I recalled that my freshman year of high school was marked by a painful and angry argument between my Mom and me about whether I could play football. I wanted to play. I lost. She was probably right.

 

But my other thought today was the absolutely ridiculous and even humorous way that  head trauma is depicted in popular culture. People are knocked unconscious in staged fights and immediately regain consciousness. Cowboys and cops and criminals are constantly being punched, dropping to the ground, and quickly waking up with little effect. In fact, in physical humor and slapstick, the very act of being knocked unconscious is presented as the zenith of hilarity.

In “they-land,” the Three Stooges can smack and poke and punch each other’s head endlessly, and the laughter only gets louder.

http://www.youtube.com/watch?v=PNjzZ7Bt-Vo

It’s not  that 1) some of this isn’t genuinely funny or 2) that it is something requiring censorship. I will, though, suggest that one result of all this consequence-free theatrical punching and poking is that the long-term consequences of sudden head trauma  have largely been buried under all the comedy and action-packed scenes in film and television. The conventions and constraints of popular entertainment simply leave no room for the variety of short and long term symptoms of real-world  concussions.

When is the last time you watched a crime drama, saw  a bad guy get knocked out, and then watched him wake up with any of the actual symptoms of a serious concussion – vomiting, memory loss, a seizure, vision problems, etc?  Never.  Because “they” knows that all these complications would simply clog up and slow down a good police procedural.

 

My point is simple:  the facts about the effects of repeated head trauma from football and boxing are slowly emerging in a number of longitudinal studies and post-mortem examinations of suspect brain tissue.  Articles, studies, and commissions will tease out the medical nuance and – perhaps – effective treatment and prevention measures will emerge.

What a shame, though, that – while this work goes on – our culture will continue to get its kicks from popular entertainment – nonsense like professional wrestling, for example —  that will depict the  good old fashioned “bop on the head” as part of a grand tradition of  performance rather than something potentially deadly and debilitating.

“They” should know better.

Steve Gorelick is Professor in the Department