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Chattanooga News Chronicle - September 18, 2015 By Robert Goldberg

A group of doctors has decided to rewrite the Hippocratic Oath. The ancient pledge charges physicians with applying all measures that are required to help the sick. The American Society of Clinical Oncol- ogy wants to add a caveat -- unless those measures are too expensive. Then let the patient die. The oncologists froup has developed a conceptual framework that relies on cost-benefit analysis to determine the most valuable treat- ments for different pa- tients. Sounds innocent enough. But healthcare outcomes cannot be re- duced to cost-benefit cal- culations. By focusing on the cost of a treatment -- rather than its potential benefit -- the oncologists are allowing dollar signs to dictate whether a pa- tient lives or dies. Under ASCOs frame- work, new treatments will be judged based on clini- cal benefit, side effects and cost. Those are the exact same measures health in- surers use in limiting pa- tient access to treatments. Indeed, ASCO wants in- surers to use its calculator to evaluate the relative value of new treatments as they develop benefit structures and adjust pre- miums. Such controls could include shifting drugs to the highest cost-sharing tier of an insurance plan or requiring patients to try older, cheaper drugs before receiving the most cutting-edge therapies. Never mind that the Obama Administration has warned placing most or all drugs that treat a specific condition on the highest cost tiers discour- ages enrollment by indi- viduals based on age or based on health condi- tions is discriminatory. The oncologists are effectively asking insur- ers to discriminate against cancer patients -- in direct contradiction of the Af- fordable Care Acts intent. Further, ASCO has concluded that a treatment that can keep patients alive for weeks or months has no value. The framework as- signs zero value to any treatment that doesnt increase survival by 20 percent. Right away, the formula would deem nu- merous modern treatments for cancer worthless. That 20 percent fig- ure is arbitrary. Take a lung cancer patient who is alive today because of the accumulation of treat- ments that never made that arbitrary threshold. Cardiologists hailed a just approved drug that reduc- es the risk of death from heart failure by 20 percent as revolutionary. Under ASCOs frame- work, sorry -- not good enough. Between 1987 and 2000, various AIDS thera- pies increased patient life expectancy by less than 20 percent a year. Had ASCOs framework been instituted then, thousands of AIDS patients who benefited from those treat- ments wouldnt be alive today. ASCO defends its fuidelines by claiming that expensive new treatments have sown unrealistic pa- tient and family expecta- tions that lead clinicians to offer or recommend some of these services, despite the lack of supporting evi- dence of utility or benefit. Americas healthcare sys- tem cant afford limitless spending on cancer treat- ments, the group says. True, spending on cancer drugs has risen. In 2014, it topped $100 billion. But thats just 1 percent of U.S. healthcare spending. Moreover, these med- icines are worth their price tags. Successful drug ther- apies reduce overall costs by diminishing the need for future medical atten- tion. According to a study from the Center for Value and Risk in Health, spe- cialty drugs tend to con- fer greater benefits and hence may still offer rea- sonable value for money. Successful treatment also benefits the nation. Cancer survivors have contributed $4.7 trillion to the economy since 1990, simply by living and working longer. By valuing treatments based on costs rather than the benefit they provide to patients, the ASCO frame- work violates both the let- ter and spirit of the Hip- pocratic Oath. It should be scrapped before it puts patients in danger. Robert Goldberg is vice president of the Cen- ter for Medicine in the Public Interest.

by Deborah Levine

Why bother writing when todays technology communicates so much for us? Templates plan for us, spell- check edits for us, and theres enough information online to produce a ocean of plagiarized work. Technical and business writing skills are becoming lost arts. Yet, the success of our com- munication with colleagues, teams, and clients increasingly relies on our ability to write memos, emails, repots, proposals, and evaluations. Surely, the training of professionals across multiple industries should include the development of writing skills. According to Alyssa Montague, SharePoint Administrator, Techni- cal writing skills are possibly one of the most important aspects of a suc- cessful career. To effectively com- municate the solutions to complex problems, you must speak the same language as the other professionals in your field. If they cannot follow your logic, they will be unable to review your work, provide feedback, and collaborate. Without the respect and understanding of your peers, your ideas will never come to life before the general public. Nowhere is the lack of writing skills more visible than in the STEM professions (Science, Technology, Engineering, Math). Long before writing skills become essential to es- tablishing professional credentials, they are key to completing a STEM college degree. As I found during my tenure as Research Coordinator at the College of Engineering and Com- puter Science at UTC, writing is too often an afterthought for STEM stu- dents. Its true for women and diverse students who fought long and hard to master the technical aspects of their education. Its also true for the busi- ness students. According to Lakweshia Ew- ing, Co-owner of Biz Boom Apps LLC, Learning to write well is a vi- tal necessity to any career path, even STEM careers. The nucleus of writ- ing, regardless of what field or indus- try an individual is embarking upon, remains the same. The ability to ef- fectively communicate an idea, to es- tablish a strong presence, and to write with clarity and impact are essential to having your voice heard. Its fair to say that writing is merely think- ing with written words. To this end, we shouldnt find it strange that even in this high tech society, we need to develop, enhance, or cultivate strong writing abilities. Regardless of how intelligent students or employees are, if they cant convey their ideas in a manner that is understandable, if theyre unable to express their bril- liant innovations, their ideas could fet lost in translation. We need to understand that if an idea that cant be communicated will find itself unfunded, under-utilized, and often non-existent in the marketplace. Sheila Boyington, President of Thinking Media, highlights the chal- lenge for climbing the corporate lad- der in most professions. As it is in many professions, writing is the skill that helps you communicate your points effectively. There can be a misconception that the English, Lan- fuage and Arts skills are less impor- tant than technical skills. However, to effectively perform, communication skills cannot be undervalued. Can you craft contracts, write grants, pub- lish papers and perform a variety of job duties that require strong writing skills? Personal writing is becoming Instant-Speak with a quick stop at e-mailing before descending into tweets. Allowing technical and busi- ness writing to take a similar path will hurt you professionally. Give your writing the time, energy, and fo- cus that it deserves. Prepare your next written memo, email, or report with same focused attention that youd five a major presentation. Truly, your written word will last longer, and, if done well, have more impact than your spoken word. Need help? Here are my free tips to get you started and keep you going: Going Writing.

COMMENTARY / CULTURE THIS WEEK IN AFRICAN AMERICAN HISTORY

Much is made of the espionage work done by Miss Van Lew during the Civil War, but little is known about the many people working in her extensive spy network throughout the Confederate capital of Richmond. These secret suppliers of information were what made Miss Van Lew so successful, and none are known to have been better placed, or more effective, than Mary Bowser. At some point during the first couple years of the war, Mary succeeded, with Miss Van Lews assistance, in getting a position as a servant in the Confederate White House. Under this humble and overlooked guise, Mary became privy to information intended only for Confederate President Jefferson Davis. The Confederate leadership felt no need to guard their conversations in the safe confines of the Presidential residence; and since it was assumed that she was illiterate, no effort was made to keep Mary from seeing secret documents. Thanks to this, she was able to gather sensitive information at all times. Whether she was dusting Jefferson Daviss office or clearing away dishes during a cabinet meeting, Mary Bowser was always on the lookout for information. A local bakery man, Thomas McNiven, supplied the Confederate White House with baked goods and served as a part of Miss Van Lews network. Thus, Mr. McNiven (he used the code name Quaker) was able to receive important information from Mary when he delivered to the White House each evening. He later described Marys incredible skill to his daughter, ...Mary [Bowser] was the best as she was working right in Davis home and had a photographic mind. Everything she saw on the Rebel Presidents desk she could repeat word for word. As with most Union spies who served in Richmond during the war, all records of Marys work were destroyed by the War Department to protect her from the retaliation she would have faced if the extent of her service were uncovered. Because of this, very little specific information is known about her activities during the war. However, it cannot be doubted that she served exceptionally well in an exceedingly dangerous position. In 1995, the Military Intelligence Hall of Fame at Fort Huachuca, Arizona, honored her effort with these words: Ms. Bowser certainly succeeded in a highly dangerous mission to the great benefit of the Union effort. She was one of the highest placed and most productive espionage agents of the Civil War. After the war ended, Mary Bowser spent time serving as a teacher for freed slaves, and gave at least one speech in which she told the story of her time as a spy in the Confederate White House. For the speech, given in the fall of 1865 in New York, she used the name, Richmonia Richards. Later, in 1867, she had a chance meeting with Harriet Beecher Stowe in Georgia, and told her story again. At that time, she was teaching under the name Mary J. R. Richards. After 1867, we dont know what happened to her... She seems to have effectively disappeared. Like a good spy would... ...and her story almost disappeared with her, only being properly researched in recent years. It is possible that Mary Bowser kept a diary detailing her exploits, but is believed that this possible lead has been lost to history as well... in the 1950s, some relatives ...ran across a diary... in which they kept ...coming across (references to) Mr. Davis... Not realizing the possible significance of Mr. Davis, they eventually, pitched it in the trash can. It will never be known if this was in fact Mary Bowsers account of her exploits or not, but it seems almost fitting that this Civil War spy and hero remains a mystery... Sadly, much of her story will probably never be known, but what is known is this: Mary Bowser rose from slavery to become possibly the best Civil War spy of them all. She is, without a doubt, a true American Civil War hero.

Mary Elizabeth Bowser

Union Spy

Sponsored by Mary Walker Historical and Educational Foundation

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