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The future of palliative care - Issue #12


The future of palliative care

May 21 · Issue #12 · View online

In many respects, we've arrived. Yet what we know now won't get us to the next level. So I'm looking for signals from the future, & I'm curating them here.

“Everything one does in life, even love, occurs in an express train racing toward death.” [Jean Cocteau] If you received this as a forward, & you like it, you can subscribe here

1. Psychedelics for existential suffering go mainstream.
Michael Pollan, well known for his insightful food journalism, got interested in psychedelics when he heard a psychologist talk about microdosing at a Berkeley dinner party. His newest book, How to Change Your Mind, traces the lively history of LSD & psilocybin, and how they are now being used in clinical trials. The results for cancer patients with end-of-life anxiety and depression are striking, in rigorously conducted trials. I’ve been following this work for some time, and it’s gotten some cautious endorsement by none other than Ira Byock. But what makes Pollan essential reading is that he puts psychedelics into context with the new science of mind. What psychedelics seem to do is not just medicate people–psychedelics provide a kind of corrective experience. It’s a new kind of healing. 
A Strait-Laced Writer Explores Psychedelics, and Leaves the Door of Perception Ajar
The Trip Treatment | The New Yorker
2. Is our focus on the self interfering with letting go?
There is a second point from Pollan’s book that merits special attention. What emerging experience with psychedelics suggests, qualitatively, is that the experience that changes people is having a direct experience of the self, or the ego, falling away. To me this outlines two pathways for dealing with existential suffering. One pathway is to intensify the importance of dying with the self intact–for many, this points towards medically assisted dying. Another pathway is to provide an experience of loosening the self–psychedelics, certain types of meditation, certain religious beliefs. Makes me wonder if we need to be careful how much we reinforce the importance of personal preferences…
Michael Pollan & Ezra Klein - Vox
3. Maryland's unique approach to cost containment.
Maryland, alone among the states, has been experimenting with global budgets–the state makes a commitment to pay a specific amount of revenue in advance of the fiscal year, regardless of the volume of services provided. From 2014 through 2016, per capita hospital spending by all insurers grew by <2 percent a year. And in an RTI study, downloadable here, this payment system points hospitals to “an increasing focus” on “high-risk, high-cost patients, many of whom have complex social needs and clinical behaviors that hospitals find difficult to change.” 26 other states have applications in progress to try this out…so you’ll see more.
Global Budgets in Maryland: Assessing Results to Date | Health Care Reform | JAMA | JAMA Network
4. Cultivating the next gen leaders.
From Caryn Lerner in NEJM: sounding the alarm about “a persistent and worsening disconnect between the capacity of the physician-leadership workforce and the needs of our expanding and increasingly complex health systems.” She is dead on. We are way overdue for a reboot in how we think about leaders–and certainly what i learned as an academic wasn’t even the primer about how to build VitalTalk. Now the question is: how to do this? How do we prepare the next gen to make sense out of our volatile, uncertain, complex, and ambiguous future?
Leadership Development in Medicine | NEJM
5. A terrific new documentary: End Game
Directed by Academy Award-winning filmmakers Rob Epstein and Jeffrey Friedman (who made the 1989 film about the AIDS Quilt, “Common Threads,” this new documentary premiered this year at Sundance. Nice cameos by BJ Miller and Steve Pantilat; behind the scenes support from Shoshana Ungerleider and Jim Mittelberger (among FutureofPC readers). Nice work, guys!
End Game | Official Trailer [HD] | Netflix - YouTube
6. If you didn't catch this part of The Wedding...
The thing I really didn’t expect at Meghan and Harry’s wedding was an African-American Episcopal Bishop, who knocked his sermon out of the park. Watch his body language–and how Camilla reacts. A reaction from the twittersphere: “we’ve been waiting 200 years for this.” Stunning. 
Bishop Michael Curry’s Full Sermon From the Royal Wedding - The New York Times
This newsletter is made possible by the John A. Hartford Foundation. The opinions, recommendations, and selections are mine alone. Late this week because I couldn’t stop reading Michael Pollan. Special thanks to Shoshana Ungerleider, James Mittelberger, & Bob Arnold! 
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