Framing the Stimulus' Impact Will Be the Next Challenge

The Obama administration had a rough start to its communication strategy on the stimulus plan, going from no message to a catastrophe frame, only at the last minute shifting to a more effective focus on localized benefits and impacts. If the Stimulus plan was a tough challenge to communicate, framing its success will be even tougher. Measuring impacts will be complex and uncertain, their interpretation will be ideologically driven, and a wide range of groups will be actively working to define its success or failure, including journalists.

At New York magazine, John Heilemann offers an apt diagnosis and prediction:

For two crucial weeks, indeed, the White House communications breakdown was all-encompassing. The administration failed to do the little stuff: deploying persuasive surrogates to campaign for the package on TV. It failed to do the big stuff: hammer the theme that the nation is in crisis, that a depression looms, that political inertia carries grave risks of economic calamity. When Obama talked about the bill, his words and demeanor lacked, to bowdlerize a phrase, the fierce urgency of ... anything. When his team made their case, they focused on process rather than substance, ignoring the imperatives of language, speaking (abstrusely) of "stimulus" or (vaguely) of "recovery" instead of "jobs"--and into that rhetorical vacuum, the Republicans stepped in with "pork."

Then, with public support for the stimulus slipping and the possibility of a filibuster threatening, Obama and his people shifted gears. Suddenly, the economic team was unspooling state-by-state job-creation numbers. Suddenly, the president was warning that inaction could lead to "catastrophe," trashing "criticisms of this plan that frankly echo the very same failed theories that helped lead us into this crisis." There were plans for a prime-time news conference and perhaps an address from the Oval Office.

No doubt all this will help the package overcome the hurdles that remain. No doubt the celebration that ensues when it's signed into law will be loud and triumphal. And let me be clear: I have no doubt that whatever emerges after the House and Senate merge their bills will be better than nothing. But it's still going to be a dog's breakfast--and far from the best thing that Obama could have achieved. Economists don't like it. The left ain't happy with it. The right positively deplores it. All of which would be fine, of course, if the damn thing works.

The question, of course, is how "works" is defined--and that's where the politics kicks in. This time next year, it's altogether plausible that the recession will still be raging. Will the stimulus therefore be seen to have failed? Or as having succeeded in staving off something worse? The greater risk for Obama, however, is that neither of these perceptions will be foremost in voters' minds, but that the stimulus will be recalled as just another partisan Washington goat rodeo that accomplished precious little--at a cost of nearly $1 trillion.

'Upstreamism': Your zip code affects your health as much as genetics

Upstreamism advocate Rishi Manchanda calls us to understand health not as a "personal responsibility" but a "common good."

Sponsored by Northwell Health
  • Upstreamism tasks health care professionals to combat unhealthy social and cultural influences that exist outside — or upstream — of medical facilities.
  • Patients from low-income neighborhoods are most at risk of negative health impacts.
  • Thankfully, health care professionals are not alone. Upstreamism is increasingly part of our cultural consciousness.
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  • A huge segment of America's population — the Baby Boom generation — is aging and will live longer than any American generation in history.
  • The story we read about in the news? Their drain on social services like Social Security and Medicare.
  • But increased longevity is a cause for celebration, says Ashton Applewhite, not doom and gloom.


After death, you’re aware that you’ve died, say scientists

Some evidence attributes a certain neurological phenomenon to a near death experience.

Credit: Petr Kratochvil. PublicDomainPictures.net.
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Time of death is considered when a person has gone into cardiac arrest. This is the cessation of the electrical impulse that drive the heartbeat. As a result, the heart locks up. The moment the heart stops is considered time of death. But does death overtake our mind immediately afterward or does it slowly creep in?

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Yale scientists restore brain function to 32 clinically dead pigs

Researchers hope the technology will further our understanding of the brain, but lawmakers may not be ready for the ethical challenges.

Still from John Stephenson's 1999 rendition of Animal Farm.
Surprising Science
  • Researchers at the Yale School of Medicine successfully restored some functions to pig brains that had been dead for hours.
  • They hope the technology will advance our understanding of the brain, potentially developing new treatments for debilitating diseases and disorders.
  • The research raises many ethical questions and puts to the test our current understanding of death.

The image of an undead brain coming back to live again is the stuff of science fiction. Not just any science fiction, specifically B-grade sci fi. What instantly springs to mind is the black-and-white horrors of films like Fiend Without a Face. Bad acting. Plastic monstrosities. Visible strings. And a spinal cord that, for some reason, is also a tentacle?

But like any good science fiction, it's only a matter of time before some manner of it seeps into our reality. This week's Nature published the findings of researchers who managed to restore function to pigs' brains that were clinically dead. At least, what we once thought of as dead.

What's dead may never die, it seems

The researchers did not hail from House Greyjoy — "What is dead may never die" — but came largely from the Yale School of Medicine. They connected 32 pig brains to a system called BrainEx. BrainEx is an artificial perfusion system — that is, a system that takes over the functions normally regulated by the organ. Think a dialysis machine for the mind. The pigs had been killed four hours earlier at a U.S. Department of Agriculture slaughterhouse; their brains completely removed from the skulls.

BrainEx pumped an experiment solution into the brain that essentially mimic blood flow. It brought oxygen and nutrients to the tissues, giving brain cells the resources to begin many normal functions. The cells began consuming and metabolizing sugars. The brains' immune systems kicked in. Neuron samples could carry an electrical signal. Some brain cells even responded to drugs.

The researchers have managed to keep some brains alive for up to 36 hours, and currently do not know if BrainEx can have sustained the brains longer. "It is conceivable we are just preventing the inevitable, and the brain won't be able to recover," said Nenad Sestan, Yale neuroscientist and the lead researcher.

As a control, other brains received either a fake solution or no solution at all. None revived brain activity and deteriorated as normal.

The researchers hope the technology can enhance our ability to study the brain and its cellular functions. One of the main avenues of such studies would be brain disorders and diseases. This could point the way to developing new of treatments for the likes of brain injuries, Alzheimer's, Huntington's, and neurodegenerative conditions.

"This is an extraordinary and very promising breakthrough for neuroscience. It immediately offers a much better model for studying the human brain, which is extraordinarily important, given the vast amount of human suffering from diseases of the mind [and] brain," Nita Farahany, the bioethicists at the Duke University School of Law who wrote the study's commentary, told National Geographic.

An ethical gray matter

Before anyone gets an Island of Dr. Moreau vibe, it's worth noting that the brains did not approach neural activity anywhere near consciousness.

The BrainEx solution contained chemicals that prevented neurons from firing. To be extra cautious, the researchers also monitored the brains for any such activity and were prepared to administer an anesthetic should they have seen signs of consciousness.

Even so, the research signals a massive debate to come regarding medical ethics and our definition of death.

Most countries define death, clinically speaking, as the irreversible loss of brain or circulatory function. This definition was already at odds with some folk- and value-centric understandings, but where do we go if it becomes possible to reverse clinical death with artificial perfusion?

"This is wild," Jonathan Moreno, a bioethicist at the University of Pennsylvania, told the New York Times. "If ever there was an issue that merited big public deliberation on the ethics of science and medicine, this is one."

One possible consequence involves organ donations. Some European countries require emergency responders to use a process that preserves organs when they cannot resuscitate a person. They continue to pump blood throughout the body, but use a "thoracic aortic occlusion balloon" to prevent that blood from reaching the brain.

The system is already controversial because it raises concerns about what caused the patient's death. But what happens when brain death becomes readily reversible? Stuart Younger, a bioethicist at Case Western Reserve University, told Nature that if BrainEx were to become widely available, it could shrink the pool of eligible donors.

"There's a potential conflict here between the interests of potential donors — who might not even be donors — and people who are waiting for organs," he said.

It will be a while before such experiments go anywhere near human subjects. A more immediate ethical question relates to how such experiments harm animal subjects.

Ethical review boards evaluate research protocols and can reject any that causes undue pain, suffering, or distress. Since dead animals feel no pain, suffer no trauma, they are typically approved as subjects. But how do such boards make a judgement regarding the suffering of a "cellularly active" brain? The distress of a partially alive brain?

The dilemma is unprecedented.

Setting new boundaries

Another science fiction story that comes to mind when discussing this story is, of course, Frankenstein. As Farahany told National Geographic: "It is definitely has [sic] a good science-fiction element to it, and it is restoring cellular function where we previously thought impossible. But to have Frankenstein, you need some degree of consciousness, some 'there' there. [The researchers] did not recover any form of consciousness in this study, and it is still unclear if we ever could. But we are one step closer to that possibility."

She's right. The researchers undertook their research for the betterment of humanity, and we may one day reap some unimaginable medical benefits from it. The ethical questions, however, remain as unsettling as the stories they remind us of.