Primary Sources

Will Saudi Arabia's Shiites remain docile?; Europe's dim view (quelle surprise!) of the United States; new doctors as menaces; the fairer, cleaner sex
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MEDICINE

First Do No Harm

They may be learning to heal, but doctors in training are often a danger to their patients (among others), two new studies suggest. The first considers the "July phenomenon" in teaching hospitals—that is, the reduced performance associated with midsummer, when a cohort of new residents arrives. Using eight years' worth of data from a large sample of U.S. hospitals, the authors find that patients who check in during this turnover period, and are therefore treated by less-experienced residents, tend to have longer hospital stays—and, at the major teaching hospitals, higher mortality rates. (The only bright spot for patients who fall ill during this period is that these increased risks are not seen at hospitals that report high "teaching intensity.") Residents, new or otherwise, can pose a risk even after hours. The second study, of thirty-four residents working in an academic medical center, found that at the close of a typically long (ninety-hour) week they were as impaired as if they had drunk three vodka tonics in half an hour.

"Cohort Turnover and Productivity: The July Phenomenon in Teaching Hospitals," Robert S. Huckman and Jason R. Barro, National Bureau of Economic Research; "Neurobehavioral Performance of Residents After Heavy Night Call vs. After Alcohol Ingestion," J. Todd Arnedt et al., The Journal of the American Medical Association

Operating Instructions

Survival rates among breast-cancer patients are the same whether the treatment is a lumpectomy followed by radiation or a full mastectomy, and current medical guidelines encourage doctors to promote the former, breast-conserving option—yet mastectomies are still widespread. A new study suggests that this is not, as is commonly thought, the result of doctors' "overtreatment and failure to involve women in treatment decisions" but just the opposite: patients are more likely to choose a mastectomy than their doctors are to recommend one. The study surveyed 1,844 breast-cancer patients in Los Angeles and Detroit, asking whether they had decided on their own what kind of surgery to have, made the decision jointly with their doctors, or let their doctors decide. Among the white women surveyed, 27 percent of those who had made their own decision chose a mastectomy, as did 17 percent of those whose doctors had helped them decide—but only 5.3 percent of the white women who'd entrusted the decision entirely to their doctors ended up with the more invasive procedure. (No variation was found among black patients.) The authors posit that patients choose mastectomy because the risk of recurrence (though not death) is greater with lumpectomy and because they want to avoid the effects of radiation.

"Patient Involvement in Surgery Treatment Decisions for Breast Cancer," Steven J. Katz et al., Journal of Clinical Oncology

THE LAW

Unprecedented

This year's Supreme Court confirmation hearings included much talk about the importance of legal precedent—but recent Supreme Court opinions have cited fewer precedents than those written during the 1950s, according to a new study. Analyzing opinions written from the late eighteenth century to the present, two political scientists find that the average number of citations rose throughout the nineteenth and early twentieth centuries, as the principle of stare decisis, or letting previous decisions stand, became widely accepted and the number of cases available for citation increased. Under Chief Justice Earl Warren the trend reversed, with the average number of citations in an opinion plummeting from about fifteen in 1953 to about five in 1969—a phenomenon, the authors note, in keeping with the popular perception of the Warren Court as activist or even revolutionary. Over subsequent years, as the Court gradually became more conservative, the average number of citations per opinion rose; by the early 1990s it stood at just over twenty. By the end of that decade, however, it had begun to fall again (the study does not speculate as to why), and in 2000 it was down to about seven—not much more than during the Warren era.

primary sources chart

"The Authority of Supreme Court Precedent: A Network Analysis," James H. Fowler and Sangick Jeon, University of California at Davis

SECURITY

Under Pressure

They're not just for making soup anymore—pressure cookers are now weapons in the terrorist arsenal, a recent Department of Homeland Security bulletin warns. Ways to convert them into improvised bombs are "commonly taught in Afghan terrorist training camps"; in the past four years pressure-cooker bombs were used in four terrorist attacks or attempted attacks in India, Algeria, and Nepal. The bulletin points out that "as a common cooking utensil, the pressure cooker is often overlooked" by police and customs officials, making it an ideal vehicle for explosives. Officials are advised to be suspicious in particular of "any pressure cooker weighing more than expected."

"Potential Terrorist Use of Pressure Cookers," Department of Homeland Security

HYGIENE

One Hand Washes the Other—Sometimes

Women appear to pay more attention than men to cleanliness, according to a study of hand-washing in public restrooms—although both sexes like to think (or like others to think) that they are more hygienic than they actually are. Ninety percent of the women observed by researchers washed their hands after using the toilet, whereas only 75 percent of the men did. Overall, 83 percent of the people observed washed their hands—but when polled, 91 percent claimed they always wash up after using public facilities. The study was conducted at six locations in four U.S. cities—so if you were in the restroom at New York's Grand Central Station or Chicago's Shedd Aquarium and noticed someone making notations on a clipboard, this may be why. The best hand-washing habits were seen at Chicago's aquarium; the worst were at Atlanta's Turner Field during a Braves game.

"Don't Get Caught Dirty Handed," Harris Interactive, American Society for Microbiology, Soap and Detergent Association

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Ross Douthat is a former writer and editor at The Atlantic.

 Marshall Poe is a writer and historian. He is the editor in chief of the New Books Network.

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