:: By Lydialyle Gibson

Investigations ::

Pay-for-performance anxiety
With Medicare seemingly poised to incorporate pay-for-performance (P4P) programs, Chicago researchers find physicians both willing and wary when it comes to the carrot-and-stick method for improving health care. Surveying 556 general internists, health-studies researcher Lawrence Casalino discovered 75 percent would support financial incentives for better care, provided that quality measures—ratings for clinical effectiveness, patient satisfaction, patient safety, and cost-effectiveness—were accurate. Yet only 30 percent of respondents believed them to be so, a situation most did not expect to change. Meanwhile, fewer than half favored publicly reporting assessments about physicians’ quality of care. Respondents worried about unintended consequences for both public reporting and P4P, saying they might penalize physicians who practice in poor neighborhoods, encourage physicians to avoid high-risk patients, and divert their attention from important but unmeasured areas of care. Casalino and U of C coauthors G. Caleb Alexander, MS’03, Lei Jin, AM’96, SM’01, PhD’05, and R. Tamara Konetzka published the findings in the March/April Health Affairs.

India’s religious right
America’s eyes may be fixed on sectarian strife in the Middle East, but Law School ethics scholar Martha Nussbaum sees religious extremism threatening democracy elsewhere too. In The Clash Within (Harvard University Press, May 2007), she examines the rise of India’s Hindu right, a movement that, led by the Bharatiya Janata Party, seeks a “pure” India undiluted by other faiths. The Hindu right has persecuted Muslims harshly, and Nussbaum details the 2002 Gujarat riots in which Hindu extremists, allied with elected officials, killed some 2,000 Muslims. Theorizing that a more liberal, humanities-heavy education system might have helped halt the rise of Hindu fundamentalism, she concludes that the clash is not between civilizations but within individuals, who are pulled between self-protective belligerence and harmonious pluralism.

Gun laws: bring ‘em on
After 9/11 some experts speculated that terrorism fears would strengthen opposition to gun-control laws as Americans clamored for weapons to defend themselves and their homes, says Tom W. Smith, director of the University-based National Opinion Research Center’s General Social Survey. Instead, in a study released in April, he found support for gun control stable or increasing since 2001, while gun ownership continued its 30-year decline, despite a two-month uptick in handgun purchases immediately after the attacks. In the mid-1970s, 55 percent of U.S. households contained firearms; in 2006 that number had shrunk to 35 percent. Between 2001 and 2006 support for gun-sale background checks rose from 77.5 to 80 percent. Three-fourths of 2006 respondents favored stricter gun laws as a result of the terrorist attacks.

Adjust the pressure
High blood pressure? Misaligned Atlas vertebra? For those with both, a chiropractic adjustment may be the answer. In the March 2 online Journal of Human Hypertension, George Bakris, AB’74, AM’75, MD’81, director of the University Medical Center’s hypertension center, and seven Chicago-area colleagues report that a single, specialized adjustment for a misaligned vertebra high in the neck can also lower hypertension as effectively as taking two blood-pressure medications at once. Instead of interlocking with other vertebrae, the Atlas vertebra (also called C-1) rests solely on soft tissue and is prone to displacement. Physicians have long recognized a connection between hypertension and circulatory abnormalities near the Atlas vertebra, but the authors say they have yet to understand why. The study enrolled 50 patients and measured their blood pressure for eight weeks following the adjustment, described as a series of “nudges” that prompt the vertebra to “recoil into normalized alignment.”