Cancer J. 2014 November/December;20(6):427-432.

The Use of Proton Therapy in the Treatment of Lung Cancers.

Simone CB 2nd1, Rengan R.

Author information

• 1From the *Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA; and †Department of Radiation Oncology, University of Washington Medical Center, Seattle, WA.

Abstract

Lung cancer is the leading cause of death from cancer in the United States and worldwide. Radiation therapy plays a prominent role in the treatment of patients with nonmetastatic disease. Radiation therapy alone can be curative for patients with stage I non-small cell lung cancer (NSCLC). Radiation therapy is also used as part of multimodality therapy to treat patients with locally advanced NSCLC. Current treatment delivery is often limited by radiation doses received by normal structures and treatment-related toxicities. Proton therapy for lung cancer can reduce the dose received by normal tissues, including the lungs, esophagus, and spinal cord, and may allow for reduced treatment toxicities. Proton therapy may also more safely allow for reirradiation and for radiation therapy to be combined with chemotherapy and surgery. This review discusses the rationales for and current uses of proton therapy to treat lung cancer, and it highlights key studies of proton therapy to treat early-stage and locally advanced NSCLC.

Pers Soc Psychol Bull. 2014 Nov 20. pii: 0146167214559720. [Epub ahead of print]

Better Know When (Not) to Think Twice: How Social Power Impacts Prefactual Thought.

Scholl A1, Sassenberg K2.

Author information

• 1Knowledge Media Research Center, Tübingen, Germany a.scholl@iwm-kmrc.de.
• 2Knowledge Media Research Center, Tübingen, Germany University of Tübingen, Germany.

Abstract

Before approaching situations, individuals frequently imagine "what would happen, if . . . ." Such prefactual thought can promote confidence and facilitate behavior preparation when the upcoming situation can benefit from forethought, but it also delays action. The present research tested howsocial power predicts prefactual thought when its benefits are clear versus ambiguous. Power enhances flexible behavior adaptation and action tendencies-presumably without much forethought. We therefore proposed that power diminishes prefactual thought, unless the situation suggests that such thought is adaptive (i.e., could benefit performance). Power-holders indeed generated less prefactuals than the powerless (Experiments 1 and 2), but only if benefits for performance were ambiguous rather than clear (Experiment 3). These findings indicate that social context factors related to confidence affect prefactual thought, and that power-holders' flexible adaptation to the situation sometimes elicits inaction (i.e., prefactual thought) rather than spontaneous action.

Health Educ Behav. 2014 Nov 19. pii: 1090198114557129. [Epub ahead of print]

Development of an Interactive Social Media Tool for Parents With Concerns About Vaccines.

Shoup JA1, Wagner NM1, Kraus CR1, Narwaney KJ1, Goddard KS1, Glanz JM2.

Author information

• 1Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA.
• 2Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA jason.m.glanz@kp.org.

Abstract

Objective. Describe a process for designing, building, and evaluating a theory-driven social media intervention tool to help reduce parental concerns about vaccination. 

Method. We developed an interactive web-based tool using quantitative and qualitative methods (e.g., survey, focus groups, individual interviews, and usability testing). 

Results. Survey results suggested that social media may represent an effective intervention tool to help parents make informed decisions about vaccination for their children. Focus groups and interviews revealed four main themes for development of the tool: Parents wanted information describing both benefits and risks of vaccination, transparency of sources of information, moderation of the tool by an expert, and ethnic and racial diversity in the visual display of people. Usability testing showed that parents were satisfied with the usability of the tool but had difficulty with performing some of the informational searches. Based on focus groups, interviews, and usability evaluations, we made additional revisions to the tool's content, design, functionality, and overall look and feel. 

Conclusion. Engaging parents at all stages of development is critical when designing a tool to address concerns about childhood vaccines. Although this can be both resource- and time-intensive, the redesigned tool is more likely to be accepted and used by parents. Next steps involve a formal evaluation through a randomized trial.

Hastings Cent Rep. 2014 Nov;44(6):38-46. doi: 10.1002/hast.386.

Innocent Fun or "Microslavery"?: AN ETHICAL ANALYSIS OF BIOTIC GAMES.

Harvey H, Havard M, Magnus D, Cho MK, Riedel-Kruse IH.

Abstract

In 2011, Ingmar Riedel-Kruse's bioengineering laboratory at Stanford University publicized an application that uses paramecia for what the researchers termed "biotic games." These games make use of living organisms, computer programs, and lab equipment to implement games like Pong, Pac-man, and soccer. Gamesand related activities are often considered nonserious or trivial, whereas life, biological systems, and science are treated very seriously in moral analysis and public perception. The manipulation of living matter frequently engenders at least some controversy in the marketplace of ideas, and using living things in games is no exception. Some of the objections lodged against biotic games have appeared in the ethics literature on similar topics; however, the addition of an entertainment element introduces some objections distinct from those about similar cases, as the online comments vividly illustrate. We aim to explore and address the objections in this paper, using the comments to organize and launch the discussion. In scientific work, there is typically a presumption of some prospect of translation and application of generated knowledge for public benefit. In the case of biotic games, these applications are not self-evident. Because of this, a serious analysis of the justifications, limitations, and features of biotic games is warranted. To this end, we outline key ethical limits that ought to be placed on these activities as well as the obligations that these activities generate for researchers, other professionals, and lay people who design, implement, use, and play them.

Prof Psychol Res Pr. 2014 Oct;45(5):309-315.

Therapeutic boundaries in telepsychology: Unique issues and best practice recommendations.

Drum KB, Littleton HL.

Author information

• Department of Psychology, East Carolina University.

Abstract

Technology-assisted mental health services are becoming much more routinely utilized by clients and practitioners alike. Clinicians practicing telepsychology must prepare themselves in order to provide competent care in this ever-evolving context of service delivery. Although much has been written with regards to considerations of ethical and legal practice, practical and logistical guidelines, and the advantages and disadvantages of the delivery of services via the use of technology, little to no attention has been paid to issues related to therapeutic boundaries in the telepsychology relationship. Clinicians must consider how to maintain appropriate boundaries in telepsychology settings in order to prevent harm and optimize treatment gains. Such considerations are also necessary given that it is probable that the telepsychology clinician will encounter novel boundary issues that are unlikely to occur in the traditional face-to-face therapy setting. We discuss the clinical utility of boundaries, potential boundary issues in telepsychology settings, and suggested best practice recommendations to ensure competent, ethical, and efficacious treatment in this novel context of service delivery.

The Global Health Policy Institute

The Global Health Policy Institute

"How could institutions in the business of information dissemination justify blocking families who are trying to make one of the biggest financial decisions there is?"

"How could institutions in the business of information dissemination justify blocking families who are trying to make one of the biggest financial decisions there is?"

HT: SD

The 3-Word Tweet That Cost a Politician Her Job

URI FRIEDMANNOV 21 20144




  
HT: RW

@AjitPaiFCC: "In Magnum Force, Dirty Harry wisely advised that “[a] man’s got to know his limitations.” The same is true with the FCC."

"In Magnum Force, Dirty Harry wisely advised that “[a] man’s got to know his limitations.” The 
same is true with the FCC." 

Emily Volk: College of American Pathologists Advocacy: The Effort to Preserve Fair Payment

Emily E. Volk (2014) College of American Pathologists Advocacy: The Effort to Preserve Fair Payment. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

College of American Pathologists Advocacy: The Effort to Preserve Fair Payment

Emily E. Volk, MD

From the Department of Pathology and Laboratory Medicine, Baptist Health System, San Antonio, Texas. Dr Volk is the vice-chair of the College of American Pathologists' Council on Government and Professional Affairs.

Accepted: September 4, 2014 ;Published Online: November 17, 2014

AK FTW: Support for Obamacare

SUPPORT FOR OBAMACARE

AIDS Patient Care STDS. 2014 Nov 14. [Epub ahead of print]

Substance Abuse, Violence, and HIV/AIDS (SAVA) Syndemic Effects on Viral Suppression Among HIV Positive Women of Color.

Sullivan KA1, Messer LC, Quinlivan EB.

Author information

• 11 Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University , Durham, North Carolina.

Abstract

Abstract The combined epidemics of substance abuse, violence, and HIV/AIDS, known as the SAVA syndemic, contribute to the disproportionate burden of disease among people of color in the U.S. To examine the association between HIV viral load suppression and SAVA syndemic variables, we used baseline data from 563 HIV+ women of color treated at nine HIV medical and ancillary care sites participating in HRSA's Special Project of National Significance Women of Color (WOC) Initiative. Just under half the women (n=260) were virally suppressed. Five psychosocial factors contributing to the SAVA syndemic were examined in this study: substance abuse, binge drinking, intimate partner violence, poor mental health, and sexual risk taking. Associations among the psychosocial factors were assessed and clustering confirmed. A SAVA score was created by summing the dichotomous (present/absent) psychosocial measures. Using generalized estimating equation (GEE) models to account for site-level clustering and individual-covariates, a higher SAVA score (0 to 5) was associated with reduced viral suppression; OR (adjusted)=0.81, 95% CI: 0.66, 0.99. The syndemic approach represents a viable framework for understanding viral suppression among HIV positive WOC, and suggests the need for comprehensive interventions that address the social/environmental contexts of patients' lives.

Perspect Med Educ. 2014 Nov;3(5):371-8. doi: 10.1007/s40037-014-0145-9.

"You teach us to listen,… but you don't teach us about suffering": self-care and resilience strategies in medical school curricula.

Outram S1, Kelly B.

Author information

• 1School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia, Sue.outram@newcastle.edu.au.

Abstract

This article examines the pre-vocational preparation of doctors to cope with the demands of clinical practice, drawing on literature from across a number of domains: mental health, psychological stress among medical students and medical practitioners; and self-care strategies in medicine curricula. High rates of psychological distress in medical students and medical practitioners were consistently reported. A number of questions remain pertinent to medical education: how does the experience of medical education impact on this level of distress, and possibly exacerbate pre-existing student vulnerabilities? What will help future doctors respond to, and cope with, suffering in their patients? Can the formal curriculum build resilience? Medical schools and educators have a responsibility to address these questions and to provide effective self-care curricula. In this review promising interventions such as mindfulness training are reported, frameworks to guide self-awareness in medical students are suggested, and recommendations for a self-care curriculum are made.

"Military service, with and without hazardous duty deployment, was not a significant predictor of the total number of symptoms of poor mental health."

J Am Coll Health. 2014 Nov 14:0. [Epub ahead of print]

Mental Health Symptoms Among Student Service Members/Veterans and Civilian College Students.

Cleveland SD1, Branscum AJ, Bovbjerg VE, Thorburn S.

Author information

• 1a School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences , Oregon State University , Corvallis , Oregon.

Abstract

Objective: The aim of this study was to investigate if and to what extent student service members/veterans differ from civilian college students in the prevalence of self-reported symptoms of poor mental health. 

Participants: The Fall 2011 implementation of the American CollegeHealth Association-National College Health Assessment included 27,774 respondents from 44 colleges and universities. 

Methods: Participants were matched using propensity scores and the prevalence of symptoms was compared using logistic regression and zero-inflated negative binomial regression models. 

Results: The odds of feeling overwhelmed in the last 12 months were significantly lower among student service members/veterans with a history of hazardous duty (OR = 0.46, adjusted p-value <0.05) compared to civlian students. Military service, with and without hazardous duty deployment, was not a significant predictor of the total number of symptoms of poor mental health. 

Conclusions: Current student service members/veterans may not be disproportionately affected by poor psychological functioning.

Qual Life Res. 2014 Nov 15. [Epub ahead of print]

Why visually impaired older adults often do not receive mental health services: the patient's perspective.

van der Aa HP1, Hoeben M, Rainey L, van Rens GH, Vreeken HL, van Nispen RM.

Author information

• 1Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands, h.vanderaa@vumc.nl.

Abstract

PURPOSE:

Older adults with a visual impairment are particularly vulnerable for increased depression and anxiety symptoms; however, they tend to underutilise mental health services. The present study aims to characterise the perceived need for and barriers to use mental health services in visually impaired older adults based on Andersen's behavioural model.

METHODS:

A cross-sectional study in 871 visually impaired older adults (mean age 73 years) from outpatient low vision rehabilitation services was conducted. A multinomial logistic regression analysis was performed to assess potential-related factors to perceived need for mental health services, measured with the Perceived Need for Care Questionnaire (PNCQ).

RESULTS:

About 35 % of the population had subthreshold depression and/or anxiety, and 13 % had a mood and/or anxiety disorder according to the DSM-IV. Almost 34 % of the participants with an actual disorder did not receive mental health services, even though 57 % perceived to be in need of these services. Participants who had more severe depression and/or anxiety, comorbid depression and anxiety, no history of major depressive disorder, a lower perceived health status and a younger age were more likely to be in need of mental health services. Barriers to receive these services were lack of knowledge and self-reliance.

CONCLUSIONS:

Findings support the implementation of counselling methods, instead of medication, and patient empowerment to reduce an unmet need of mental health services in visually impaired older adults, for which extensive research is warranted.

Matern Child Health J. 2014 Nov 15. [Epub ahead of print]

Neighborhood Deprivation and Maternal Psychological Distress During Pregnancy: A Multilevel Analysis.

Yang S1, Kestens Y, Dahhou M, Daniel M, Kramer MS.

Author information

• 1Department of Pediatrics, Research Institute of McGill University Health Centre, McGill University, Montreal, QC, Canada, seungmi.yang@mail.mcgill.ca.

Abstract

Maternal psychosocial distress is conceptualized as an important factor underlying the association between neighborhood deprivation and pregnancy outcomes. However, empirical studies to examine effects of neighborhood deprivation on psychosocial distress during pregnancy are scant. Based on a large multicenter cohort of pregnant women in Montreal, we examined (1) the extent to which psychosocial distress is clustered at the neighborhood-level, (2) the extent to which the clustering is explained by neighborhood material or social deprivation, and (3) whether associations between neighborhood deprivation and psychosocial distress persist after accounting for neighborhood composition (individual-level characteristics) using multilevel analyses. For 5,218 women residing in 740 neighborhoods, a prenatal interview at 24-26 gestational weeks measured both general and pregnancy-related psychological distress using well-validated scales: perceived stress, social support, depressive symptoms, optimism, commitment to the pregnancy, pregnancy-related anxiety, and maternal locus-of-control. Neighborhood deprivation indices were linked to study participants by their residential postal code. Neighborhood-level clustering (intraclass correlation) ranged from 1 to 2 % for perceived stress (lowest), optimism, pregnancy-related anxiety, and commitment to pregnancy to 4-6 % for perceived social support, depressive symptoms, and maternal locus of control (highest). Neighborhood material deprivation explained far more of the clustering (23-75 %) than did social deprivation (no more than 4 %). Although both material and social deprivation were associated with psychological distress in unadjusted analyses, the associations disappeared after accounting for individual-level socioeconomic characteristics. Our results highlight the importance of accounting for individual-level socioeconomic characteristics in studies of potential neighborhood effects on maternal mental health.

Alberto M. Marchevsky and Mark R. Wick (2014) Evidence-Based Pathology: Systematic Literature Reviews as the Basis for Guidelines and Best Practices. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Evidence-Based Pathology: Systematic Literature Reviews as the Basis for Guidelines and Best Practices

Alberto M. Marchevsky, MD; Mark R. Wick, MD

From the Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California (Dr Marchevsky);

and the Department of Pathology, University of Virginia Medical School, Charlottesville (Dr Wick).

Context.— Evidence-based medicine has been proposed as a new paradigm for the identification and evaluation of medical information. Best available evidence or data are identified and used as the basis for the diagnosis and treatment of individual patients. Evidence-based pathology has adapted basic evidence-based medicine concepts to the specific needs of pathology and laboratory medicine.

Objectives.— To briefly review the history and basic concepts of evidence-based medicine and evidence-based pathology, describe how to perform and interpret systematic reviews, and discuss how to integrate best evidence into guidelines.

Data Sources.— PubMed (National Library of Medicine, Washington, DC) and Web of Science (Thompson Reuters, New York, New York) were used.

Conclusions.— Evidence-based pathology provides methodology to evaluate the quality of information published in pathology journals and apply it to the diagnosis of tissue samples and other tests from individual patients. Information is gathered through the use of systematic reviews, using a method that is less biased and more comprehensive than ad hoc literature searches. Published data are classified into evidence levels to provide readers with a quick impression about the quality and probable clinical validity of available information. Best available evidence is combined with personal experience for the formulation of evidence-based, rather than opinion-based, guidelines that address specific practice needs.

Am J Manag Care. 2014 Sep;20(9):750-6.

New thinking on clinical utility: hard lessons for molecular diagnostics.

Peabody JW1, Shimkhada R, Tong KB, Zubiller MB.

Author information

• 1QURE Healthcare, 1000 Fourth St, Suite 300, San Rafael, CA 94901. E-mail: peabody@psg.ucsf.edu.

Abstract

Objectives To describe 5 basic requirements for planning, implementing, and proving clinical utility for diagnostic tests, drawing on recent reimbursement decisions. 

Study Design Review of recent reimbursement decisions by Palmetto GBA's MolDx program, and summary of lessons learned. 

Methods Qualitative review of publicly available coverage and reimbursement decisions, plus our industry experience. 

Results Lack of clinical utility data is the most commonly cited reason for why companies fail to receive favorable coverage and reimbursement decisions in this rapidly growing industry. We summarize 5 strategies to establish clinical utility and secure coverage with reimbursement: 1) understanding that outcomes are hard to capture, but that clinical behavior change is always proximate to outcomes change, 2) starting clinical utility studies early, 3) learning from successes and failures, 4) determining clinical utility with rigorous science, and 5) understanding that clinical utility studies may need to involve private payers and providers from the start. 

Conclusions Coverage and reimbursement are shifting from relatively low entry barriers to higher, evidence-based barriers that will require test developers to generate evidence of the net clinical benefits before widespread clinical use will occur. Concerted, early investment in rigorously designed clinical utility studies is necessary.

"staggering": More than 25,000 military personnel diagnosed 'obese'

More than 25,000 military personnel diagnosed 'obese'

"Health campaigners said the figures were "staggering" after The Sunday Times reported that more than 25,000 military workers suffered from obesity and that officers had established an "obesity working group" to help look at how to boost fitness levels and encourage healthy eating."

Should we be thankful that pro-Obamacare professor duped us? PennLive letters

By Letters to the Editor 
on November 16, 2014 

I wonder if most Americans realize how fortunate we are to live in a country where some of the most brilliant leaders are willing to lie to protect us from our stupidity? Where else could a populace benefit from the distortions of people like the dedicated university professor Jonathan Gruber, who set aside his ethics to protect us from ourselves via Obamacare?

J Ethn Subst Abuse. 2014 October-December;13(4):362-384.

Strategies Employed by Inner-City Activists to Reduce Alcohol-Related Problems and Advance Social Justice.

Drabble L1, Herd D.

Author information

• 1a San José State University School of Social Work , San José , California.

Abstract

This study explored strategies employed by activists engaged in efforts to change policies and laws related to selling and promoting alcoholic beverages based on in-depth interviews with 184 social activists in seven U.S. major cities. Nine strategies aimed at improving local conditions and influencing policy were described by activists across regional contexts. Grassroots mobilization was central to all other strategies, which included the creation or enforcement of laws, meeting with elected officials, media advocacy, working with police/law enforcement, education and training, direct action, changing community norms, and negotiating with store owners.

J Interpers Violence. 2014 Nov 10. pii: 0886260514555866. [Epub ahead of print]

Affective Dispositions and PTSD Symptom Clusters in Female Interpersonal Trauma Survivors.

Brown WJ1, Bruce SE2, Buchholz KR3, Artime TM4, Hu E3, Sheline YI5.

Author information

• 1University of Missouri-St. Louis, MO, USA wilsonbrown@umsl.edu.
• 2University of Missouri-St. Louis, MO, USA Washington University, St. Louis, MO, USA.
• 3University of Missouri-St. Louis, MO, USA.
• 4Saint Martin's University, Lacey, WA, USA.
• 5Washington University, St. Louis, MO, USA.

Abstract

Interpersonal trauma (IPT) against women can have dire psychological consequences including persistent maladaptive changes in the subjective experience of affect. Contemporary literature has firmly established heightened negative affect (NA) as a risk and maintenance factor for posttraumatic stress disorder (PTSD). However, the relationship between NA and PTSD symptoms is not well understood within IPT survivors, the majority of whom are female, as much of this research has focused on combat veterans. In addition, the connection between positive affect (PA) and PTSD symptoms has yet to be examined. With increased emphasis on "negative alterations in cognitions and mood . . ." as an independent symptom cluster of PTSD in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5), understanding the relationship between self-reported affectivity and the classic PTSD symptom clusters may be increasingly useful in differentiating symptom presentations of trauma-related psychopathology. The current study directly compared self-reported trait NA and PA with total severity and frequency cluster scores from the Clinician-Administered PTSD Scale (CAPS) in 54 female survivors of IPT who met criteria for PTSD. Results identify NA (but not PA) as a consistent predictor of total PTSD symptoms and, specifically, re-experiencing symptoms.

“...are you happy having your own polyps thrown out?”

Is ‘Resect and Discard’ Gaining Acceptance?

by Caroline Helwick

Guidelines are in place because of the need to precisely know the pathology of colorectal lesions and to be able to identify those containing invasive carcinoma, which often is not obvious, because size is not a perfect indicator, Dr. Riddell pointed out. There are also rare instances when the unexpected occurs.

“There are less common things that can easily be missed by this technique,” Dr. Riddell said, for example, neuroendocrine polyps in the rectum, metastatic carcinomas presenting as small polyps, and lymphomas and melanomas in the gastrointestinal tract.

“Can we assume that all these variants really do get picked up and sent to pathology?” he asked. “Throwing these away is not without its consequences.”

Dr. Riddell also offered a few “intangibles,” asking the gastroenterologists in attendance, “Are you comfortable with never knowing what you are dealing with? And are you happy having your own polyps thrown out?”

Contemporary Issues for Protecting Patients in Cancer Research: Workshop Summary.

Editors

National Cancer Policy Forum; Board on Health Care Services; Institute of Medicine.

Source

Washington (DC): National Academies Press (US); 2014 Sep.

Excerpt

In the nearly 40 years since implementation of federal regulations governing the protection of human participants in research, the number of clinical studies has grown exponentially. These studies have become more complex, with multisite trials now common, and there is increasing use of archived biospecimens and related data, including genomics data. In addition, growing emphasis on targeted cancer therapies requires greater collaboration and sharing of research data to ensure that rare patient subsets are adequately represented. Electronic records enable more extensive data collection and mining, but also raise concerns about the potential for inappropriate or unauthorized use of data, bringing patient protections into a new landscape. There are also long-standing concerns about the processes and forms used to obtain informed consent from patients participating in clinical studies. These changes and challenges raise new ethical and practical questions for the oversight of clinical studies, and for protecting patients and their health information in an efficient manner that does not compromise the progress of biomedical research. Contemporary Issues for Protecting Patients in Cancer Research is the summary of a workshop convened by the National Cancer Policy Forum of the Institute of Medicine in February 2014 to explore contemporary issues in human subjects protections as they pertain to cancer research, with the goal of identifying potential relevant policy actions. Clinical researchers, government officials, members of Institutional Review Boards, and patient advocates met to discuss clinical cancer research and oversight. This report examines current regulatory provisions that may not adequately protect patients or may be hindering research, and discusses potential strategies and actions to address those challenges.

University of Chicago Law Review: Campaign Finance, Federalism, and the Case of the Long-Armed Donor

Campaign Finance, Federalism, and the Case of the Long-Armed Donor

Todd E. Pettys†

81 U Chi L Rev Dialogue 77 

"While promoting a new book this past spring,¹ retired justice John Paul Stevens sat down for interviews with Jeffrey Toobin of the New Yorker and Adam Liptak of the New York Times.² In both conversations, Stevens sharply criticized the ruling that the US Supreme Court had handed down a few weeks earlier in McCutcheon v Federal Election Commission.³ In that case, Alabama businessman Shaun McCutcheon challenged federal aggregate limits on how much an individual may contribute during an election cycle to all federal candidates nationwide and to certain political committees.⁴ Those limits had prevented McCutcheon from donating as much money as he would have liked to a variety of political committees and to individuals running for Congress in states and districts other than his own.⁵ By a 5–4 vote, the Court struck down the aggregate limits, holding that they violated McCutcheon’s and other would-be campaign donors’ First Amendment rights.^6"