1. Featured Article: Life and Death in Russia

Russia's human capital is in steep decline.

A 15-year-old boy there won't even live as long as one in Afghanistan.

By Nicholas Eberstadt, WSJ

History is full of instances where a rising power, aggrieved and dissatisfied, acts aggressively to obtain new borders or other international concessions. In Russia today we see a much more unusual case: This increasingly menacing and ambitious geopolitical actor is a state in decline.

Notwithstanding Russia's nuclear arsenal and its vast territories, the distinguishing feature of the country today is its striking economic underdevelopment and weakness. For all Russia's oil and gas, the country's international sales of goods and services last year only barely edged out Belgium's—and were positively dwarfed by the Netherlands'. Remember, there has never been an "energy superpower"—anywhere, ever. In the modern era, the ultimate source of national wealth and power is not natural resources: It is human resources. And unfortunately for Russia, its human-resource situation is almost unrelievedly dismal—with worse likely in the years to come. Read more . . .

Let's start with the "good" demographic news for Moscow: Russia's post-Soviet population decline has halted. Thanks to immigration chiefly from the "near abroad" of former Soviet states, a rebound in births from their 1999 nadir and a drift downward of the death rate, Russia's total population today is officially estimated to be nearly a million higher than five years ago. For the first time in the post-Soviet era, Russia saw more births than deaths last year.

Yet even this seemingly bright news isn't as promising as it seems. First: Russia's present modest surfeit of births over deaths comes entirely from historically Muslim areas like Chechnya and Dagestan, and from heavily tribal regions like the Tuva Republic. Take the North Caucasus Federal District out of the picture—Chechnya, Dagestan, etc.—and the rest of Russia today remains a net-mortality society.

Second: Despite its baby surge, which takes Russia's fertility level from below the average to just above the average for the rest of Europe, the 1.7 births per Russian woman in 2012 was still 20% below replacement level. According to the most recent official Russian calculations, on current trajectories the country's population, absent immigration, is still set to shrink by almost 20% from one generation to the next.

But while Russia's childbearing patterns today look entirely European, its mortality patterns look Third World—and in some ways worse. According to estimates by the World Health Organization, life expectancy in 2012 for a 15-year-old male was three years lower in Russia than in Haiti. By WHO's reckoning, a 15-year-old youth has worse survival chances today in Russia than in 33 of the 48 places the United Nations designates as "least developed countries," including such impoverished locales as Mali, Yemen and even Afghanistan. Though health levels are distinctly better for women than men in Russia, even the life expectancy of 61 years for a 15-year-old Russian female in 2012 was an estimated three years lower than for her counterpart in Cambodia, another of the U.N.'s least-developed countries.

How is this possible in an urbanized and educated society? In least-developed countries, life is foreshortened by such killers as malnutrition and communicable "diseases of poverty" such as tuberculosis, malaria and cholera. Data from WHO in 2010 show that in Russia the major threats are cardiovascular disease (resulting in heart attacks, strokes and the like) and injuries (homicides, suicides, traffic fatalities, deadly accidents).

For decades, Russia's death rates from cardiovascular disease have been higher than the highest levels ever recorded in any Western country. For Russian women in 2010, the rate was over five times higher than for Western European women. In 2008—the latest such global figures available from the World Health Organization—working-age Russian men had the worst cardiovascular-disease death levels in the world. . .

Russia's "high education, low human capital" paradox also shows up in Russia's extreme "knowledge production" deficit. Long-term economic progress depends on improving productivity through new knowledge—but this is something Russia appears mysteriously unable to do.

Patent awards and applications provide a crude but telling picture. Consider trends in international patent awards by the U.S. Patent and Trade Office, the world economy's most important national patent office. Of the 1.3 million overseas patents awarded since 2000, applicants from Russia have taken home about 3,200—a mere 0.2% of the overseas total. In this tally Russia is behind Austria and Norway, barely ahead of Ireland. The Russian Federation's total annual awards from the Patent Office regularly lag behind the state of Alabama's. . .

If all this were not bad enough for Moscow, Russia's geopolitical potential is being squeezed further by the rapid world-wide growth of skilled manpower pools. According to the International Institute of Applied Systems Analysis in Austria, in 1990 Russia accounted for nearly 9% of the world's working-age college graduates; that share is declining and by 2030 will have dropped to 3%. On this front, as on many others, Russia is simply being left behind by the rest of the world.

Despite Vladimir Putin's posturing, he is leading a country in serious decline. If his dangerous new brinkmanship is a response to that bad news, then we should expect more of it in the future, possibly much more.

Mr. Eberstadt is a political economist at the American Enterprise Institute. His books include "Russia's Peacetime Demographic Crisis" (National Bureau of Asian Research, 2010).

http://online.wsj.com/news/articles/SB10001424052702303701304579547672003321680?KEYWORDS=eberstadt&mg=reno64-wsj&url=http%3A%2F%2Fonline.wsj.com%2Farticle%2FSB10001424052702303701304579547672003321680.html%3FKEYWORDS%3Deberstadt

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2. In the News: WSJ: Notable & Quotable: Mike Bloomberg at Harvard

Intolerance of ideas—whether liberal or conservative—is antithetical to individual rights and free societies.

From former New York City Mayor Michael Bloomberg's commencement address at Harvard University

Repressing free expression is a natural human weakness, and it is up to us to fight it at every turn. Intolerance of ideas—whether liberal or conservative—is antithetical to individual rights and free societies, and it is no less antithetical to great universities and first-rate scholarship.

There is an idea floating around college campuses—including here at Harvard—that scholars should be funded only if their work conforms to a particular view of justice. There's a word for that idea: censorship. And it is just a modern-day form of McCarthyism.

Think about the irony: In the 1950s, the right wing was attempting to repress left wing ideas. Today, on many college campuses, it is liberals trying to repress conservative ideas, even as conservative faculty members are at risk of becoming an endangered species. And perhaps nowhere is that more true than here in the Ivy League. Read more . . .

In the 2012 presidential race, according to Federal Election Commission data, 96% of all campaign contributions from Ivy League faculty and employees went to Barack Obama.

Ninety-six percent. There was more disagreement among the old Soviet Politburo than there is among Ivy League donors. . .

When 96% of Ivy League donors prefer one candidate to another, you have to wonder whether students are being exposed to the diversity of views that a great university should offer.

Diversity of gender, ethnicity, and orientation is important. But a university cannot be great if its faculty is politically homogenous. In fact, the whole purpose of granting tenure to professors is to ensure that they feel free to conduct research on ideas that run afoul of university politics and societal norms.

When tenure was created, it mostly protected liberals whose ideas ran up against conservative norms.

Today, if tenure is going to continue to exist, it must also protect conservatives whose ideas run up against liberal norms. Otherwise, university research—and the professors who conduct it—will lose credibility.

Great universities must not become predictably partisan. And a liberal arts education must not be an education in the art of liberalism.

The role of universities is not to promote an ideology. It is to provide scholars and students with a neutral forum for researching and debating issues—without tipping the scales in one direction, or repressing unpopular views.

Requiring scholars—and commencement speakers, for that matter—to conform to certain political standards undermines the whole purpose of a university.

This spring, it has been disturbing to see a number of college commencement speakers withdraw—or have their invitations rescinded—after protests from students and—to me, shockingly—from senior faculty and administrators who should know better.

It happened at Brandeis, Haverford, Rutgers, and Smith. Last year, it happened at Swarthmore and Johns Hopkins, I'm sorry to say.

In each case, liberals silenced a voice—and denied an honorary degree—to individuals they deemed politically objectionable. That is an outrage and we must not let it continue.

If a university thinks twice before inviting a commencement speaker because of his or her politics, censorship and conformity—the mortal enemies of freedom—win out.

And sadly, it is not just commencement season when speakers are censored.

Last fall, when I was still in City Hall, our Police Commissioner was invited to deliver a lecture at another Ivy League institution—but he was unable to do so because students shouted him down.

Isn't the purpose of a university to stir discussion, not silence it? What were the students afraid of hearing? Why did administrators not step in to prevent the mob from silencing speech? And did anyone consider that it is morally and pedagogically wrong to deprive other students the chance to hear the speech?

. . . As a former chairman of Johns Hopkins, I strongly believe that a university's obligation is not to teach students what to think but to teach students how to think. And that requires listening to the other side, weighing arguments without prejudging them, and determining whether the other side might actually make some fair points.

If the faculty fails to do this, then it is the responsibility of the administration and governing body to step in and make it a priority. If they do not, if students graduate with ears and minds closed, the university has failed both the student and society.

Read the entire address at WSJ: Notable & Quotable . . .

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3. International Medicine: The 10 leading causes of death in the world 2000-2012 - WHO

Ischaemic heart disease, stroke, lower respiratory infections and chronic obstructive lung disease have remained the top major killers during the past decade.

Noncommunicable diseases (NCDs) were responsible for 68% (38 million) of all deaths globally in 2012, up from 60% (31 million) in 2000. Cardiovascular diseases alone killed 2.6 million more people in 2012 than in the year 2000.

Lung cancers (along with trachea and bronchus cancers) caused 1.6 million (2.9%) deaths in 2012, up from 1.2 million (2.2%) deaths in 2000. Similarly, diabetes caused 1.5 million (2.7%) deaths in 2012, up from 1.0 million (2.0%) deaths in 2000. . .

Major causes of death

I: How many people die every year?

In 2012, an estimated 56 million people died worldwide. Read more . . .

II: What kills more people: infectious diseases or noncommunicable diseases?

Noncommunicable diseases were responsible for 68% of all deaths globally in 2012, up from 60% in 2000. The 4 main NCDs are cardiovascular diseases, cancers, diabetes and chronic lung diseases. Communicable, maternal, neonatal and nutrition conditions collectively were responsible for 23% of global deaths, and injuries caused 9% of all deaths.

III: Are cardiovascular diseases the number 1 cause of death throughout the world?

Yes, cardiovascular diseases killed 17.5 million people in 2012 that is 3 in every 10 deaths. Of these, 7.4 million people died of ischaemic heart disease and 6.7 million from stroke.

IV: Do most NCD deaths occur in high-income countries?

In terms of number of deaths, 28 million (about three quarters) of the 38 million of global NCD deaths in 2012 occurred in low- and middle-income countries.

In terms of proportion of deaths that are due to NCDs, high-income countries have the highest proportion – 87% of all deaths were caused by NCDs – followed by upper-middle income countries (81%). The proportions are lower in low-income countries (37%) and lower-middle income countries (57%).

V: WHO often says that smoking is a top cause of death. Where does tobacco use affect these causes of death?

Tobacco use is a major cause of many of the world’s top killer diseases – including cardiovascular disease, chronic obstructive lung disease and lung cancer. In total, tobacco use is responsible for the death of about 1 in 10 adults worldwide. Smoking is often the hidden cause of the disease recorded as responsible for death.

Why do we need to know the reasons people die?

Measuring how many people die each year and why they died is one of the most important means – along with gauging how diseases and injuries are affecting people – for assessing the effectiveness of a country’s health system.

Cause-of-death statistics help health authorities determine their focus for public health actions. A country where deaths from heart disease and diabetes rapidly rise over a period of a few years, for example, has a strong interest in starting a vigorous programme to encourage lifestyles to help prevent these illnesses. Similarly, if a country recognizes that many children are dying of malaria, but only a small portion of the health budget is dedicated to providing effective treatment, it can increase spending in this area.

High-income countries have systems in place for collecting information on causes of death in the population. Many low- and middle-income countries do not have such systems, and the numbers of deaths from specific causes have to be estimated from incomplete data. Improvements in producing high quality cause-of-death data are crucial for improving health and reducing preventable deaths in these countries.

Using a numbered code for each medical or surgical procedure helps define the procedure for greater consistency. These are the CPT codes, Current Procedural Terminology, which define the time and work involved with each procedure required for the diagnosis and management of each recorded ICD code. These have been spelled out with E & M (Evaluation and Management) descriptions for all medical and

surgical procedures. Read more . . .

The CPT coding system describes how to report procedures or services. These formerly included a Relative Value Scale. Then physician could use a conversion factor to determine all their fees in proportion to each other based on the number assigned. This was known as the 1964 RVS Medical Codes. These were revised five years later as the 1969 RVS Medical Codes. They were again revised five years later as the 1974 RVS Codes. When these were ruled as anticompetitive or collusion by the AMA (physicians) a study ensued. A large number of physicians and surgeons then met and designed a detailed description of each procedure to include the resources and time necessary to perform each procedure but with no numeric scale which was ruled as fee setting. This would allow a physician to base his or her fee more accurately on the basis of the amount of effort and resources required to perform each individual procedure but not all of his or her procedures. This was then called the Resource Based Relative Value Scale or RBRVS of 1992. The subsequent evaluation and management guidelines placed an estimate of the amount of time the physician should be spending on each procedure without any relative value.

This in turn provided the data which federal attorneys could use to prosecute physicians. For example if a procedure required 60 minutes or one hour per the guidelines, and if a physicians billings indicated that he or she did 20 such procedures in an 8 hour day, Medicare would down code the procedure to a lesser value. If this represented the usual practice, the physician could be prosecuted for up coding, e.g. since there could not be 20 one hour procedures done in one day, the RBRVS code should have been a 20 or 30 minute procedure. The brightest physicians, who could diagnose and treat two or three times faster than the dumbest, were at the highest risk of being prosecuted.

The prosecution would review a certain number of charts and if they found an average of a 50% error, they would apply that to his or her entire income and then fine the physician 50% of his or her income for the period in question and frequently a jail term. There is one report of a family physician making an error in going from the prior procedure code to the current one and he spent 22 months in jail. An ophthalmologist spent 66 months in prison. Of course, this made both physicians felons, and neither could practice or vote again. In many cases it disrupted or broke up the family when they lost their homes as their income became negligible. Their parents, of course, lost the quarter million dollars or so that was invested in their education. This was a governmental retaliation against physicians which had nothing to do with quality of care. In fact, the best of physicians who could do excellent care in half the time of the slowest and most inefficient among us, were very ones being prosecuted, imprisoned, becoming felons, losing their voting and basic civil rights. One federal attorney was heard bragging that he had jailed three doctors that helped clean up the medical profession.

With new coding scheduled to be implemented in Oct 2015, our HMO is already warning us to have three months of income stowed away because of the confusion and payment delays or payment cancellations in October 2015. Hence a number of physicians are planning to close their practice that day, not only to avoid any such financial risks, but also the risk of losing their medical license, their most valuable asset.

http://www.philhealth.gov.ph/circulars/2013/annexes/circ35_2013/Annex2_ListOfProcedureCaseRates.pdf

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Medical Gluttony thrives in Government and Health Insurance Programs.

It could become devastating when the government changes the basis for payment in bureaucratese.

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6. Medical Myths: The more tests I am able to obtain, the better my healthcare will be.

There is a prevailing opinion that the more test I can convince my doctor to order, the better my health care outlook. Please read Dr. Goodman’s report above. He points out that you could obtain your entire health care benefits in diagnostic studies and not even obtain a single helpful treatment. This you could use up your entire health care benefit and never get treated. Read more . . .

With personal control of your health benefits, this would never occur. You would always be aware of your benefits and control your costs to obtain the best for the money that you are willing to spend. Since this comes out of your available benefits, you would spend them wisely rather than maximize the testing which may not improve your health care. In fact if your diagnostic spending depleted your insurance benefit before you had arrived at a diagnosis, you couldn't get treated.

The magazine of the Sonoma County Medical Association

INTEGRATIVE MEDICINE - Weaning GERD Patients off PPIs

Sarah Murphy, MD, and Hana Grobel, MD

Mary (not her real name) is a 45-year-old woman who originally presented with mild gastroesophageal reflux disease (GERD) and was started on a proton pump inhibitor. When we first saw her three years later, she was still on PPIs.

As family physicians, we see many patients like Mary who are initially prescribed PPIs for mild GERD, continue their medication for a long time, and subsequently suffer various side effects associated with PPIs. The question that arises is how to safely wean these patients off PPIs. One possible answer is to use an integrative medicine approach.

But first, let’s back up and consider the function of the entire gastrointestinal tract and the processes that are involved in maintaining the health of our guts. Taken as a whole, the GI tract is one of the largest organs in our body, and its surface area can expand to the size of a tennis court. In our lifetime, we take in 30-40 tons of food that we break down, process, sort, and then use or eliminate . . . Read more . . .

In addition to the cells of the GI tract, the gut contains 100 trillion bacteria (400 different species), which is 10 times more than the amount of cells we have in our entire body. These bacteria break down food to make nutrients more available, inhibit pathogenic bacteria, and form a layer on the gut mucosa, which protects the intestinal lining and communicates with the enteric immune system.[1,2]

From the perspective of integrative medicine, when we ingest substances that harm this delicate ecosystem, the gut barrier can break down (known as increased intestinal permeability), the microbial ecology can become imbalanced (called dysbiosis), and we can ultimately get sick.[1] Disease not only shows up in the form of GI disorders (e.g., GERD, IBD, IBS, gastroenteritis), but can also present as systemic problems.[3] When the gut mucosa is disrupted, it can become inflamed. Through the more permeable intestinal walls, improperly digested food substances can cross the GI mucosa and trigger further inflammation.[1]

How do we keep our guts healthy and our immune systems intact? One integrative approach is to use the 5Rs of Functional Medicine, where the goal is to support optimal GI health and address the underlying mechanism of disease. The 5Rs stand for remove, replace, repopulate, repair and rebalance. These methods can be applied to many GI conditions, including GERD.

The problem with GERD is not that there is too much acid, but that the acid is in the esophagus rather than the stomach. PPIs block the secretion of acid, thus eliminating symptoms, but they do not address the underlying problem of regurgitation of the gastric lumen contents into the esophagus. In other words, PPIs don’t cure GERD; they only treat the symptoms.

Over time, the body upregulates acid production to compensate for the lack of acid secretion, so stopping PPIs becomes difficult because of rebound symptoms.[4] Some studies have found that long-term PPI use is associated with hyperplasia from increasing gastrin production, as well as increased gastric atrophy.[5,6] Although long-term PPI use has been associated with an increased incidence of gastric cancer, no direct link has been established.

PPIs are valuable in the short-term treatment of GERD, but long-term use may lead to serious complications, including increased risk for pneumonia and Clostridium difficile, and decreased absorption of vitamin B12, calcium, magnesium and iron.[7-12] In fact, our patient Mary was found to be Vitamin B12 deficient.

Despite these potential complications, PPIs are recommended in many circumstances, such as preventing gastrointestinal bleeding in elderly patients on NSAIDs. As with other medications, physicians need to balance the risks and benefits of PPIs, depending on the condition. They should also bear in mind that many patients are on PPIs with no good indication.

The long-term side effects of PPIs make sense based on the multiple roles of acid in the stomach. Acid functions to kill bacteria in the stomach, and it helps break down food to make nutrients more available. In the duodenum, acid helps stimulate release of pancreatic enzymes, which further aid digestion. Higher acidity in the stomach also increases the tone of the lower esophageal sphincter. Thus, acid production plays an important role in tightening LES tone, getting rid of unwanted bacteria, and providing us with properly digested nutrients.

Our goal with Mary was to wean her off PPIs and help her regain the normal function of her GI system. We used an integrative approach based on the 5Rs, as outlined below. Such an approach should begin at least one week before starting to wean patients off PPIs.

Remove. To stop symptoms and prevent their return, it is important to remove the triggers. Certain foods can be aggravating, including caffeine, spicy foods, alcohol, chocolate, fatty foods, dairy, and acidic foods, such as orange juice and tomatoes.[13,14] To identify triggers, patients can use a food diary to document food intake and symptoms. Alternatively, patients can try an elimination diet where specific foods are eliminated from the diet for 2-4 weeks, and re-introduced one at a time to see if symptoms return.[15] Other triggers may include tobacco use, increased weight, prone position, stomach distention and stress.[14] For some patients, addressing lifestyle factors may be enough to stop their GERD symptoms. Don’t underestimate the power of tobacco cessation, weight loss, propping the head of the bed 4-6 inches, eating meals several hours before lying down, eating smaller meals and stress management.

Replace. Once the main triggers are removed, non-aggravating nutritious foods can take their place. Patients may also benefit from replacing vitamin B12, calcium, magnesium or iron, if low.[10] In addition, one small study found that, instead of suppressing acid, some patients may benefit from supplementing with acid to increase LES tone, break down food and stimulate digestion.[16]

Repopulate. Patients who suffer from small bowel bacterial overgrowth after long-term suppression of stomach acid may benefit from probiotics. We recommend at least 10-14 billion units daily, preferably with several different species present. Some symptoms of bacterial overgrowth include bloating, gas, diarrhea and abdominal cramps.[17]

Repair. Various herbs and supplements may help protect and repair the lining of the gut.[3] Many of them act as demulcents and create mucoprotection of the esophageal mucosa, but they can also decrease absorption of other medications, so medication doses must be monitored.[3] One week prior to weaning off PPIs, patients can start taking one or more of the following herbs:

· Marshmallow (althea officinalis): can be ingested as tea, up to 5-6 grams daily, or as a tincture, 5 mL after meals.

· Licorice (glycyrrhiza glabra): best taken as deglycyrrhizinated licorice (DGL) 380 mg tablets, 2-4 tablets taken before meals. Glycyrrhizin acts as a mineralocorticoid and can cause hypertension, hypokalemia and edema with prolonged use, so deglycyrrhizinated licorice is recommended.

· Slippery elm (ulmus fulva) root bark powder: one to two tablespoons of the powder mixed with water and taken after meals and before bed. To increase palatability, mixture can be sweetened with honey.

· Chamomile (matricaria recutita): used for inflammation and spasmodic effects. 1-3 grams steeped as tea, 3-4 times a day.

· Throat Coat tea (Traditional Medicinals): contains all the above herbs (licorice root, slippery elm, marshmallow root), but in smaller amounts. Can be taken with meals.

Rebalance. The enteric nervous system houses more neurotransmitters than the brain and makes up 70% of the entire immune system, so stress can affect gut symptoms.[1,18] Many modalities can be used to help decrease stress and prevent the return of symptoms. Stress-reduction modalities include biofeedback, relaxation techniques, meditation, self-hypnosis and journaling. Some studies have found that acupuncture may be helpful for treating GERD symptoms.[19,20] Regular aerobic exercise is also recommended when tapering off PPIs, but symptoms can be exacerbated if exercise occurs right after meals.[13] High-intensity activities like running or cycling may aggravate symptoms.

When using the 5R approach above, it’s important to taper off the PPI slowly. The higher the dose, the longer the taper; counsel your patient to expect rebound symptoms. Begin by decreasing the current PPI dose by 50% each week until the patient is on the lowest dose once daily. After two weeks on this dosage, change to an H2 blocker. If the patient cannot tolerate going straight to an H2 blocker, you can alternate an H2 blocker every other day with omeprazole. After 2-4 weeks on the H2 blocker, taper or stop altogether. After 2 weeks off the H2 blocker, try tapering off supplements. Your patient will benefit from continued lifestyle modifications. . .

Read the entire article including the details of the 5Rs, lifestyle modification and references in Sonoma Medicine . . .

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VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about

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9. Book Review: The Bookshelf by Barton Swaim, WSJ

Book Review: 'Poems That Make Grown Men Cry,' edited by Anthony and Ben Holden

You don't need a degree in creative writing to be brought to tears by verse.

Terry George, the Irish screenwriter and director, chokes up whenever he reads Seamus Heaney's "Requiem for the Croppies." The sonnet is an acutely condensed retelling of the 1798 Irish rebellion, a series of battles in which an army of mostly peasants—"the pockets of our greatcoats full of barley"—tried to throw off British rule. He's right; the last three lines, recalling the rebellion's final battle on June 21, catch in the throat: Read more . . .

The hillside blushed, soaked in our broken wave,

They buried us without shroud or coffin

And in August . . . the barley grew up out of our grave.

Mr. George is one of the 100 men Anthony and Ben Holden queried for their anthology of "Poems That Make Grown Men Cry." The editors aren't trying to make the case for poetry—perhaps a hopeless task in our time—but the book does it anyway. Poetry, so easily assumed to be merely weird self-expression since the death of rhyme and meter, isn't that at all: It's the arrangement of language into rhythmical structures to make it say what it can't say otherwise. The Holdens remind us that you don't have to be an academic or a postgraduate in creative writing to be moved by verse. Or, indeed, brought to tears by it.

The editor Harold Evans couldn't fight them back reading Wordsworth's "Character of the Happy Warrior" at a colleague's funeral. The critic Clive James sheds them for his parents at "Canoe" by Keith Douglas. The novelist Sebastian Faulks cries over Samuel Taylor Coleridge's "Frost at Midnight" (a marvelous poem—though not, I would have thought, one likely to induce tears). Despite the slight hokeyness of the whole idea, the overall effect is to make excellent poetry seem like what it is: a wholly accessible language with its own range of expression and its own pleasures. . .

Read the entire book review found in the WSJ . . .

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The Book Review Section Is an Insider’s View of What Doctors are Reading about.

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10. Hippocrates & His Kin: Obamacare may be the most important issue in the next election.

Obama is losing members of his own party on multiple fronts including draconian EPA rules:

Leon Panetta, CIA director and defense secretary, has been blunt about the president’s mismanagement of the Middle East . . . after drawing a “red line” that would require the use of force against Bashar Assad if he used chemical weapons: “When the president of the United States draws a red line, the credibility of this country is dependent on him backing up his word.” [He didn’t]

Rob Ford, former ambassador to Syria, resigned in March and told CNN: “I was no longer in a position where I felt I could defend the American Policy.”

Senator Dianne Feinstein, Senate Intelligence Committee Chair, once a staunch Obama supporter has become increasingly unhappy over the administration’s lack of communication with Congress about the National Security Agency’s surveillance practices; disturbed that Congress was out of the loop regarding the exchange of five Taliban commanders to win the release of Army Sgt. Bowe Bergdahl. Read more . . .

Senator Mary Landrieu, Louisiana, has spoken out against the EPA rules that will severely punish coal-fired plants and endanger jobs.

Alison Lundergan Grimes, Democratic Senate candidate for Kentucky, has pledged to fight what she calls Mr. Obama’s “attack on Kentucky’s coal industry.”

Nick Rahall, West Virginia Rep, says that the EPA rule shows “disregard for the livelihoods of our coal miners and thousands of families throughout West Virginia.”

Max Baucus, former Senator, call the law a “train wreck.”

Sen Jay Rockefeller says the law is “beyond comprehension.”

Joe Garcia, Florida Democratic Congressman, is running for re-election by openly bashing ObamaCare.

Democrats have increasingly resisted the president’s judicial Picks including Michael Boggs and Mark Cohen, who blocked Vivek Murthy, Obama’s surgeon general appointee; and killed the nomination of Debo Adegbile, his appointee to head the Justice Department’s civil-rights division.

Nancy Pelosi, House Minority Leader, promised that Democrats would run on ObamaCare in November.

Many are not listening

Americans may still reject ObamaCare and save American Medicine, the world’s most advance Medical Care.

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Hippocrates and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Yesterday, Today & Tomorrow

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11. Restoring Accountability in Medical Practice, HealthCare, Government and Society:

• The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick wrote Lives at Risk, issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at www.ncpa.org and register to receive one or more of these reports.

• Pacific Research Institute, (www.pacificresearch.org) Sally C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may signup to receive their newsletters via email by clicking on the email tab or directly access their health care blog.

• The Mercatus Center at George Mason University (www.mercatus.org) is a strong advocate for accountability in government. Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, is now director of the Mercatus Center's Government Accountability Project. Join the Mercatus Center for Excellence in Government.

• To read the rest of this column, please go to www.medicaltuesday.net/org.asp.

• The National Association of Health Underwriters, www.NAHU.org. The NAHU's Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page. Be sure to scan their professional journal, Health Insurance Underwriters (HIU), for articles of importance in the Health Insurance MarketPlace. The HIU magazine, with Jim Hostetler as the executive editor, covers technology, legislation and product news - everything that affects how health insurance professionals do business.

• The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging on at www.galen.org. A study of purchasers of Health Savings Accounts shows that the new health care financing arrangements are appealing to those who previously were shut out of the insurance market, to families, to older Americans, and to workers of all income levels.

• Greg Scandlen, an expert in Health Savings Accounts (HSAs), has embarked on a new mission: Consumers for Health Care Choices (CHCC). Read the initial series of his newsletter, Consumers Power Reports. Become a member of CHCC, The voice of the health care consumer. Be sure to read Prescription for change: Employers, insurers, providers, and the government have all taken their turn at trying to fix American Health Care. Now it's the Consumers turn. Greg has joined the Heartland Institute, where current newsletters can be found.

• The Heartland Institute, www.heartland.org, Joseph Bast, President, publishes the Health Care News and the Heartlander. You may sign up for their health care email newsletter. Read the late Conrad F Meier on What is Free-Market Health Care?

• The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Lawrence W Reed, President, and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. Be sure to read the current lesson on Economic Education.

• The Council for Affordable Health Insurance, www.cahi.org/index.asp, founded by Greg Scandlen in 1991, where he served as CEO for five years, is an association of insurance companies, actuarial firms, legislative consultants, physicians and insurance agents. Their mission is to develop and promote free-market solutions to America's health-care challenges by enabling a robust and competitive health insurance market that will achieve and maintain access to affordable, high-quality health care for all Americans. "The belief that more medical care means better medical care is deeply entrenched . . . Our study suggests that perhaps a third of medical spending is now devoted to services that don't appear to improve health or the quality of care–and may even make things worse."

• The Independence Institute, www.i2i.org, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter.

• Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at www.quebecoislibre.org/apmasse.htm to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis.

• The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at www.fraserinstitute.ca for an overview of the extensive research articles that are available. You may want to go directly to their health research section.

• The Heritage Foundation, www.heritage.org/, founded in 1973, is a research and educational institute whose mission was to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. -- However, since they supported the socialistic health plan instituted by Mitt Romney in Massachusetts, which is replaying the Medicare excessive increases in its first two years, and was used by some as a justification for the Obama plan, they have lost sight of their mission and we will no longer feature them as a freedom loving institution and have canceled our contributions and many of our colleagues have done the same.

• The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we've seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at www.mises.org to obtain the foundation's daily reports. You may also log on to Lew's premier free-market site to read some of his lectures to medical groups. Learn how state medicine subsidizes illness or to find out why anyone would want to be an MD today.

• CATO. The Cato Institute (www.cato.org) was founded in 1977, by Edward H. Crane, with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens' ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. Read his bio, articles and books at www.cato.org/people/cannon.html.

• The Ethan Allen Institute, www.ethanallen.org/index2.html, is one of some 41 similar but independent state organizations associated with the State Policy Network (SPN). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor.

• The Free State Project, with a goal of Liberty in Our Lifetime, http://freestateproject.org/, is an agreement among 20,000 pro-liberty activists to move to New Hampshire, where they will exert the fullest practical effort toward the creation of a society in which the maximum role of government is the protection of life, liberty, and property. The success of the Project would likely entail reductions in taxation and regulation, reforms at all levels of government to expand individual rights and free markets, and a restoration of constitutional federalism, demonstrating the benefits of liberty to the rest of the nation and the world. [It is indeed a tragedy that the burden of government in the U.S., a freedom society for its first 150 years, is so great that people want to escape to a state solely for the purpose of reducing that oppression. We hope this gives each of us an impetus to restore freedom from government intrusion in our own state.]

• The St. Croix Review, a bimonthly journal of ideas, recognizes that the world is very dangerous. Conservatives are staunch defenders of the homeland. But as Russell Kirk believed, wartime allows the federal government to grow at a frightful pace. We expect government to win the wars we engage, and we expect that our borders be guarded. But St. Croix feels the impulses of the Administration and Congress are often misguided. The politicians of both parties in Washington overreach so that we see with disgust the explosion of earmarks and perpetually increasing spending on programs that have nothing to do with winning the war. There is too much power given to Washington. Even in wartime, we have to push for limited government - while giving the government the necessary tools to win the war. To read a variety of articles in this arena, please go to www.stcroixreview.com.

• Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of "educating for liberty." It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. While schools throughout the nation are bowing to an unconstitutional federal mandate that schools must adopt a Constitution Day curriculum each September 17^th or lose federal funds, Hillsdale students take a semester-long course on the Constitution restoring civics education and developing a civics textbook, a Constitution Reader. You may log on at www.hillsdale.edu to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. Congratulations to Hillsdale for its national rankings in the USNews College rankings. Changes in the Carnegie classifications, along with Hillsdale's continuing rise to national prominence, prompted the Foundation to move the College from the regional to the national liberal arts college classification. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, read Choose recent issues. The last ten years of Imprimis are archived.

• PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist, practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.patmosemergiclinic.com/ To read more on Dr Berry, please click on the various topics at his website. To review How to Start a Third-Party Free Medical Practice . . .

• PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. (http://home.earthlink.net/~doctorlrhuntoon/) Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.

• FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder, www.westandfirm.org, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance. Read Lin Zinser’s view on today’s health care problem: In today’s proposals for sweeping changes in the field of medicine, the term “socialized medicine” is never used. Instead we hear demands for “universal,” “mandatory,” “singlepayer,” and/or “comprehensive” systems. These demands aim to force one healthcare plan (sometimes with options) onto all Americans; it is a plan under which all medical services are paid for, and thus controlled, by government agencies. Sometimes, proponents call this “nationalized financing” or “nationalized health insurance.” In a more honest day, it was called socialized medicine.

• Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis."

• David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at www.ssvms.org. To read his "Lessons from the Past," go to www.ssvms.org/articles/0403gibson.asp. For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm.

• Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, which would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at www.peerreview.org.

• Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848, no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment. Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as the California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD. To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to www.semmelweissociety.net.

• The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to read News of the Day in Perspective: Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents.

• The AAPS California Chapter is an unincorporated association made up of members. The Goal of the AAPS California Chapter is to carry on the activities of the Association of American Physicians and Surgeons (AAPS) on a statewide basis. This is accomplished by having meetings and providing communications that support the medical professional needs and interests of independent physicians in private practice. To join the AAPS California Chapter, all you need to do is join national AAPS and be a physician licensed to practice in the State of California. There is no additional cost or fee to be a member of the AAPS California State Chapter.
Go to California Chapter Web Page . . .

Bottom line: "We are the best deal Physicians can get from a statewide physician based organization!"

• PA-AAPS is the Pennsylvania Chapter of the Association of American Physicians and Surgeons (AAPS), a non-partisan professional association of physicians in all types of practices and specialties across the country. Since 1943, AAPS has been dedicated to the highest ethical standards of the Oath of Hippocrates and to preserving the sanctity of the patient-physician relationship and the practice of private medicine. We welcome all physicians (M.D. and D.O.) as members. Podiatrists, dentists, chiropractors and other medical professionals are welcome to join as professional associate members. Staff members and the public are welcome as associate members. Medical students are welcome to join free of charge.

Our motto, "omnia pro aegroto" means "all for the patient."

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12. Words of Wisdom, Recent Postings, In Memoriam, Today in History . . .

Words of Wisdom—Aphorisms

Government is an endless pursuit of new ways to tax.

They used to say that the only thing the government didn’t tax was taxes. Then Lyndon Johnson invented the surtax.

The power to tax involves the power to destroy. Chief Justice John Marshall, Supreme Court decision in McCulloch v Maryland, March 6, 1819.

Some Recent Postings

In The March Issue:

MEDICAL TUESDAY . NET	NEWSLETTER
Community For Better Health Care	Vol XIII, No 1, April, 2014

Russia's human capital is in steep decline.

A 15-year-old boy there won't even live as long as one in Afghanistan.

Major causes of death

I: How many people die every year?

II: What kills more people: infectious diseases or noncommunicable diseases?

III: Are cardiovascular diseases the number 1 cause of death throughout the world?

IV: Do most NCD deaths occur in high-income countries?

V: WHO often says that smoking is a top cause of death. Where does tobacco use affect these causes of death?

Why do we need to know the reasons people die?

The magazine of the Sonoma County Medical Association

Book Review: 'Poems That Make Grown Men Cry,' edited by Anthony and Ben Holden

You don't need a degree in creative writing to be brought to tears by verse.

In Memoriam

Anthony Wedgwood Benn, spear-thrower of the British left, died on March 14th, aged 88

Del Meyer