MedicalTuesday

1. Featured Article: HIPAA - The Grand Deception

HIPAA does not protect health privacy

State Health Information Exchanges (HIEs) have been created to share your medical records statewide and in the National Health Information Network, now called eHealth Exchange.

2.2 million entities (600,000 health care providers and 1.5 million business associates) can access your private medical records without your consent. Read more . . .

The government has broad access to your medical records unless a stronger state law exists. HIPAA allows state laws to limit sharing and require consent.

Interoperable computerized medical records allow your data to be shared by health insurers, government officials, the data industry and others.

TAKE ACTION

NOTE: Signing the HIPAA form does not provide you with any privacy or consent rights, but your signature could be used against you if you ever declare that your privacy rights have been violated. Clinics and hospitals could use your signature to argue that you knew your information could be shared.

Take action to protect your health privacy:

Refuse to sign HIPAA acknowledgment forms.

Ask your state lawmakers to pass legislation that protects you from HIPAA and protects your private medical records from being accessed by the government and others without your voluntary informed written consent.

* Health Insurance Portability and Accountability Act of 1996 (HIPAA), the federal HIPAA Privacy Rule, and the Health Information Technology for Economic and Clinical Health Act (HITECH, 2009)

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2. In the News: Scandinavia says same sex marriage is not a right, but a privilege.

Strasbourg rules again: there is no human right to same-sex marriage and enshrines the traditional concept of marriage as being between a man and a woman [and] cannot be construed as imposing an obligation on the Contracting States to grant access to marriage to same-sex couples

There is no human right to a same-sex marriage; human rights law does not require countries to “grant access to marriage to same-sex couples”, and the state acts lawfully in seeking to defend the traditional understanding of marriage as between a man and a woman, according to a ruling by Europe’s highest human-rights court last week.

The judgement handed down by the European Court of Human Rights (ECHR) at Strasbourg both reiterates and reinforces a previous 2012 ruling which made clear that same-sex couples did not have a human right to enter marriage. Strasbourg’s consistent view is noteworthy because it has a clear remit to uphold anti-discrimination and human rights laws, and vigorously pursues the rights of gay among other minority groups.

Last week’s ruling is the final stage of a case first brought in Finland, where, uniquely in Scandinavia, there is no same-sex marriage (SSM) law, but where gay couples can access legal privileges through a civil union law similar to the UK’s 2004 civil partnership scheme. Read more . . .

The case involved a man, Heli Hämäläinen, who fathered a child with his wife of ten years, then (in 2009) had gender-reassignment surgery to acquire the anatomy of a woman. When she (as she regards herself) changed her first names in June 2006, she was told that she could not be registered as female while remaining married unless her wife consented to the marriage being turned into a civil partnership, which she refused to do; or unless the couple divorced, which they said they would not do.

Heli Hämäläinen took her case to Strasbourg after a six-year battle in the Finnish courts. She argued that her religious beliefs prevented her from seeking a divorce and that a civil union did not offer the same as marriage in terms of benefits and security to them and their child. The judges found however that

it was not disproportionate to require the conversion of a marriage into a registered partnership as a precondition to legal recognition of an acquired gender, as that was a genuine option which provided legal protection for same-sex couples that was almost identical to that of marriage.

Significantly, the judges also said that the European Convention on Human Rights cannot be interpreted “as imposing an obligation on Contracting States to grant same-sex couples access to marriage”. Only ten of the 47 signatories to the Convention have legalised SSM.

The Court had previously found no right to same-sex marriage exists in the Convention. This time it went further and explicitly stated that Article 12 of the Convention (dealing with marriage)

enshrines the traditional concept of marriage as being between a man and a woman [and] cannot be construed as imposing an obligation on the Contracting States to grant access to marriage to same-sex couples (§ 96).

Strasbourg has rightly read its human rights charter as stating that, while a state has the power to redefine marriage, it cannot create a human right by fiat (human rights should be recognized, not created, by the law of states.) The constant understanding of marriage as a conjugal institution based on sexual complementarity is what lies behind the universal human right to enter it, a right that can only be exercised by those able (an adult man and a woman, who are free to do so, and capable of consenting to its requirements) to fulfil its conditions.

This unambiguous clarification is also important for those who opposed, and continue to oppose, the UK government’s redefinition of marriage rushed through Parliament last year. The refuseniks were told at the time, and are increasingly told, that their opposition reflects “homophobia” or that they don’t respect gay peoples’ “human rights”. In fact, as the eminent judges at Strasbourg have made clear, their opposition upholds the human rights spelled out in the great international charters which laid the postwar foundation of western pluralistic democracies.

[Austen Ivereigh]

Read the entire report . . .

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3. International Medicine: Socialized medicine, same song, another verse

The Ugly Truth About Canadian Health Care

David Gratzer, MD

Socialized medicine has meant rationed care and lack of innovation. Small wonder Canadians are looking to the market.

_I was once a believer in socialized medicine. I don’t want to overstate my case: growing up in Canada, I didn’t spend much time contemplating the nuances of health economics. I wanted to get into medical school—my mind brimmed with statistics on MCAT scores and admissions rates, not health spending. But as a Canadian, I had soaked up three things from my environment: a love of ice hockey; an ability to convert Celsius into Fahrenheit in my head; and the belief that government-run health care was truly compassionate. What I knew about American health care was unappealing: high expenses and lots of uninsured people. When HillaryCare shook Washington, I remember thinking that the Clintonistas were right.

My health-care prejudices crumbled not in the classroom but on the way to one. Read more . . . On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute. Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care. I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic—with a three-year wait list; or the woman needing a sleep study to diagnose what seemed like sleep apnea, who faced a two-year delay; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks.

I decided to write about what I saw. By day, I attended classes and visited patients; at night, I worked on a book. Unfortunately, statistics on Canadian health care’s weaknesses were hard to come by, and even finding people willing to criticize the system was difficult, such was the emotional support that it then enjoyed. One family friend, diagnosed with cancer, was told to wait for potentially lifesaving chemotherapy. I called to see if I could write about his plight. Worried about repercussions, he asked me to change his name. A bit later, he asked if I could change his sex in the story, and maybe his town. Finally, he asked if I could change the illness, too.

My book’s thesis was simple: to contain rising costs, government-run health-care systems invariably restrict the health-care supply. Thus, at a time when Canada’s population was aging and needed more care, not less, cost-crunching bureaucrats had reduced the size of medical school classes, shuttered hospitals, and capped physician fees, resulting in hundreds of thousands of patients waiting for needed treatment—patients who suffered and, in some cases, died from the delays. The only solution, I concluded, was to move away from government command-and-control structures and toward a more market-oriented system. To capture Canadian health care’s growing crisis, I called my book Code Blue, the term used when a patient’s heart stops and hospital staff must leap into action to save him. Though I had a hard time finding a Canadian publisher, the book eventually came out in 1999 from a small imprint; it struck a nerve, going through five printings.

Nor were the problems I identified unique to Canada—they characterized all government-run health-care systems. Consider the recent British controversy over a cancer patient who tried to get an appointment with a specialist, only to have it canceled—48 times. More than 1 million Britons must wait for some type of care, with 200,000 in line for longer than six months. A while back, I toured a public hospital in Washington, D.C., with Tim Evans, a senior fellow at the Centre for the New Europe. The hospital was dark and dingy, but Evans observed that it was cleaner than anything in his native England. In France, the supply of doctors is so limited that during an August 2003 heat wave—when many doctors were on vacation and hospitals were stretched beyond capacity—15,000 elderly citizens died. Across Europe, state-of-the-art drugs aren’t available. . .

_But single-payer systems—confronting dirty hospitals, long waiting lists, and substandard treatment—are starting to crack. Today my book wouldn’t seem so provocative to Canadians, whose views on public health care are much less rosy than they were even a few years ago. Canadian newspapers are now filled with stories of people frustrated by long delays for care:

back patients waiting years for treatment:

vow broken on cancer wait:

most hospitals across canada fail to meet ottawa’s four-week guideline for radiation therapy

patients wait as p.e.t. scans were used in animal experiment

As if a taboo had lifted, government statistics on the health-care system’s problems are suddenly available. In fact, government researchers have provided the best data on the doctor shortage, noting, for example, that more than 1.5 million Ontarians (or 12 percent of that province’s population) can’t find family physicians. Health officials in one Nova Scotia community actually resorted to a lottery to determine who’d get a doctor’s appointment. . .

Read more, including Dr Jacques Chaoulli’s famous case which he took to the Canadian Supreme Court and Won: Final verdict: Canadians don’t have access to healthcare, they only have access to a waiting list.

Thank GOD, that we had a DOCTOR who was willing to give up his PRACTICE and fight for our suffering PATIENTS who were denied relief from a compressed spinal nerve.

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Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

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4. Medicare: Lifts the ban on Sex-Reassignment surgery

Medicare Ban on Sex-Reassignment Surgery Lifted

Decisions on Procedure Now Will be Made on Case-by-Case Basis

By Stephanie Armour, WSJ, June 1, 2014

WASHINGTON—Transgender people who receive Medicare benefits will no longer be automatically denied coverage for sex-reassignment surgery, a federal review board ruled Friday.

The decision means that Medicare, the federal health insurance program for seniors and those with disabilities, will now cover sex-reassignment surgery on a case-by-case basis rather than routinely denying the surgery under guidance adopted during the 1980s.

Although the Department of Health and Human Services appeals-board decision involved a single case—a New Mexico woman who sought gender-reassignment surgery—it could have broad ramifications because private insurance companies and Medicaid, the state-federal program for the poor, often follow Medicare's lead on coverage. Read more . . .

The surgery is often the last step in a long process toward gender-reassignment. Some people call themselves transgender even if they haven't had the operation.

"It's pretty clear there's no basis for the arbitrary discriminatory rule they established in the 1980s when they wouldn't cover it," said Mara Keisling, executive director at the National Center for Transgender Equality, an advocacy organization in Washington, D.C. "It's not up to bureaucrats anymore. It's up to doctors and patients. It's very important."

While the ruling doesn't require Medicare to pay for the surgery, it does mean coverage decisions will be made on a case-by-case basis by doctors and other Medicare contractors, based on clinical evidence that the procedure is medically appropriate, according to the Centers for Medicare and Medicaid Services.

The case decided Friday involved Denee Mallon, a 74-year-old transgender woman from Albuquerque, N.M., who was born as a male.

Her doctors agreed she should have sex-assignment surgery, but Medicare denied the procedure two years ago.

"Medicare determined there is no medical reassurance for this exclusion," said Ms. Mallon's attorney, Jennifer Levi, who heads the Transgender Rights Project of Gay and Lesbian Advocates and Defenders in Boston.

"This brings Medicare policy into the 21st century," Ms. Levi said.

America's Health Insurance Plans, a trade association for the health-insurance industry, said coverage for sex-reassignment surgeries varies by plan.

The total cost of transgender-specific care for one person is estimated at between $25,000 and $75,000, according to the Human Rights Campaign, an advocacy group for lesbian, gay, bisexual, and transgender people. The organization also said that many providers of gender-reassignment surgery might not accept Medicare coverage, posing a challenge to those seeking the procedure.

http://online.wsj.com/articles/medicare-ban-on-sex-reassignment-surgery-lifted-1401478303?KEYWORDS=Medicare+ban+on+Sex-reassignment

Editorial Comment:

We have one sexual dysphoria patient in our practice who was married, had three children and thought she was really a man trapped in a female body. She divorced her husband and had sex-reassignment surgery at a prestigious medical center. She is now a DAD (although a biologic mom) to her three children who also have another dad.

After the surgery, she married another female, and her clitoris, now with hormone treatment, is a small male phallus. He is able to insert his clitoris, after hormone therapy, into his wife’s vagina and achieve an orgasm. He has no ejaculation and cannot urinate through his penis since there is no urethra inside the shaft of his clitoris, now his penis. His urethra is still beneath the clitoral phallus, and does not go through it. Hence, he empties his bladder as she (he) did when he was still a woman. He had a scrotum built behind the clitoris which is now his phallus, and the urethra is behind his two aluminum testicles resting in his newly built scrotum. Since a female urinates straight down, the urinary stream does miss his aluminum testicles. He enjoyed showing the nurses on his last hospitalization where they had to insert the catheter by elevating his scrotum with the aluminum testicles, which are always in the male tight ejaculating position, even though he (she) does not ejaculate during his clitoral orgasm.

Of course, he had the rest of the transforming surgery. His breasts were amputated, his vagina was removed. He had a hysterectomy and a bilateral oophorectomy. And voila, he thought he was now in a male body. After hormone therapy, he was able to grow a beard, mustache, pubic hair, and his clitoris began to enlarge. It is now about 4 cm long. Which he states is long enough to stimulate his new wife’s clitoris and give her an orgasm.

He went through a psychiatric crisis. He was treated as a schizophrenic for a few years and on his last visit, his female wife states he is no longer schizophrenic, but was given a new diagnosis.

Was she really a male trapped in a female body? Or was she primarily homoerotic and liked girls better than boys? In our current open society, could she not have achieved her current status in a lesbian relationship without such mutilating surgery? Or is he now really a genetic female trapped in a female body modified to look like a male but still with the x-x chromosome which ultimately defines him as a genetic female. And she (he) is married to a genetic female with all the secondary female sex characteristics. Doesn’t this define the lesbian relationship, genetic female having sex with a true genetic female? Couldn’t she have this relationship without the operations and years of psychotherapy which more likely than not cost taxpayers more than $100,000.

Are sex-reassignment operations for sexual dysphoria ever indicated in our present society?

And now Medicare pays for these sex change operations?

How does a sex change operation in a 74-year-old transgender person bring us into the 21^st century?

Feel free to email any comments to delmeyermd@ix.netcom.com We may publish several. We’ll be happy to include your name and position with your permission.
PHI has to be sent through the Practice Fusion website.

Be sure to go to the WSJ site to read a large number of comments.

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Government is not the solution to our problems, government is the problem.

- Ronald Reagan

It may also make the problem worse!

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5. Medical Gluttony: It may be a good time to say Good-Bye to medicine.

See this section in previous issues concerning ICD 9 and CPT coding

The International Classification of Diseases is currently in its ninth edition and identifies 16,000 medical diseases or diagnosis. It is known as the ICD 9 and used by all physicians and surgeons. This is being up graded in the 10^th edition to 68,000 diseases and diagnosis in October 2015. It then will be known as the ICD 10 and all physicians and surgeons who bill Medicare, Medicaid, or any insurance plan will be required to use it

Current Procedural Terminology – CPT codes which include the Evaluation and Management Guidelines with descriptions for all medical and surgical procedures—are upgraded on an annual basis. These were discussed in this column in the previous issues of MedicalTuesday. This causes confusion in every specialty and many denials of payment for an inappropriate code. These denials will continue until the physician’s office staff sifts through the payment receipts and recognizes the error by lack of payment for a type of medical work done. Even then, it may be difficult to obtain a working code. Read more . . .

In our office we noted the lack of payment for pulmonary function tests. We thought that the diagnosis of asthma or emphysema would identify the disease and justify the procedure. After a number of months of doing PFTs free, our biller’s friend said you have to designate “wheezing” in addition to asthma or emphysema. Medicare was cross checking on a symptom or physical finding of a disease and wouldn’t accept the diagnosis alone. The Medicare bureaucrats didn’t think that doctors would come up with the correct diagnosis of a disease unless he/she also mentioned the symptom of the disease. But there are many symptoms of asthma or emphysema in addition to wheezing, such as shortness of breath, coughing, with or without phlegm or purulent sputum, and others. Maybe the next edition will require other symptom.

With 68,000 new diagnostic codes, with each having a number of symptoms and findings, is this a new Medicare weapon against physicians? Is that why our practice association has warned us to have at least three months income in the bank before October 2015?

In this column, we have been warning our colleagues that we may have Armageddon in October 2015. We have also given a number of examples of our colleague who thought he was very diligent in his coding, until several years after the last ICD 9 or CPT codes were upgraded. Then he had a visit by CMS and a US Attorney and was told he made an error in “up-coding” which is a federal crime. Without an attorney present, he apologized, said he would use whatever code they said should be used. The US Attorney obtained a signature from the doctor admitting that he did use the code they said was incorrect. (Later in the trial, he had witnesses stating that he did use the appropriate code, was actually down coding, and thus saved CMS money. Thus by some experts testimony he had not committee a crime.) After the signature, he was handcuffed and spent two years in jail. Of course, that doctor will never vote again, he lost his home paying attorneys after the fact rather than before the interview, and is a felon and will never practice medicine again. (The facts at the trial suggesting that no crime was committed made no difference in his outcome.)

There are numerous examples of high income surgeons having multi-million dollar fines and spending up to six years in prison. There are numerous examples that you will never hear about from your local, state medical societies or the AMA, which was a strong supporter of Obama and Obamacare. I’m told by those that should know that the leadership of the AMA was looking forward to being the chief negotiator for physicians in Obamacare just as the BMA is the chief negotiator for the NHS.

To keep in touch with all the hostilities toward physicians, you must join the AAPS, the Association of American Physicians and Surgeons. See below. Our attorney told us never respond to any medical legal matter, whether from Medicare, Medicaid, Medical Board, hospital board, HMO, IPA, Blue Cross-Blue Shield or any insurance carrier. Call her first and let her write the letter and provide all the legal response. She told us that Medicare, Medicaid, Medical Boards, Hospital Boards, HMOs, IPAs, Blue-Cross-Blue Shield or any insurance carrier is not and will never be your or any physician’s friend.

This became forcefully apparent to me. About six years ago when I went half time with a three office-day week, I moved further into suburban Carmichael. Since I still had a Carmichael address and phone, I thought this would be a simple address change. However, Medicare threw every obstacle at me for seven solid months. They treated me as a medical student entering practice for the first time. Every form had to be redone several times to please them even though they were letter perfect and very neat. After seven months, my wife got on the phone to Medicare and pleaded with them that lack of income for seven months was very devastating to her. She received a promise that Medicare would promptly expedite payment and we got our first check after seven months the following week. It was not a check that we felt covered seven months of rebilling, but it was a check for one week’s income. But the checks did come weekly thereafter. However, we never got a check that would indicate back payment for the 28 weeks of no payment.

So on the day that the New ICD 10 is implemented and required, I will close my office and say goodbye to the practice of Medicine, the love of my life where I spent all my energies for 50 years. I don’t want to spend the last 10 or 20 years of my life in prison. Or even 22 months in prison, which is the shortest sentence I’ve found in the 30 years I’ve been observing government’s hostility towards doctors. I will devote my energies to expanding this newsletter which now goes to six continents and 14 countries. This month we would like to thank the new MedicalTuesday subscribers from the US, UK, Canada, Chile, Japan, Korea, India, S. Africa and Germany. Welcome to all and thanks for joining us in our efforts for freedom in health care choice.

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Medical Gluttony thrives in Government and Health Insurance Programs.

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6. Medical Myths: Medicine is all about Science

In its quest to become the epitome of scientific discipline, the medical profession has lost sight of its

original goal—that is, to relieve suffering. Today, with our obsession with the “scientific method,” we have deviated far from that goal.

That is why the medical elite have coined the term “evidence-based medicine,” to emphasize that the new medicine is based solely on science. In the past, great doctors such as William Osler, call the “Father of Modern Medicine,” recognized that medicine should entail not just cold, hard science, but also humanistic arts.

The great men of medicine knew that doctors who were compassionate and who spent time with their patients produced better outcomes than those who were simply focused on “facts.” Read more . . .

Since the time of Hippocrates, it was known that God had placed within man the ability to heal. Benjamin Franklin expressed this best when he said “God heals and the doctor takes the fee.” . . .

Yet it is the chronic conditions . . . that have been most resistant to traditional treatments and have benefited the most from alternative treatments.

Modern medicine treats cancer with powerful drug combinations that have little positive impact on the majority of cancers. However, these drugs do make many curable cancers incurable and often shorten lives. Likewise, doctors ignore recent scientific advances in nutrients and nutrient supplements that do suppress cancer development and growth.

Worse yet, modern medicine ignores scientific evidence that common food additives such as MSG, omega-6 oils, and aspartame dramatically promote cancer growth. Ironically, many cancer patients are even encouraged to include these cancer-promoters in their diet.

But why are these things happening? Mostly, it’s because third-party payers have gradually taken over the decision-making process and inserted themselves between patients and doctors. Insurance companies, in several important ways, are as bad for your health as the government. They both can be unresponsive to the people’s desires or even the facts.

In addition, doctors who show an independent spirit and work outside the mainstream are ostracized. Creativity is being crushed beneath a system that rewards obedience and punishes independent thought. As a result, doctors are dispirited and many are retiring early.

Blaylock Wellness Report, Myth # 1, Jan 2013: 6 medical myths that threaten your life

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Doctors must arise and re-assume the role of physician-clinician-in-charge.

Myths disappear when Patients are able to solely relate to their physician.

Health insurers, Hospitals, and Government must respond only to what the “Doctor Ordered.”

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7. Overheard in the Medical Staff Lounge: Insurance companies practicing medicine

Dr. Rosen: The other day my doctor asked me what I did with all the information I received from our patient’s insurance carrier telling us how to care for our patients. How do most of you handle that scenario?

Dr. Edwards: I frequently scan the letter if I have an extra 30 seconds and then I toss it.

Dr. Milton: I usually give it a five second glance and then toss it. . . Read more . . .

Dr. Ruth: I read the first 20 or 30 before I realized that they were all government induced and thus of little importance except for their bracing for their own legal defense from a hostile government.

Dr. Joseph: As a retired surgeon you’d be surprised by the number of letters I still receive from insurance companies and pharmaceutical companies. That cost is a total waste of health care dollars. And I’m not sure what the reasoning it.

Dr. Michelle: I have my staff attach these letters to the patient’s chart so I can quickly cross check the topic with the patient’s medication list if from a pharmaceutical company or against the patient’s diagnosis list if it’s from the CMS (Center for Medicare and Medicaid Services).

Dr. Rosen: Much of this imposition of our time is no longer letters, brochures, or even samples. The new twist is a CD or even a CDROM from an insurance carriers, HMOs, IPAs, as well as pharmaceuticals in providing. I actually inserted one of these monstrosities into my computer, and within just a few minutes I had a giant textbook of information on display. It seemed like an 1800 page textbook of pharmacology. Since I had patients waiting, I had no time to peruse this any further. In fact, I never had an opportunity to return to this disk.

Dr. Sam: I had similar experiences. After tossing the first few, I started using those CDs as mats for tea or coffee cups.

Dr. Patricia: Thanks Sam, that’s a great idea to make use of those CDs. I always hate to throw useful things away.

Dr. Paul: I seem to keep everything that’s sent to me. I have books, journals, by-laws, drug company paraphernalia, and patient derived trinkets all over my office.

Dr. Patricia: Don’t the patients feel you might be a little disturbed mentally?

Dr. Paul: I don’t know. But so many of them seem to be impressed by what they see.

Dr. Rosen: I have a small sculpture of a silly old dog standing upright with a white coat and stethoscope that catches the fancy of just about every patient that comes in. I’ve kept it there for years. It’s even gotten a smile out of some of the most sourpuss patients in my practice. That’s worth its weight in gold.

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The Staff Lounge Is Where Unfiltered Opinions Are Heard.

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8. Voices of Medicine: The Dhar Diet, or D-Diet

Sonoma Medicine
The magazine of the Sonoma County Medical Association

COMMENTARY: The D-Diet

By Sanjay Dhar, MD

There are several hundred different types of diets out there, so I figured why not add one more to the list, the Dhar Diet, or D-Diet. How difficult can it be to come up with a diet? All I need to do is read a few books, adopt some basic ideas, tweak the concept and present it with a new “designer” name.

Diets range from A (Atkins) to Z (Zone), and there is no shortage of advice regarding the different diet plans. You may decide to choose one and stick with it or seamlessly switch from one diet to another. However, with all the diets out there and the endless advice offered, why then are Americans getting heavier at a faster pace than ever before? It seems that it’s a never-ending battle between the food industry pushing processed products that make us gain weight, and the diet industry, which has convinced us that we can never be satisfied with the way we are. Read more . . .

Is the truth somewhere in between? We do know that both these sectors are reaping billions of dollars in profits. Let us also not forget the consumer, who is the most important member in this complex relationship. Ultimately we have to be responsible for our actions, even though we know that we live in a free country where we can eat and drink whatever we want.

As a cardiologist, I have been giving dietary advice to my patients over the last 25 years. Diets come in various shapes and forms, with each having a tailored approach or a certain niche. My focus has been on preventing and hopefully reversing heart disease. I try to evaluate dietary habits rather than just giving a blanket order to “lose weight.”

Patients often have difficulty following guidelines because of poor food labeling. The label on a jar of peanuts may report 200 calories, for example, but you have to read the fine print to realize that the calorie amount mentioned is per serving, and that there are several servings per package. Unless patients take the time to read the label in detail, they often consume many more calories in a single sitting than they think. (A cup of peanuts actually contains 830 calories). The same concept is also true for salt and corn syrup content in processed foods. Unfortunately, we don’t have a fuel-gauge sensor in our body that tells us to stop eating when we have reached sustenance levels in calorie intake.

Why do people diet? Most do so to lose weight, to jumpstart the summer season, or to keep up with their new year’s resolution. Some are forced to lose a lot of weight because they have become morbidly obese and it’s affecting their health. Some diet to help their medical conditions, such as diabetes, hypertension, heart disease, arthritis of lower extremity joints, swelling of legs, reduced aerobic and functional capacity, exertional shortness of breath, easy fatigability, sleep apnea and abnormal cholesterol panels, to name a few. Some people have to change their diet because they have developed food intolerances, whether it’s gluten, dairy, nuts or other food ingredients. Then there are some disease states that demand special attention to food choices, such as chronic kidney disease, gout or other metabolic conditions.

For my patients, I recommend a drawn-up plan, any plan that has a chance of being successful. Ultimately losing weight is simple mathematics: calories in vs. calories out … or is it? We know that under extreme starvation, everyone will lose weight. However, since starvation is not practical or sustainable, weight loss should occur without extreme effort or significant time consumption. A good diet plan should be effortless and simple and yet not boring. . .

Providers and corporations have a financial incentive to treat obesity, and they market this concept everywhere. There are billboards (10 days and 10 pounds or your money back) and TV programs (The Biggest Loser), along with ads of all kinds for gyms, diet plans, weight-loss centers, fat farms and so on. Some of them do present compelling messages, but some sound too good to be true. How can you lose weight by eating more? When all else fails, there is always bariatric surgery. Although complications are rare, mortality is not 0%, and some patients do end up having lifelong morbidities.

In a nutshell, it is for us as physicians to decide what is appropriate, how far to promote weight-loss strategies, and what reasonable goals are. It also is up to patients to find a mandate of their own choice and not be driven by outward pressure to look a certain way.

What we do know is that if you consume fresh fruits and vegetables (Mediterranean diet) and reduce intake of highly processed foods, deep-fried foods, artificial sweeteners, foods high in corn syrup, sodas, and saturated fats, you will most likely reduce the probability of becoming obese and/or developing chronic disease conditions linked to heart disease, diabetes and cancer.

So what is the D-Diet? It is simply an ideal diet (heart healthy), made fresh every day from local ingredients. It’s not a liquid diet and it doesn’t come in small containers, cans or cardboard boxes. It’s effortless to follow, quick and easy to make, and is loaded with all kinds of flavors, colors and textures to take you on a pleasing gastronomic cruise. It doesn’t affect your bodily systems in any way, and there are new food choices every day. There are no worries about how much to eat and when to eat. It doesn’t cost a whole paycheck. And by the way, I am still working on it.

http://www.nbcms.org/AboutUs/SonomaCountyMedicalAssociation/Magazine/tabid/747/language/en-US/pageid/685/spring-2014-medical-controversies-feature-articles-commentarybrthe-d-diet.aspx +

Dr. Dhar is a Santa Rosa cardiologist. Email: santarosadoc@aol.com

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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 WSJ Bookshelf by Barton Swaim

Book Review: 'Sorry About That' by Edwin L. Battistella

The typical public apology purports to be an expression of regret and self-reproach, but in fact is meant to defend and justify

Public apologies might not be so nauseating if there weren't so many of them: Corporations apologize for real and imagined misdeeds; celebrities apologize for drunken tirades; and politicians apologize for nearly everything. Their aim, you feel, isn't to express genuine remorse or accept blame but to make the offense go away as quickly as possible. In 10 short chapters that examine scores of public apologies, Edwin Battistella's readable and incisive "Sorry About That" explains why some apologies succeed, or at least avoid exacerbating the original offense, but most of them fail. Read more . . .

The problem begins with the word itself: What is an apology, anyway? The classical meaning was a defense or explanation; the modern definition emphasizes the mental disposition of sorrow, regret and self-reproach. The typical public apology purports to be an apology in the modern sense—assigning blame to oneself, pleading for forgiveness—but in fact is meant to defend and justify. . .

Sometimes it's not clear what is and isn't an apology. After Hillary Clinton's health-care initiative failed in Congress in 1994, the first lady said in an interview: "I regret very much that the efforts on health care were badly misunderstood, taken out of context and used politically against the Administration. I take full responsibility for that, and I'm very sorry for that." Clearly she meant to blame others for the bill's demise, but was she apologizing for letting them do it? . . .

Read the entire book review at WSJ. . .

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

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10. Hippocrates & His Kin: Sophisticated terrorists with a sense of humor?

When al-Qaida-style insurgents overran the northern city of Mosul, among the war booty they seized were what they claimed were five U.S.-made helicopters. Noting that they were still nearly new, the group said in a posting on its Twitter feed, “We’ll expect the Americans to honor the warranty and service them for us.”

You think Obama may just do that?

The insurgents from the Islamic State of Iraq and Syria are sophisticated extortion racketeers in Mosul netting as much as $8 million a month. Once they are in charge, they typically levy taxes which are just as lucrative. Road taxes of $200 on trucks are collected all over northern Iraq to allow them safe passage. The Iraqi government says they are levying a tax on Christians in Mosul to avoid being crucified.

They must be trying to change their image from casual executioners to standard government practices.

Miss Manners is weighing in on Business Letters.

Dear Miss Manners: I like Best Wishes or Best Regards to end business correspondence, but I’ve been toying with alternatives for friends and family: “Live Healthy,” “Live free,” “Live well,” “Be well,” “Be safe.” Etc. Am I creating a trend perhaps not respectful of traditional (manners)?

Dear Gentle Reader: When traditions need improving, Miss Manners will let you know. There is nothing wrong with signing off with assurances of sincerity or good wishes or affectionate sentiments. Admonishing your correspondents to lead safe, healthy lives sounds remarkably like nagging.

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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?. This month, be sure to read ?

• 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.

• 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, Choose recent issues. The last ten years of Imprimis are archived.

• John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information

• Medi-Share Medi-Share is based on the biblical principles of caring for and sharing in one another's burdens (as outlined in Galatians 6:2). And as such, adhering to biblical principles of health and lifestyle are important requirements for membership in Medi-Share. This is not insurance. Read more . . .

• 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

Medicine is a science of uncertainty and an art of probability.

The art of the practice of medicine is to be learned only by experience; ‘tis not an inheritance; it cannot be revealed. Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone can you become expert.

Absolute diagnoses are unsafe, and are made at the expense of the conscience.

Taking a lady’s hand gives her confidence in her physician.

Things medical and gruesome have a singular attraction for many people.

Sir William Osler | Aphorisms | From his bedside teachings and writings.

Some Recent Postings

In The May Issue:

MEDICAL TUESDAY . NET	NEWSLETTER
Community For Better Health Care	Vol XIII, No 3, June, 2014

Strasbourg rules again: there is no human right to same-sex marriage and enshrines the traditional concept of marriage as being between a man and a woman [and] cannot be construed as imposing an obligation on the Contracting States to grant access to marriage to same-sex couples

The typical public apology purports to be an expression of regret and self-reproach, but in fact is meant to defend and justify

In Memoriam

Del Meyer