MEDICAL TUESDAY . NET
Community For Better Health Care
Vol XIII, No 7, Oct, 2014
In This Issue:
11. Restoring Accountability in Medicine, Government and Society
* * * * *
The Annual World Health Care Congress, a market of ideas, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study dataError! Hyperlink reference not valid. For more information, visit www.worldcongress.com. The future is occurring NOW.
* * * * *
1. Featured Article: A Campus Crusade Against the Constitution
By Harvey A. Silverglate | WSJ | Houses of Worship | Sept. 18, 2014
In my lifetime I have been fortunate to see private associations within civil society promote astonishing social and political advancements in civil rights for African-Americans, women and gays. The voices of a like-minded minority, when allowed to associate and present a unified message, can be powerful. Yet we cannot pick and choose which groups have rights. Thus the current controversy surrounding evangelical Christian organizations on college campuses is a test of our commitment to liberal and constitutional ideals.
Earlier this month the California State University System "de-recognized" 23 campus chapters of the InterVarsity Christian Fellowship (IVCF). This decision stems from a December 2011 chancellor's executive order stating that "No campus shall recognize any . . . student organization unless its membership and leadership are open to all currently enrolled students." Read more . . .
The new policy has insidious implications. Any student may attend IVCF meetings or participate in its activities regardless of belief. But because IVCF asks its leaders to affirm their adherence to evangelical Christian doctrine—a "belief" requirement—California state-university administrators have deemed the group discriminatory. IVCF chapters will no longer have use of certain campus facilities and benefits available to other groups. This policy guts the free association right that was enshrined in the First Amendment precisely to protect minority or unpopular views.
It is obvious why IVCF would want to restrict leadership to true believers. It would be anomalous for a conventional religious group of any kind to open its top leadership to, say, atheists who would want to change the group's beliefs and activities. The pope has to be Catholic, after all.
Yet this concept of associational rights is apparently foreign to college administrators, especially regarding religious students who hold out-of-favor views about marriage and abortion rights. As contentious as these issues are—especially within the ideological rigidity of the college campus—it is the constitutional right of students to hold unpopular beliefs and collectively espouse them.
The battle over the status of evangelical and other orthodox religious groups was long resolved in favor of the rights of such students to organize and enjoy equal access to colleges'—especially public colleges'—facilities. But this changed in 2010 when a narrowly divided Supreme Court decided Christian Legal Society v. Martinez.
In a confused 5-4 decision, the justices held that a public university did not violate the Christian Legal Society's First Amendment rights in depriving equal access to campus funds and facilities—as long as the university adopted an "all comers" policy that required all student organizations to accept all students as voting members and leaders, regardless of belief. Martinez was decided in the same muddled spirit as the California state-university policy, with all the same pitfalls. . .
Given the heat that surrounds discussion of gay marriage and abortion, out-of-the-ordinary disruptive tactics—by either side against the other's organizations—are a realistic concern. This is one reason why in an earlier era beleaguered minority groups like the NAACP and gay-rights groups were most in need of, and usually received, official protection from those who would undermine them.
In more recent years on college campuses the tables have turned, and religious groups that were once conventional now find themselves in need of protection. The Martinez ruling inadvertently compromised, rather than protected, the rights of minority groups.
The Martinez case and the plight of IVCF on campuses calls to mind an incident in 1995, some months after a wiser Supreme Court decided Hurley v. Irish-American Gay, Lesbian and Bisexual Group of Boston. The Hurley court held that a socially conservative organization that for decades had sponsored Boston's St. Patrick's Day parade had the right to exclude a gay-liberation group from marching while displaying its own gay-rights banners and placards.
Writing for the unanimous court, Justice David Souter declared that "a speaker has the autonomy to choose the content of his own message" and that the conservative Boston group didn't have to include marchers who would "alter the expressive content of their parade." The parade was a form of expression, and organizers didn't have to include off-message contingents.
One of the lawyers who lost in Hurley told me that he came to have a better understanding, and even an appreciation, of the ruling: He told me he had cited the Hurley opinion as precedent while representing a gay-rights group that went to court to prevent neo-Nazi brownshirts from marching in full regalia in the gay group's parade. Only when the First Amendment is applied equally to everyone can it fulfill its crucial role.
Mr. Silverglate, a Boston criminal-defense and civil-liberties lawyer, participated in the filing of a friend-of-the-court brief on behalf of the Christian Legal Society by the Foundation for Individual Rights in Education, of which he is chairman.
* * * * *
2. In the News: Obama’s ‘Horrible Bosses 3’ Audition
The president’s playbook when things go wrong: Deny knowledge, blame hapless subordinates
Announcing Defense Secretary Chuck Hagel’s resignation. Reuters
Of all the reputations Barack Obama has built over these years, the one that may figure most into his struggling presidency is the one that has received the least attention: He is a lousy boss. Every administration has its share of power struggles, dysfunction and churn. Rarely, if ever, has there been one that has driven more competent people from its orbit—or chewed up more professional reputations.
The focus this week is on Chuck Hagel, and the difficulty the White House is having finding the next secretary of defense. The charitable explanation is that lame-duck executives always have a challenge finding a short-termer to mop up the end of a presidency. The more honest appraisal came from a former Defense official who told Politico that Michèle Flournoy—a leading contender who removed herself from consideration—didn’t “want to be a doormat” in an administration that likes its failed foreign policy, and is keeping it.
“Doormat” has been the job description for pretty much every Obama employee. The president bragged in 2008 that he would assemble in his cabinet a “Team of Rivals.” What he failed to explain to any of the poor saps is that they’d be window dressing for a Team of Select Brilliant Political Types Who Already Had All the Answers: namely, himself and the Valerie Jarretts and David Axelrods of the White House.
These days, what able-minded Democrat would want to work for a boss who asks hires to check their brains at the door and then read from the talking points? Respected economist Christina Romer came in as Mr. Obama’s first head of his Council of Economic Advisers; she left after 18 months, tired of putting out imaginary numbers in support of the stimulus. Former Marine Commandant Jim Jones lasted about the same duration as national security adviser, until he wearied of saluting the political gurus.
The experienced Bill Daley came in 2011 as the chief of staff tasked with repairing Mr. Obama’s relations with the business community. He left a year later, having been stripped of many duties and trashed by the White House to the press. The sage Leon Panetta stepped up as defense secretary in 2011; he too left after 20 months of getting his head patted. The folks who look smartest now are those who fled early, while the fleeing was still relatively good—Rahm Emanuel, Austan Goolsbee, Larry Summers, Peter Orszag, Vivek Kundra.
Who would want to work for a boss who micromanages everything but takes no responsibility when things don’t work out? This president’s playbook for controversy: Deny knowledge, blame subordinates. Mr. Obama fails to recognize the threat of ISIS; it’s the fault of Director of National Intelligence James Clapper. The administration cancels White House tours to ratchet up the pain of the sequester, then blames the Secret Service for the uproar. The ObamaCare website fails; Mr. Obama faults the Department of Health and Human Services (run then by Kathleen Sebelius ) for not telling him of the problem. Veterans Affairs wilts under the scandal of waiting lists; the president claims he read about it in the news.
Who would want to work for a boss whose experiments in big government all but guarantee their reputation will be ruined in the aftermath of a bureaucratic collapse? Ms. Sebelius was once the governor of Kansas. She will be remembered as the woman who oversaw the most disastrous government rollout in history. Steven Miller will always be the guy who was running the IRS when the targeting scandal broke. Eric Shinseki was awarded three bronze stars and two purple hearts in Vietnam. He’ll be remembered for the waiting list cover-up at Veterans Affairs, an agency that is the model for ObamaCare.
And who wants to work for a boss who doesn’t have your back? . . . As Mr. Hagel was kicked to the curb this week, an anonymous White House campaign heaped the administration’s foreign-policy failures on the departing Republican.
Not that Ms. Sebelius or Mr. Shinseki and others didn’t deserve to have to resign; they oversaw disasters. The question so many potential nominees have about working for this White House goes to that very point: Is it possible to have any other experience working for Mr. Obama—a boss who doesn’t listen, views everything politically, always thinks he’s right, and whose policies are a recipe for a lost reputation? Hey Washington: Don’t all put your hands up at once.
* * * * *
3. International Medicine: NHS litigation claims double under coalition
Scale of clinical negligence claims is now unprecedented prompting claims that reorganisation has harmed patient care
The number of litigation claims made against the NHS in a year has almost doubled under the coalition, prompting claims that the service is failing to deal with growing demands on its limited resources.
The scale of the clinical negligence claims is unprecedented, with 11,945 cases reported by NHS trusts over the last financial year compared with 6,562 in 2009-10. Read more . . .
Such are the costs of dealing with the legal actions that the NHS has increased the amount of money it retains to deal with claims, up from £8.7bn in the first year of the coalition government to £15.6bn in 2013-14 – adding to the financial stresses within the service.
The analysis, based on figures published annually by the NHS Litigation Authority, comes as NHS England revealed that 35,373 patients waited more than four hours for treatment in the first week of December. That number was 66% higher than the same period last year. Meanwhile 7,760 people were kept on a trolley for between four and 12 hours before a ward bed was found – up from 3,666.
Amid a barrage of criticism on Friday, Dame Barbara Hakin, the national director of commissioning operations for NHS England, was forced to admit in interviews that the NHS was “under a huge amount of pressure”. “We are seeing far more patients than we ever have before,” she said. The Department of Health has insisted that the NHS was well prepared for winter and that an injection of £700m would pay for extra nurses, doctors and beds this winter. . .
Shadow health minister Jamie Reed said: “These figures provide indisputable proof that the NHS is heading seriously downhill.
“The vast majority of NHS staff now say David Cameron’s NHS reorganisation has harmed patient care. The sad truth is that, by turning the NHS upside down with a damaging reorganisation and causing a crisis in A&E, this government has made care problems more likely, not less.
“It is forcing the NHS to set aside soaring amounts for negligence claims – money that is desperately needed on the front line.”
It is believed that the rise of “no win, no fee” agreements has been another factor pushing up the number of people suing the NHS.
A change to the law in April 2013 might have been responsible for a rise in the number of claims in the period before the new law came in, but it is also likely to reduce the number of claims in the future. From April last year, the fee lawyers could charge was reduced from 100% to 25%.
The NHS Litigation Authority has also launched a new mediation service to resolve any claims “quickly and cost effectively”.
Its latest annual accounts said that maternity claims “represent the highest value and third highest number of clinical negligence claims reported to us”. It added: “The value of maternity claims can be very high (sometimes more than £6m) as the amount paid is for ongoing care, accommodation and specialist equipment needs. The NHS funds these settlements by way of a lump sum, followed by annual payments for life.
“This ensures that the child has financial security and that compensation that would otherwise be paid upfront is available for patient care.”
Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.
--Canadian Supreme Court Decision 2005 SCC 35,  1 S.C.R. 791
* * * * *
4. Medicare: Palliative and End-of-Life Care
September 23, 2014
The country's system for handling end-of-life care is largely broken and should be overhauled at almost every level, a national panel concluded in a report released on Wednesday, according to the New York Times.
According to some, the system is geared toward towards simply doing more toward the end of life which can be costly and not consistent with what the patients actually want. A report by a nonpartisan committee that was appointed by the Institute of Medicine has some recommendations for dealing with end of life care: Read more . . .
· First, Reimburse health care providers for conversations on advanced care planning.
· Restructuring Medicare, Medicaid, and other health care delivery programs.
· Eliminate perverse financial incentives that encourage expensive hospital procedures when low-tech services like pain management and home health care are available.
· Finally, accredited medical schools and groups as well as health providers should greatly increase training in palliative care.
Some recommendations, like changing the reimbursement structure so that Medicare would pay for home health services would require congressional action. In all, however ,the 507-page report, titled "Dying in America," said its recommendations would improve the overall quality of care and save a significant amount of money for our health care system.
Some critics argue that end-of-life choices that stem from the standpoint of economic savings would prompt the medical establishment to pressure people into rejecting life-sustaining treatment. However, in a survey of doctors about their own end-of-life care, many wish to be at home and simply free from pain. The conclusion of the study would not necessarily prompt premature deaths, but instead provide more choices for an increasingly diverse set of wants from a growing American population.
To accommodate this shift to more end-of-life planning, higher health education needs to be completely revolutionized to teach more palliative care skills and teaching. As it stands, many doctors are uncomfortable or ill-equipped to deal with the subject.
Source: New York Times, "Panel Urges Overhauling Health Care at End of Life," September 17, 2014.
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
5. Medical Gluttony: Government medicine cannot avoid gluttony.
Having worked primarily in government hospitals for the first 12 years of my professional life, I knew very little about private health care. Medical school had a university hospital for all our clinical work. There were generally two services: the ones that the resident/intern were primarily responsible for; and another for the professor’s private practice where only the resident was allowed/required to record the history and physical, and to order the laboratory, x-rays and other necessary procedures. Some of the attending staff were volunteers who taught one day a week and represented private practice. Read more . . .
On the colon/rectal service during my senior year, I must have gain the respect or admiration of a colon-rectal surgeon, who invited me to spend an afternoon in his office. Our first patient was an elderly lady with rectal pain and difficulty with having evacuation. Since she was a referral from an Internist he had reviewed the record and found no significant cardio-pulmonary as well as no other medical problems and went directly to a focused rectal/colon history. His nurse then prepared the lady for a digital rectal exam. We then re-entered the examination room where the patient was lying on her left side, her buttocks were neatly position and spread apart by the nurse. He applied K-Y lubricant to his gloved index finger and entered the anus and immediately found a large mass nearly obstructing the anal canal. He invited me to put on a pair of gloves. I applied K-Y Jelly to my index finger and immediately found the large mass, about the size of a lemon, covered by rectal mucosa. The buttocks were then covered by the nurse with a white sheet and the clinical professor addressed the patient and her husband who was at the head of the patient examination table. He discussed the tumor, which he stated was malignant, and needed to be removed. Since it was so close to the anus, she could only be reasonably cured by removing not only the cancer, but the anal sphincter. Thus she required a combined approach through her abdomen and from the anus. This was called an A-P resection and colostomy which would remain permanent. It would also require wearing a colostomy bag which would collect her feces. There then followed a discussion of the cost. The surgeon replied that would vary from $500 to as low as $0 if they had no funds to pay for it.
This was very impressive to a medical student who saw medicine in the raw before the advent of wide spread health insurance. This whole interface was in the world of private medicine, free enterprise, a direct relationship between a purchaser of health care and a provider of healthcare, which produced the lowest possible cost that was favorable to both parties. There could be no Medical Gluttony since no other party was involved to manipulate the system.
The world of health insurance companies’ determining what procedures were covered, by whom, and what the reimbursement would be was still decades away.
When insurance companies started to control prices allegedly to contain health care costs, prices mushroomed and inflation of nearly 100% occurred in the next two to three decades. The major unintended consequences of fee control were poorly understood by organized medicine and doctors in general. As doctors became more open to socialized medicine and as organized medicine openly supported Obamacare, they gradually became members of the TSR (Tax & Spend & Regulate) party. They adopted the fascist concept that we must exert greater control to reign in health care costs. They actually agreed with the socialist that controlling costs was their "sine qua non" and failed to understand how that was the very reason health care costs got out of control. They actually believed that we must “Regulate” and “Control” more firmly. This was epitomized by my successor as editor of Sacramento Medicine, who stated that the only reason socialized medicine hasn’t worked so far, is that people have too much freedom. This has also been echoed by Hillary Clinton when she also stated that Americans have too much Freedom. But isn’t that why our grandparents came to this country in the first place? Why return to Europe, where most of us originated from, when Europe is now in a death spiral?
Many insurance companies are now covering 100% of more and more items. This destroys the very concept that was putting any breaks on health care gluttony--a copayment on every test and procedure.
Medical Gluttony thrives in Government and Health Insurance Programs.
It is controlled with Appropriate Deductibles and Co-payments on Every Service.
Medical Gluttony disappears with a cash co-payment on every test and procedure which controls abuse and misuse.
* * * * *
6. Medical Myths: Government Medicine will give immediate access for everyone.
We’ve been in the practice of pulmonary medicine for the last 45 years. We've seen a large number of patients in respiratory failure. Hospitalization in an intensive or respiratory care unit may be required by some if the patient has obvious difficulty in moving air into and out of his lungs as manifested by a rise in his CO2 level heralding CO2 narcosis and impending coma. Then a quick intubation by placing an endotracheal tube into the trachea and attaching a mechanical ventilating machine to move the air for him can be lifesaving, slowly reducing the CO2 retention and reducing the work of breathing so the patient can rest and sleep. Read more . . .
At the other end of the spectrum are COPD and ASTHMA patient that aren’t going downhill as fast and are in the early phases of respiratory failure. These can frequently be reversed by tweaking the pulmonary treatment on an outpatient basis. There are a host of options from adding antibiotics if there is evidence of associated bronchitis; increasing the bronchodilator regimen orally or by increasing the frequency of the nebulizers.
It is in this phase that management skills come into play when trying to keep the patient out of the ICU. Every pulmonary patient, whether asthmatic, COPD, chronic bronchitis, pneumonia, and others has a pulse oxygen level taken on each visit. If the oxygen saturation is dropping, this is an emergency developing. The oxygen companies have been able to deliver oxygen within two hours so we can safely allow the patient to go home and know that he will be on oxygen shortly.
This has worked very well for 45 years with huge savings in health care costs by avoiding the high rent district of the ICU which costs thousands of dollars per day.
Approximately July 1, 2014, Medicare in their cost containment mode, decided to get rid of many of the respiratory care companies who deliver the oxygen to our patients and deal with just the lower bidders. Last month we had a patient who was very short of breath. She could barely make it from her car to our office. Her oxygen saturation was 83% by the time she reached our office. It improved to 94% while resting. Medicare requires documentation of the severity of the respiratory failure. This is normally done by measuring the saturation and proceeding on a six minute walk to see how low the oxygen goes. This patient collapse within three minutes and her oxygen saturation fell to 81%. Normal arterial oxygen saturation is 95 to 99%. Normal venous oxygen saturation is 75%. The lungs bring it back up to 95%.
So we called the oxygen vender company to have oxygen delivered to this patient’s home. We assumed that she would be safely on oxygen within two hours. Unfortunately we didn’t check on this. The next day we received a phone call from the patient notifying us that the oxygen had not arrived. We called the oxygen company and were told they were processing the request. But it appeared that our request had not followed the Medicare guideline. The guidelines required the additional step of adding the oxygen and then rechecking the oxygen saturation while walking with the oxygen to make sure the oxygen was effective in correcting the hypoxemia. If resting breathing room air was effective in restoring a normal blood oxygen level, adding oxygen was not necessary at rest since she corrected at rest. She was not able to ambulate without oxygen and thus she would be bedfast without the addition of supplemental oxygen.
But the vendor manager stated that this was not valid enough. The stats had to be printed out directly from the pulse-oximeter. Today's visit was an urgent F/U inasmuch as the patient still has no oxygen after one month. Hence we made an urgent phone call to Apria with whom we have dealt for many years. Brianne answers the phone. She won't give us her last name stating there is no one else with the same first name. She reviews the submission and states she wants office notes. We minded her that we have a consultative pulmonary practice, that we don't have office notes as a family doctor may have, and all our notes are complete exams and consultations. We sent her the entire office visit for Oct 29 with the detailed oxygen saturation studies at rest and on walking along with the oxygen orders. Brianne acknowledged she had these notes, the detailed order, and the saturations that were required
Our oximeter has no printout - she stated that Medicare required a printout directly from the recording device. But the stats were recorded directly in our Electronic Medical Record - She stated that Medicare could not accept my EMR because it had my input instead of directly from the Oximeter and therefore may not be valid. We pointed out that we are a pulmonologist and had done this for 45 years and never had a problem with getting our lung failure patients who were in desperate respiratory straits get oxygen the same day. She stated they could do still get oxygen out the same day, but it had to be a valid request on valid printout forms. She stated that I was responsible for following Medicare guidelines. We asked Brianne to fax the page of Medicare Guidelines she was using so we could verify her statements in regards to a patient's life at risk. She stated she would try but it would take a long time. But aren't you following the Medicare guidelines to have this discussion? This is a critical disregard of a patient's life in lung failure who can't walk more than 20 yards before her oxygen gets so low she essentially loses consciousness if she can't hold on to something or sit down while gasping at 30 breaths per minute. She can't even get into her own car without collapsing and holding on to the building rails panting at 30 breaths per minute. This is a callous disregard for human life. . . We are now two months post evaluation and our patient in severe lung failure still has not received the lifesaving oxygen because of government medicine bureaucracy.
This has increased with Obamacare which delays lifesaving care, lowers the quality of care (QOC), and jeopardizes human life. This is what health care is like in UK, Canada, and much of the rest of the world. We should not have to go through the same failed experiment. The United States chartered a new world order in 1776. We shouldn't have to deviating from own success story.
Medical Myths originate when someone else pays the medical bills.
Myths disappear when Patients pay Appropriate Deductibles and Co-payments on Every Service.
If Patients had a financial leg in the decision, they would deal directly with Medicare to obtain oxygen.
* * * * *
7. Overheard in the Medical Staff Lounge: How can we reduce reversed race riots?
Dr. Rosen: The events of Ferguson, riots, continue to have huge medical implications.
Dr. Sam: But the riots didn’t start until Jesse Jackson arrived and stirred up his base. Read more . . .
Dr. Dave: Without Jesse Jackson, there probably would not have been any riots.
Dr. Edwards: That’s probably correct. Racial prejudice today is primarily from the black against the white.
Dr. Milton: Talk radio suggested that Black people are more prejudiced than the white.
Dr. Edwards: Maybe we are placing the emphasis on the wrong end of the problem?
Dr. Rosen: Our editor has just eliminated the rest of this column feeling it would be misinterpreted by some.
The Staff Lounge Is Where Unfiltered Opinions Are Heard.
* * * * *
Kate Alfano, Colorado Medical Society, contributing writer
State effort focuses on safe use, storage and disposal
Tuesday, July 01, 2014
Aaron started using prescription opioids when he was in high school. From an upper-middle-class family, his parents described him as a typical teenager; light-hearted and full of energy, he was athletic and loved to wrestle. He went to a so-called “pharming” party where students raid their home medicine cabinets, bring any prescription drugs they can find, mix them up in a bowl, pick one or two, and chase them with a beer. Read more . . .
“That’s considered fun, a reasonable thing to do and reasonably safe because the kids think, ‘they’re just prescription medications. How dangerous can pills be?’” said Rob Valuck, PhD, president of the Colorado Prescription Drug Abuse Task Force and coordinating center director of the Colorado Consortium for Prescription Drug Abuse Prevention.
Without major incident from that first experience, Aaron continued his nonmedical use: trying one or two of his parents’ Vicodin, then one or two more; getting more from friends; and gradually falling into a downward spiral. Tolerance led to increased use, then to dependence, and ultimately addiction.
As his addiction became stronger, Aaron started to scam doctors for opioid medications. In an interview with authorities, he estimated that he visited between 40 and 50 doctors over an 18-month period and went to about an equal number of pharmacies to stay beneath the radar. He said most doctors would give him at least an initial prescription for Vicodin. When he developed a tolerance he progressed to OxyContin.
Aaron eventually started using Oxy- Contin at very high doses, often mixed it with Xanax and alcohol, and overdosed at age 21. He had a difficult stay in the ICU: two myocardial infarctions, seizures, a staph infection and pneumonia, on top of extreme withdrawal symptoms. Doctors prepared Aaron’s parents for his death, which appeared imminent and very likely. Surprisingly, he regained consciousness and eventually recovered well enough to be discharged home. But the overdose left him paralyzed and unable to speak.
“The worst consequence is death,” his mother said in a video about this real patient case for the Medicine Abuse Project. “Other consequences are, like Aaron, trapped in your own body alive but unable to communicate in the way that you would hope that you could. You also lose all of your hopes and dreams and everything you wanted to accomplish in your life.”
The growing epidemic
Prescription drug abuse and misuse is serious problem in Colorado and around the United States. In 2010, more than 38,000 people died from a drug overdose in the United States – one every 14 minutes, Valuck said. Nearly 60 percent of those deaths involved prescription drugs and, of those, 75 percent were opioid painkillers. In Colorado, the number of drug overdose deaths range from 250-500 per year; in 2010 it was just over 300.
The rates of misuse and overdose death are highest among men, persons ages 20-64, non-Hispanic whites, and those in poor and rural areas. “That said, this cuts across all strata demographically – age group, gender, race, ethnicity, diagnoses; it’s a problem all over the place,” Valuck said.
And while the public typically hears statistics on overdose deaths, Aaron’s story demonstrates that death isn’t the only outcome. In 2011, for every opioid overdose death, there were 10 treatment admissions for abuse, 32 emergency department visits for misuse or abuse, 130 people who met the medical criteria for abuse or dependence, and 825 selfadmitted nonmedical users.
“What’s gotten our attention in Colorado is that we’re high in the ranking in self-reported nonmedical use of prescription pain relievers among anyone age 12 or older,” Valuck said. “It’s nonmedical use that puts people at very high risk for becoming addicted and having those problems. That’s led us to do something about it.”
A small percentage of providers prescribe the majority of controlled substances. In Oregon, 8.1 percent prescribed 79 percent of these drugs, which Valuck said is typical, especially considering some specialties’ scope of work. “Many doctors prescribe few; some doctors don’t prescribe them ever. It’s really variable and we know that this isn’t an indictment on doctors or one type of doctor.”
However, providers who do prescribe these medications frequently inherently see more higher risk patients and are more likely to have patients who are doctor shopping for opioids. “It’s not necessarily your fault; it’s just the territory,” Valuck said. “You’re working with highly addictive stuff and people who become addicted. That’s where 63 percent of the overdose deaths come, among the 20 percent of prescribers who prescribe the most.”
One of the answers is to try to develop a coordinated response among the many stakeholders. “We could attack this problem at any place in the distribution chain, from manufacturers to the medical system to pharmacies to insurers and payers to patients and the public. Everyone needs education about this,” Valuck said.
As for physicians, he has six recommendations for what an individual can do to help mitigate the prescription drug abuse epidemic.
1. Take continuing education courses and seek out additional training.
2. Find and follow guidelines for safe opioid prescribing, whichever they are.
3. Be willing to prescribe less, whether that’s smaller quantities or other alternatives, and see patients more often.
4. Check the prescription drug monitoring program (PDMP) more often.
5. Educate patients on the importance of safe storage and disposal of unused medications.
6. Talk with colleagues, family, friends and neighbors about the issue and tell them stories about affected patients. . .
VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about
* * * * *
CURRENT BOOKS: More Happiness, Less War
Brien A. Seeley, MD
Moral Tribes: Emotion, Reason and the Gap Between Us and Them, Joshua Greene, 432 pages, Penguin (2013).
Think about your mom and dad. Remember their unconditional loving-kindness, their memorable storytelling and their exemplariness. Tenderly whisper your thanks to them for your precious morality, your compass for navigating life. Your morality runs deep, etched into your heart. It is the cornerstone of who you are and is used in decision-making every day. It evolved from the sum of your life experiences as a perfect fit for your culture, your tribe. Though it is not infallible, it provides your first, fastest and usually best assessment of what to do. Even though it was formed from sayings as simple as “because Mommy said so,” your morality is your surest tool for achieving happiness.
The above paragraph states the basic premise on which Harvard brain scientist and sociobiologist Joshua Greene builds a more expansive view of morality in his new book, Moral Tribes. Greene views morality as our human capacity for solving five basic types of social conflict: “me vs. you,” “me vs. us,” “us vs. it,” “us vs. us” and “us vs. them.” If we look at some memorable examples of these conflicts, we can better appreciate Greene’s prescription for happiness. Read more . . .
Me vs. you. In a 1960s television skit, Red Skelton plays a hungry hobo on a park bench (Freddie the Freeloader) who sees a cake fall out of a passerby’s grocery bag. As Freddie gets ready to cut the cake, the other hobo on the bench insists that Freddie share the cake with him, saying, “If we are to split the cake fairly, you should let me cut the cake.” Freddie shrugs and hands him the cake, which he cuts into a big piece and a little piece, keeping the big piece for himself. Freddie objects, saying, “That’s not fair. Why, if I had cut that cake I would have given you the bigger piece.” The sly hobo indignantly retorts, “Well, what are you whining for? That’s exactly what I did.” The issue here is clearly individual selfishness.
Me vs. us. After the famous mutiny on the Bounty in 1789, the mutineers set Captain Bligh and 18 loyal crew adrift in the Pacific Ocean in a 23-foot boat with meager provisions. Bligh and his crew soon faced a classic potential “tragedy of the commons” in which selfishness by some can lead to disastrous results for all. Miraculously, aside from one crewman killed by natives of Tofua, all of the Bligh loyalists cooperated well enough to survive an arduous 47-day voyage to the island of Timor in the Dutch East Indies.
Us vs. it. In the movie All Is Lost, Robert Redford plays a single-handing sailor who awakes to find that the hull of his sleek ocean-going sailboat has been fatally gashed by a large metal shipping container floating in the middle of the Indian Ocean. As the bobbing sailboat’s cabin floods and ruins his high-tech equipment and water supply, the solitary Redford realizes his desperate plight against a relentless, amoral opponent, the sea. A violent storm sinks the sailboat, leaving him in a flimsy raft. His only real hope is to raise the awareness of strangers to his plight, but crew on the containerized cargo ships in the area pass unaware of him. This allegory about the peril of disregard for the environment presents a cautionary tale about us vs. it.
Us vs. us. George Washington’s farewell address is devoted to warning about the divisive perils of factions and party politics. It is read ceremonially each year to Congress and bears repeating here:
[Parties] serve to organize faction, to give it an artificial and extraordinary force; to put, in the place of the delegated will of the nation, the will of a party, often a small but artful and enterprising minority of the community; … [parties] are likely, in the course of time and things, to become potent engines, by which cunning, ambitious, and unprincipled men will be enabled to subvert the power of the people, and to usurp for themselves the reins of government; destroying afterwards the very engines, which have lifted them to unjust dominion.
Amazingly, Washington’s prescient words foretell such momentous events as the Civil War and Hitler’s rise to power. Even today, our staunchly partisan Congress fiddles myopically while major problems continue to burn. Greene points out that, unlike the world’s major religions, the diverse tribes that make up the American public lack a single unifying moral code, an “us.” Instead, our polarizing two-party system, recurring re-election campaigns and the Citizens United decision provide a perfect nest for amoral corporate lobbyists who fulfill the role of the “enterprising minority” described by Washington.
Us vs. them. These are the titans of conflicts, occurring usually between nations and religions. Examples abound, and include all wars, genocide and terrorist group activity. Greene gives these conflicts the most attention, reminding us that political and religious strife tragically killed 230 million people in the last century.
Of the five types of conflicts, Greene admits that the lower-stakes “me” types are usually solved by our innate moral compass, our gut feelings, our heart. But the larger “us” type, he says, urgently demand a different moral compass, one with a mindset toward utilitarian solutions--solutions that impartially seek the greatest happiness for all. This dual-process approach to morality is the main message of Moral Tribes. Greene presents extensive results from psychological thought experiments and brain imaging to support the dual-process approach as the best one available.
Greene wants us all to become moral thinkers. Like Damasio, Kahneman and Claxton before him, Greene recognizes that we need both fast and slow thinking to ideally sift our choices from our enormous decision trees. The fast thinking is our knee-jerk parental morality. The slow, deliberate thinking is how we cooperate on more complex issues. It is the tool one uses in chess to plan moves ahead, to foresee outcomes and consequences.
Green gives cooperation the highest respect: “From simple cells to supersocial animals like us, the story of life on Earth is the story of cooperation. Cooperation is why we’re here, and yet, at the same time, maintaining cooperation is our greatest challenge”. Morality, writes Greene, evolved because “cooperation by individuals conferred a survival advantage to their group” or tribe. The problem came when such tribes grew large and began to interact and selfishly compete. (Oddly, Greene makes no mention of Harvard’s E.O. Wilson, the pioneering authority on the evolution of social cooperation.)
Selfishness--that abomination to Aristotle, yet the engine of progress to Adam Smith and Ayn Rand--underlies each of the five types of social conflict. It is how each of us inherently perceives the world. The Golden Rule, for most of us the touchstone of morality, works because selfishness can be seen in others better than in oneself. If we had a selfishness thermometer whose spectrum ran from greedy to supremely generous, most of us could place people we know somewhere along that spectrum. Greene presents research to show that one’s place on that spectrum is closely related to which “tribe” we are from. . .
Greene enumerates 16 human factors that guide our moral impulses, ranging from empathy and love to embarrassment and righteous indignation. These factors collectively determine our sense of decency and our innate reactions to cheaters in our tribe. The human tendency to gossip and rumors, says Greene, extends these reactions widely across a tribe or community, and ensures effective accountability for everyone in the tribe.
Our sense of decency makes us care that people have rights to things that were unjustly taken from them. We do what we can to atone for past sins; but Greene would have us shorten the scorecard for past wrongs by employing another moral principle: forgiveness. Our tendencies for forgiveness, he writes, “are adaptive strategies in a world where mistakes happen.” He suggests that all legacy rights must be tempered with an overriding rule to seek the greatest future happiness.
Greene devotes a good deal of space to discussing the goodness of utilitarianism and defining its goal of happiness as being far more generic than smiles and plenty. Greene wants utilitarianism to be embraced as everyone’s common moral currency. He makes this seem reasonable and acceptable at first blush. However, philosophers like John Rawls point out that utilitarianism can violate the rights of the individual, rights that many philosophers and religions consider sacrosanct. Greene dismisses the sanctity of individual rights as an annoying impediment to negotiating best-case solutions to titanic problems. When an opponent objects that a solution violates some right(s), Greene says, that opponent is seeking to effectively end the argument by inserting an ingredient that cannot be decided by evidence. To many, this will be a key weakness in Greene’s approach. Again, the innate moral compass runs deep. . .
Greene communicates well, with a just-right mix of formality and jargon. He personalizes in places and confronts current events with his own frank views. This approach makes the book flow with understandable meaning.
He concludes with six rules for solving moral problems. The rules can be paraphrased as follows:
• For “me vs. us” disputes, use your fast, innate moral compass--what your parents taught you as right and wrong.
• Do not use “rights” in arguments or disputes. Though they feel like a trump card, rights are abstract and not amenable to reason by evidence.
• Focus on facts and evidence regarding the actual consequences of proposed policies. Include both primary and secondary consequences.
• Beware of insidious and obvious “biased fairness” in all positions taken.
• In “us vs. them” disputes, use the common moral currency of maximizing happiness by employing the common factual currency of science.
• Give. The affluent need to make sacrifices to help the less fortunate.
Greene’s comprehensive treatise to develop a scientifically supported, universally accepted set of rules for negotiating maximum happiness is heroic, if naive. Such rules, like Robert’s Rules of Order, would be a great help if widely ratified by diplomats, elected officials, school boards and church councils. It remains to be seen if these rules can win the kind of commitment necessary for resolving deep conflicts about abortion, evolution, climate change or the distribution of wealth. One hopes that Greene’s next book will map a way to win such commitment.
Dr. Seeley, a Santa Rosa ophthalmologist, serves on the SCMA Editorial Board.
The Book Review Section Is an Insider’s View of What Doctors are Reading about.
* * * * *
10. Hippocrates & His Kin: The In Vivo organ grinder
Hysterectomy by morcellator: A sophisticated meat grinder used to grind up the uterus and use the peritoneal cavity as the mixing bowl while aspirating the “uterine sausage” that the morcellator made. Read more . . .
Any second year medical student knows that would cause cancer to spread faster than any metastases by blood or lymph channels.
Tax the Web
Europe wants to tax the internet magnus companies but hasn’t figured out how. Germany & France, the world’s 4th and 5th largest economies, don’t have one successful web site.
Instead of taxing Silicon Valley out of existence, maybe they should learn the basics first.
Does Europe really want Silicon Valley to retreat in this war?
OK, since Europe has declared war on silicon valley, how about Google, Apple, Amazon & Facebook, abandoning Europe and let the Eurozone see how long their “Crib to Casket” economies last.
They would probably ask Google, Apple, Amazon and Facebook to come back before Europe totally tanked.
Hippocrates and His Kin / Hippocrates Modern
The Challenges of Yesteryear, Yesterday, Today & Tomorrow
* * * * *
• 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.
AND NOW WE’VE LEARNED THAT THE PERSON THAT DESIGNED ROMNEY’S SOCIALISTIC MEDICAL PROGRAM WAS THE SAME PERSON DESIGNING OBAMACARE. HE THOUGHT PEOPLE WERE TOO STUPID TO RECOGNIZE WHAT IT REALLY WAS. HERITAGE FOUNDATION--YOU CANNOT MAKE SUCH SOCIALISTIC MISTAKES AND SAY THAT YOU PROMOTE PUBLIC POLICIES BASED ON THE PRINCIPLES OF FREE ENTERPRISE, LIMITED GOVERNMENT, INDIVIDUAL FREEDOM, TRADITIONAL AMERICAN VALUES AND A STRONG NATIONAL DEFENSE WHEN YOU SUPPORTED MITT ROMNEY AND OBAMACARE LITE IN MASSACHUSETTES ENSLAVING A ONCE NOBLE PROFESSION.
• 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 17th 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.
• 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."
* * * * *
“Laughter is God’s gift to mankind,” said the preacher.
“And mankind is the proof that God has a sense of humor,” said the cynic.
Being funny is no laughing matter.
A joke that has to be explained is at its wit’s end.
Whether something is funny often depends on whom it is happening to.
Laughter is more contagious than tears.
He who laughs lasts. . . .
People who can agree on what’s funny can usually agree on other things.
Many friends have been lost by jest, but few have been gained.
Some Recent Postings
In The September Issue:
11. Restoring Accountability in Medicine, Government and Society
| From the print edition | The Economist | Oct 11th 2014
WHEN the job of dictator of Haiti fell to his lot in 1971, Jean-Claude Duvalier did not want it. “What about Marie-Denise?” he asked. His bossy elder sister would make an ideal tyrant for this dilapidated, sun-scorched, miserable western end of the island of Hispaniola. And she was desperate to do it, too. Or what about Simone, his mother, already First Lady in the gleaming white National Palace in Port-au-Prince? Even his father, the much-feared Papa Doc, had been heard to say that his fat, gormless son was “not the best option”. But when the time came, Papa Doc’s successor had to be a man; and so the grim paternal hand, small and wiry as a claw, descended on Jean-Claude’s ample shoulder. “I’ve chosen him”, the posters said.
The people of Haiti had not had that pleasure. They endorsed the choice, though, in a referendum that passed by 2,391,916 to one. The machinery of terror set up by Papa Doc, reinforced by tontons macoutes(“bogeymen”) armed with sugar-hacking machetes, obviously held good. And Jean-Claude’s life of indolence, which consisted of snoozing through any instruction, rampant all-night sex romps and platefuls of grilled spiced pork washed down with 7-Up, was jolted up a bit. Read more . . .
He was 19, and had no idea what a ruler-for-life was supposed to do. His father, consumed by the revolution he was visiting on Haiti, never had time to train him. His childhood was that of most spoiled rich boys, punctuated by bursts of close gunfire—once during a Mardi Gras parade and once, killing the chauffeur of his limousine and two of his bodyguards, as he walked into school. He did not seem either bothered, or alerted. It became apparent only later that he had ingested many of his father’s ideas: of Haiti’s ruler as a version of God, or in his case God the Son; of its people as flawed, confused and barely rational, needing the slap of firm rule; of Haiti as a fief, and its paltry revenues as his own bank account; of marauding macoutes as his back-up plan of choice; and of his own ideology, Jeanclaudisme, as something to make “hearts beat and chests swell”.
Early on, he was happy to let himself be led by the forceful women round him. The habit took hold. At first it was his mother who dragged him to cabinet meetings (through which he slept) and fired ministers right and left. Then, after he had fallen in 1980 for the wildly sexy Michèle Bennett, a woman he saluted as “really dangerous!”, she did the firing. She also sent his mother packing, after months of screaming arguments all round the palace.
Jean-Claude already had a taste for stylish dressing and nice cars; but marriage to Michèle accelerated the plundering of government departments, to the tune of $16m in the first three months of 1981 alone. The cash went on furs, jewels, shopping trips to Paris, Givenchy gowns, champagne parties and gold-and-lapis lazuli fittings for the palace bathrooms. Few Haitians at the time enjoyed sewerage, or a paved road. The more miserable they were, though, the more foreign aid came in, to be smartly diverted into Duvalier pockets. There was simply no incentive for the playboy dictator to improve things. In fact, the reverse.
Dancing with the devil-
On This Month in History – October
Between the lazy days of summer and the chilly days of autumn, there’s a time when the days are sunny and warm, but the nights are crisp and cool. It’s called Indian Summer. The green leaves of summer begin to change their hue to yellow, orange, and burnt red; pumpkins and maize ripen in the fields. Native Americans harvested nature’s bountiful array of nuts, fruits, and vegetables; fished its clear running rivers for salmon and trout; hunted the herds of wild buffalo; and stalked the mountains for bear, moose, and deer.
On October 1, 1939, the files of history record that Winston Churchill said: “I cannot forecast to you the actions of Russia. It is a riddle wrapped in a mystery inside an enigma.” Churchill was wise to admit that no crystal ball or logical progression could predict the future actions of something and someone over whom he exerted no control.
On October 1, 1908, Henry Ford introduced the Model T. The Model T, known affectionately as the Tin Lizzie, pulled automobile manufacturing into the era of assembly lines, interchangeable parts and mass production. Even though Ford borrowed some of his production methods from Eli Whitney and other inventers, he was the first to apply it to such a complex piece of machinery that appealed to so many people.
After Leonard and Thelma Spinrad
Thank you for joining the MedicalTuesday.Network and Have Your Friends Do the Same. If you receive this as an invitation, please go to www.medicaltuesday.net/Newsletter.asp, enter you email address and join the 10,000 members who receive this newsletter. If you are one of the 80,000 guests that surf our web sites, we thank you and invite you to join the email network on a regular basis by subscribing at the website above. To subscribe to our companion publication concerning health plans and our pending national challenges, please go to www.healthplanusa.net/newsletter.asp and enter your email address. Then go to the archives to scan the last several important HPUSA newsletters and current issues in healthcare.
Please note that sections 1-4, 6, 8-9 are entirely attributable quotes and editorial comments are in brackets. Permission to reprint portions has been requested and may be pending with the understanding that the reader is referred back to the author's original site. We respect copyright as exemplified by George Helprin who is the author, most recently, of “Digital Barbarism,” just published by HarperCollins. We hope our highlighting articles leads to greater exposure of their work and brings more viewers to their page. Please also note: Articles that appear in MedicalTuesday may not reflect the opinion of the editorial staff.
ALSO NOTE: MedicalTuesday receives no government, foundation, or private funds. The entire cost of the website URLs, website posting, distribution, managing editor, email editor, and the research and writing is solely paid for and donated by the Founding Editor, while continuing his Pulmonary Practice, as a service to his patients, his profession, and in the public interest for his country.
Spammator Note: MedicalTuesday uses many standard medical terms considered forbidden by many spammators. We are not always able to avoid appropriate medical terminology in the abbreviated edition sent by e-newsletter. (The Web Edition is always complete.) As readers use new spammators with an increasing rejection rate, we are not always able to navigate around these palace guards. If you miss some editions of MedicalTuesday, you may want to check your spammator settings and make appropriate adjustments. To assure uninterrupted delivery, subscribe directly from the website rather than personal communication: www.medicaltuesday.net/newsletter.asp. Also subscribe to our companion newsletter concerning current and future health care plans: www.healthplanusa.net/newsletter.asp
Del Meyer, MD, Editor & Founder
6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608
Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, any single payer initiative, Social Security was born for the benefit of the state and of a contemptuous disregard for people’s welfare.
We must also remember that ObamaCare has nothing to do with appropriate healthcare; it was similarly projected to gain loyalty by making American citizens dependent on the government and eliminating their choice and chance in improving their welfare or quality of healthcare. Socialists know that once people are enslaved, freedom seems too risky to pursue.