MedicalTuesday

1. Featured Article: Why do we pay our administrators so much money?

Hospital administrators are being paid two to ten times as much money as they pay their physicians in the groups they are purchasing and managing. Perhaps it is time that physicians read Malcolm Gladwell’s piece in the New Yorker: Why do we pay our stars so much money?

There was a time, not so long ago, when people at the very top of their profession—the “talent”—did not make a lot of money. In the postwar years, corporate lawyers, Wall Street investment bankers, Fortune 500 executives, all-star professional athletes, and the like made a fraction of what they earn today. In baseball, between the mid-nineteen-forties and the mid-nineteen-sixties, the game’s minimum and highest salaries both fell by more than a third, in constant dollars. In 1935, lawyers in the United States made, on average, four times the country’s per-capita income. By 1958, that number was 2.4. The president of DuPont, Crawford Greenewalt, testified before Congress in 1955 that he took home half what his predecessor had made thirty years earlier. (“Being an honest man,” Greenewalt added wryly, “I think I should say that when I pointed the discrepancy out to him he replied merely that he was easily twice as good as I and hence deserved it.”) That era was an upside-down version of our own: when society gazed upon captains of industry and commerce, it marveled at how ordinary their lives were. . .

The truly rich in the nineteen-fifties and sixties were people who had inherited money—the heirs of the great fortunes of the Gilded Age. Entrepreneurs who sold their own businesses could also become wealthy, because capital-gains taxes were relatively low. But the marketplace chose not to pay salaried professionals and managers a lot of money, and society chose not to let them keep much of what they made. On income above two hundred thousand dollars a year, the marginal tax rate was as high as ninety-one per cent. Formerly exclusive occupations, meanwhile, were opening themselves to new talent, as a result of the expansion of the public university system. Economists of the era were convinced, as one analysis put it, that there was a “connection between economic growth and the advance of democracy on the one hand and the worsening economic status of the intellectual and professional classes on the other.” In 1956, Roswell Magill, a partner at Cravath, Swaine & Moore, spoke for a generation of professionals when he wrote that law firms “can no longer honestly assure promising young men that if they become partners they can save money in substantial amounts, build country homes and gardens for themselves like their fathers and grandfathers did, and plan extensive European holidays.”

And then, suddenly, the world changed. Taxes began to fall. The salaries paid to high-level professionals—“talent”—started to rise. Baseball players became multimillionaires. C.E.O.s got private jets. The lawyers at Cravath, Swaine & Moore who once despaired of their economic future began saving money in substantial amounts, building country homes and gardens for themselves like their fathers and grandfathers did, and planning extensive European holidays. In the nineteen-seventies, against all expectations, the salaryman rose from the dead.

The story of how this transformation happened has been told in many different ways. Economists have pointed to the globalization of the world economy and the rise of what Robert Frank and Philip Cook call the “winner-take-all” economy. Political scientists speak of how the social consensus changed in favor of privilege: taxes came down, and the commitment to economic equality eroded. But there is one more crucial piece to the puzzle. As Roger Martin, the dean of the Rotman School of Management, at the University of Toronto, argued in the Harvard Business Review a few years ago, people who fell into the category of “Talent” came to realize that what they possessed was relatively scarce compared with what the class of owners, “Capital,” had at their disposal. People like O’Rourke and Mr. C and Roswell Magill “woke up”—in Martin’s phrase—to what they were really worth. And who woke them up? The Marvin Millers of the world. . . .

To read who the Marvin Millers of the world are, go to Malcolm Gladwell’s treatise: The Talent Grab http://www.newyorker.com/magazine/2010/10/11/talent-grab

Physicians: Wake up to the fact that the knowledge we possess is also far more scarce and thus far more valuable compared with what the class of hospital owners, administrators, HMOs, are really worth. Let MedicalTuesday wake you up!

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2. In the News: Unanticipated Medical Outcomes.

Isn’t it a physician’s duty to be perfect in clinical outcomes?

The Kansas legislature has introduced SB 96. The disclosure of unanticipated medical outcomes and errors act was introduced in 2015 and has been scheduled for a hearing in Senate Judiciary this week. This bill imposes a duty on health care providers to make mandatory disclosures to patients and licensing agencies of any unanticipated outcomes and medical errors. Failure to disclose such events is punishable by a $10,000 fine per event.

It also requires hospitals to develop and implement disclosure policies, and mandates meetings and discussions between patients and providers about these events. It also mandates disclosure of unanticipated outcomes or medical errors to past patients if they weren't previously informed of the event. It also prohibits confidential settlements in medical liability claims which arise from unanticipated outcomes or medical errors. Though the intent of the bill is to encourage communication and disclosure between providers and patients, the bill is overly prescriptive and complex and would be difficult, if even possible, to comply with. KMS has submitted testimony in opposition to SB 96.

Overheard in the courthouse attorney’s lounge:

If we can get SB 96 passed, that should be a gold mine.
No, it would be a diamond mine.
You really think that much?
Every doctor I know makes mistakes every day.
At $10,000 for each mistake, we should easily find at least a hundred in each physician.
That’s a million dollars from each doctor.

When are we as Physicians going to understand the huge amount of ill will out there? The attorneys in practice and in the legislature, despite what they say, will continue to harass us. The doctors that go through law school are no help. They are neither fish nor fowl. They also fail to understand the underlying issues. Quality has always been our middle name. Why do we put up with the lay folks asking us to improve quality? The best quality will always include unanticipated outcomes which the litigious public views as mistakes. They expect us to be perfect.

I guess that takes us back to the old days when even we thought we were gods.

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3. International Medicine: The Long Road to Freedom in Canadian Medicine

Jacques Chaoulli’s, M.D.

The right of free citizens to spend their own money as they see fit on their own medical care is a moral precept that is fundamental to a free society. Recognizing what is moral and right, however, is often not sufficient to bring about a positive change.

Challenging a powerful state monopoly of medical services is not easy, but as I had reached the point where I could no longer tolerate seeing my patients suffer and die while on waiting lists, I had to do something.

The road to freedom in medicine in Canada was filled with disappointments, sacrifice, and personal hardships, and often very lonely. The philosophy of “live free or die” does not attract a large number of fellow travelers. Odds were against winning such an ambitious battle. I now see victory as part accident of history, and part miracle.

My journey began in May 1997 when I requested and was granted a meeting with officials of the government of Alberta. I knew that the Alberta government was more open to the concept of private medical care, and I set out to explore the possibilities. A representative of a large American health insurance company, Columbia HCA, accompanied me.

Unfortunately, the Alberta government was not very receptive to removing the prohibition against private insurance and private treatment. The Alberta official said that would require permission from the federal government. After I showed him that the prohibition was actually an Alberta statute, not a federal one, the official said: Oh, that would be a big deal. Social debate.

I replied: “If it is like this, then I will go to court to break down your law.”

He said: “Go ahead.”

So, I did, although at the time I had no knowledge or formal training in law.

When I returned to Montreal, I asked a few lawyers for help, but they provided little. So, I undertook the study of law by myself, in law libraries. I also studied medical service systems around the world. By the end of 1997, I was ready to launch the legal battle against Goliath, representing myself and pleading before the courts, eventually reaching the Supreme Court of Canada.

By 2000 I had achieved “troublemaker” status in the eyes of many Canadian scholars. It was at that point that I applied to the Montreal University School of Law to earn an LLB degree, so that I could be more effective in my goal to help more Canadian patients.

Since I had some free time before registering for law school, I took a few law courses in a separate program. I was very proud of the fact that I earned several A’s in those courses, particularly in constitutional law.

After the law school failed to answer my request to become a full-time law student, I realized that I had been blacklisted. I subsequently contacted a well-known Montreal newspaper and publicly declared my intention to attend the Montreal Law School in order to obtain a law degree so that I could help patients.

The following day, I was quoted in a major article, and soon afterward I was accepted to law school.

My time in law school was short. It seems that Canadian law professors do not appreciate questions that challenge socialist interpretations of the law. In Canada, the government not only has a monopoly on medical care, but a monopoly on law universities as well. The government pays law professors poorly, so they are often dependent on additional, more remunerative, contracts from the state.

I saw firsthand how socialist law professors were brainwashing impressionable young law students. Something had to be done.

After I challenged my law professors in class concerning their interpretation of the law, my grades went from A’s to D’s. Having learned a valuable lesson about tolerance as extolled by socialists, I left law school and pursued further study of the Canadian Charter of Rights and Freedom, the Canadian equivalent of the American Bill of Rights on my own. Ironically, five years later the Canadian Supreme Court would uphold my interpretation of the Canadian Charter of Rights and Freedom, as opposed to that of the socialist law professors.

Along the road to freedom I sought the help of Canadian physicians, naively thinking that they would fully support my legal challenge, for the benefit of our patients. Of course, I was wrong again. Most people seemed to care only about their own wallets. So, at the risk of alienating physician leaders, I subpoenaed presidents of certain key medical associations, including specialty societies for oncologists and ophthalmologists, without first talking to any of these physician leaders. As angry as some of these involuntary witnesses were, they told the truth when they got in the witness box, as I had hoped.

Hearing the truthful testimony about patients suffering and dying while on waiting lists of the Canadian Medicare program, the trial judge ruled that the prohibition against private medical care did, in fact, violate the rights to life, liberty, and security.

Nevertheless, she rejected my motion on the grounds that a two tiered health system would be unacceptable under the Canadian version of equality.

Ultimately, I took the challenge to the Supreme Court of Canada. On June 9, 2005, in a historic decision, the Supreme Court of Canada ruled that the Canadian single-payer medical system has led to situations whereby patients do, in fact, suffer and die on government waiting lists, in violation of the rights to life, liberty, and security under Section 1 of the Quebec Charter of Rights and Freedoms and under Section 7 of the Canadian Charter of Rights and Freedoms. The Supreme Court’s decision has invalidated the unconstitutional prohibition of a parallel private medical system in addition to the government-mandated Medicare program.

Interestingly, after this victory for freedom, the same Alberta official who had previously rebuffed any attempt at removing the prohibition on private medicine was quoted by the Canadian news wire as saying: The Alberta government is very pleased with this decision. Premier Klein fully supports any change that will allow Canadians more choice in getting timely access to the health care services they want.

Following my victory against socialism, I have been called a national hero, both in Canada and in the United States. The fact is that this battle would not have been possible without the love and support of my family. In 1997, my wife and daughter were staying with my father-in-law in Japan. I missed seeing my daughter grow up. In the early years of the battle, I was in Montreal, home alone, near bankruptcy, with barely enough money to buy food for myself.

Had it not been for the generous and gracious financial support of my father-in-law, the outcome of this journey would have been quite different. I was fortunate that my father-in-law saw in me a person who was dedicated to doing the right thing for people, and he felt a need to do whatever he could do to help.

I feel blessed to have a wife who demonstrated her love and support throughout very real hardships imposed by my pursuit of freedom. I also feel a sense of satisfaction knowing that I have taught an important lesson to my daughter about the value of fighting for freedom, and I am pleased that she is proud of her father. My father-in-law is now very old and no longer in a position to sacrifice further, but he can take pride in knowing that because of his support, the Canadian medical monopoly has come to an end . . .

Perhaps my victory in Canada might spark new debate about the constitutionality of the U.S. Medicare program. Both systems derive from the same socialist ideology, and both exist because of misinterpretation of constitutional rights . . .

Read the entire article by Dr. Chaoulli: http://www.jpands.org/vol10no3/chaoulli.pdf

Journal of American Physicians and Surgeons Volume 10 Number 3 Fall 2005

Jacques Chaoulli, M.D., is a family physician in Montreal, whose private emergency house call service was shut down by government for years because of a prohibition against private payment, while patients went without urgently needed care.

Contact: dr.chaoulli@videotron.ca

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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-csc.lexum.com/scc-csc/scc-csc/en/item/2237/index.do

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4. Medicare: Doctors are saying NO to Medicare

One In Five Doctors Say: “No New Medicare Patients” If you learned that 93 percent of non-pediatric primary care physicians took Medicare patients and 94 percent took patients with private insurance, you would likely conclude that Medicare is doing just fine. Unfortunately, such data do not describe physicians’ behavior at the margin, which is what will determine future access to Medicare. The Kaiser Family Foundation/Commonwealth Fund 2015 National Survey of Primary Care Providers also asks which physicians are not accepting new patients: 21 percent are not taking new Medicare patients and 14 percent are not taking new privately insured patients. That is, the proportion not taking new Medicare patients is 1.5 times greater than the proportion not taking new privately insured patients. . .

Nevertheless, even this level of detail indicates baby boomers aging in to Medicare will have increasingly difficult access to care. The idea of premium support (whereby Medicare beneficiaries receive subsidies to choose lightly regulated private plans), which NCPA advocates, should become more politically acceptable – if not unavoidable.

Read the entire article at http://healthblog.ncpa.org/category/medicare/

- See more at: http://healthblog.ncpa.org/one-in-five-doctors-say-no-new-medicare-patients/#more-42866

- See more at: http://healthblog.ncpa.org/category/medicare/#sthash.pe08VLVF.dpuf

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

- Ronald Reagan

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5. Medical Gluttony:

Deferred: The Medical Gluttony section will resume in 2016 after I recover from Obamacare.

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Medical Gluttony thrives in Government and Health Insurance Programs.

It Disappears with Appropriate Deductibles and Co-payments on Every Service.

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6. Medical Myths: Is the Rectum is an Appropriate Phallic Receptacle

See section 8 for a psychiatrist’s detailed review of homosexual history and behavior.

The homosexual lobby has been very active in San Francisco. They were not adverse to calling themselves queer. There were establishments with large signs saying “Queer beers,” or “Suckers Liquors.” They catered to the “Queerty” crowd. There were numerous Bath Houses all over the city which was the acceptable name for these houses of homosexual prostitution. The most famous one was the Fair Oaks Hotel which still maintains a website.

Physician spoke of a different kind of medical care these participants required. Even at Medical Grand Rounds in Sacramento given by physicians from San Francisco General hospital the medical data accommodated the homosexual behavior despite a new disease at that time, initially called AIDS (acquired immune deficiency syndrome) and then HIV as the virus (Human Immune-deficiency Virus) became known. It was universally fatal for nearly a decade. The professors would present their data on slides. Instead of incidence in males or females, there was a third column for the different frequency in men having sex with men (MSWM).

California is known for its Proposition 13, which limited property tax to 1% of the appraised value with a max of 2% increase in the appraised value per year if warranted. Many senior citizens with limited income had lived in their houses for many decades. With property values rising rapidly, property taxes would also rise rapidly. This would put many of the older generations into the poor house—or on welfare. Many were otherwise well set for their old age and retirement. Now they were losing their houses. A friend had a house for which he paid $20,000 forty years ago which was now appraised for $200,000. Without proposition 13, his property taxes would have increased from $200 a year to $2,000 a year. He said he would not have been able to keep his home without proposition 13. One of the authors of Proposition 13, had heart surgery in 1980. He became infected with HIV from the blood transfusions for his surgery. HIV was a fatal disease in the early 1980s and he died in about two years as I recall.

Attempts to keep the blood banks free of HIV, the gay lobby stated they would not donate blood if it required testing. This forceful lobby intimidated the blood bank physicians and thus the HIV, a homosexual disease, was widely distributed to heterosexuals. It was now seen in a number of diseases that required periodic blood transfusions, such as hemophilia, many blood dyscrasias that require blood transfusions as well as major operations that required transfusions. The homosexual lobby thus was very successful in promoting a wide distribution of this fatal disease so it would no longer cast aspersions on the homosexual community.

Eventually scientific reasoning prevailed and our blood supply became safe again. Bath houses were now becoming regulated or closed. San Francisco has an over a 30-year ban on gay bathhouses that really isn’t a ban at all. The city hasn’t had any legal bathhouses since 1984 when, according to the Bay Area Reporter: a San Francisco Superior Court judge issued an injunction forcing several bathhouse owners to remove doors from private rooms and have staff monitor patrons to ensure they were practicing safe sex. The order was to remain in place until the city’s public health director declared the AIDS epidemic over. Virtually all of the clubs closed rather than comply with the rules…

But there’s actually nothing on the books that says bathhouses are banned. Some sex clubs have been offering their services in the city’s gay(est) district, the Castro, for 21 years. Some recently learned that their saunas qualify the club as a bathhouse, requiring them to obtain a permit.

Under the permit, however, they would have to comply with the minimum standards — monitors and all — that is, unless the health department revises these standards. The department just released this handy-dandy FAQ about bathhouses, sex clubs and other commercial sex venues in anticipation of a public forum. . .

An extraordinary, glimpse into the pre-AIDS gay sexual culture, "The Fairoaks Baths" is an exhibit of Polaroids taken by Frank Melleno during the spring and summer of 1978 at the Fairoaks Hotel, a San Francisco bathhouse. These candid images are remarkable because they document the life of the bathhouse with celebration and no apology. Many of the images contain nudity and frank erotic scenes, but they also capture men dressed in festive attire and the general life at the bathhouse. There is no other collection of photographs that so clearly visualizes this period in bathhouse culture.

A day and a night at the Fairoaks could mean a lot of things. The acrid smell of popper fumes and stale marijuana smoke. The clank of an eight ball in a rear pocket, the rattle of chains. Low moans and orgasmic shouts heard over an endlessly played Sylvester tune, “Do You Want to F**k With Me?” Giggles. Grunts. And whispers. The passing drifts of another cool fog spied through a curtained bay window. The happy laughter of good friends getting together. The slapping flesh of one-time lovers lustily gettin’ it on.

Those were the times to remember, not to ever forget— as if one could in their fleeting glory. Dateline: San Francisco, 1978. Life seemed never better in this fabled City-by-the-Bay. The gay revolution was in full flower — sexy, charged with itself, admitting no shadows. This brief zenith would be over in a blink. But for the denizens of the Fairoaks Hotel and other places like it all over town, it was eyes wide-open, as if every second counted. Because they did. The ticking of the clock of youthful beauty and passion was about to chime midnight and who knew what another morning would bring?

Read more history from the homosexual viewpoint at . . .
http://www.queerty.com/question-after-30-years-should-san-francisco-allow-gay-bathhouses-20130820

Another neglected considerations in homosexual practices is the structure of the rectum. The rectum is a frequent access for treating patient in whom no available intravenous infusions can be given. Many drug addicts have effectively destroy all their veins by many years of narcotic infusions with dirty needles which then cause scarring of the veins and even total clotting of the veins preventing a needle to be inserted to administer drugs. Many patients with asthma, lung failure, heart failure were consequently treated with suppositories. The rectal mucosa is a very thin walled structure that absorbs many medications rather well. For decades asthma attacks were treated with suppositories and results could be seen in 10 or 15 minutes—almost as fast as if given intravenously.

Hence, using the rectum for sexual intercourse was essentially injecting the various sexually transmitted diseases as well as HIV essentially into the body circulation and widely distributed to every organ within minutes. Transmission of a deadly disease could not have been more effective. The rectum was not designed by our creator for this purpose.

Only the vagina was especially designed to afford man and woman to be one flesh or one functioning organism. The vagina is a very hardy and muscular structure with wide adaptability. Just think of the male phallus in the day to day operation of this organ vs the delivery of a full size baby weighing 10 pounds or more through this structure now transformed into a birth canal several times in a woman’s life time. Isn’t this amazing and a source of great pleasure rather than death?

As physicians we must think of these things so we can counsel our patients wisely and without jeopardy.

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Medical Myths originate when someone else pays the medical bills.

Myths disappear when Patients pay Appropriate Deductibles and Co-payments on Every Service.

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7. Overheard in the Medical Staff Lounge: Gender Dysphoria

Dr. Rosen: We are in the midst of a lot of Gender Dysphoria? People think they are trapped in the bodies of someone of the opposite gender.

Dr. Edwards: I guess psychiatrists are not able to remove this delusional thinking.

Dr. Paul: Maybe the psychiatrists aren’t interested in removing this feeling?

Dr. Milton: They have the same problem with homosexual behavior. They consider that as normal.

Dr. Ruth: I have several homosexual patients. They talk to me as one girl to another.

Dr. Rosen: Does that make you feel uncomfortable?

Dr. Ruth: Not really. They usually touch primarily my wrist or my elbow. Never to the small of my back or waist.

Dr. Michelle: Remember our previous governor referred to them as girly men.

Dr. Yancy: And he didn’t get into trouble for using that term.

Dr. Sam: I’m sure the homosexual community didn’t think that would help their cause. What if they lost the battle?

Dr. Yancy: They are very shrewd.

Dr. Rosen: But don’t you think that applies primarily to their political leaders? I’ve known many homosexuals and none would think about getting married. They enjoy all the fiduciary benefits of being married without all the hassles when they change partners, which many of them do.

Dr Edwards: It is unfortunate that our Supreme Court didn’t act like the EU supreme court—they just dismissed the law suit saying gay couples have all the rights of hetero-sexual couples and therefore, we don’t have to change long standing patterns.

Dr. Milton: The EU has left it to the member states. Several Scandinavian countries have homosexual marriages but that doesn’t disrupt the entire Union.

Dr. Edwards: If that had been left to the states in our country, we could all live peacefully together without challenging the morality of those who think differently.

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The Staff Lounge Is Where Unfiltered Opinions Are Heard.

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8. Voices of Medicine: A Review of Local and Regional Medical Journals: JAPS

Homosexuality: Some Neglected Considerations

Nathaniel S. Lehrman, MD

ABSTRACT

In recent decades, American perceptions of homosexuality have changed significantly, largely because of the questionable concept of the homosexual “orientation”: a genetic or biological, rather than a behavioral, etiology. These newer beliefs greatly influence how its morbidity, mortality, and social impact are seen, often causing us to overlook how the “gay” male lifestyle significantly increases the incidence of infectious disease and shortens life expectancy by about 20 years.

History

Homosexuality in Ancient Times

Homosexual behavior has always existed, and was accepted throughout the ancient world; Greek kings and Roman emperors all engaged in it. These men were also involved with women, and decisions about sexual partners were seen as entirely a matter of individual choice and responsibility.

Historically, homosexual behavior has been viewed as both criminal and sinful ever since Judaism first defined it as an “abomination” along with incest, adultery, and bestiality and Christianity continued this stance. Judaism and Christianity’s new prohibitions represented an immense moral and legal change that greatly strengthened family life.

Homosexuality in 19^th and 20^th Century Germany

In 1869, German same-sex devotees created the term “homosexual” seemingly more neutral and “scientific” than pejorative terms like “sodomite.” They claimed they were born with women’s souls inside men’s bodies (“Fems”), which supposedly made them unable either to respond sexually to women or to control their urges toward other men. As Foucault put it, “the sodomite had been a temporary aberration; the homosexual was a species.”

That same year, the first psychiatric study of homosexuality appeared. It advocated the replacement of criminal penalties for homosexual behavior with medical treatment, thus acknowledging that such behavior was undesirable, but indicating that same-sex choices were not completely under an individual’s control. This transformed lawless behavior, for which people are fully responsible, into illness-evoked activity, with reduced or absent responsibility.

Other Germans involved in same-sex relationships rejected the apology implied by this inborn-causation idea. To their Spartan ideology, same-sex relationships, especially between men and boys, were morally superior to heterosexual behavior and traditional marriage. Ironically, these super-masculine men held the homosexual “Fems” in deepest contempt and persecuted them fiercely.

Homosexuality grew rapidly in Germany over the following decades. In 1891, Richard Krafft-Ebbing’s Psychologia Sexualis declared that “sex perversion” in Germany was alarmingly on the increase”. In 1922, a Berlin police commissioner wrote that “homosexualist groups have been steadily on the increase in recent decades, especially in the big cities. . . They are closely banded together and even have their own [news] paper.” In 1933 when Hitler took power, Ernst Roehm, leader of his 300,000-man terrorist storm troopers—the Sturmabteilung, or SA—was a notorious pederast, and his corps commanders were “almost without exception homosexuals.”

Redefining Homosexuality in America Today

In the United States, homosexuality was considered an illness or perversion until 1973, when the American Psychiatric Association decided to remove homosexuality from its list of “mental disorders” without “morally judging” it as sin or crime. Thus, homosexuality could be seen as an acceptable alternate lifestyle. The definitional change helped to make homosexuality, once a felony, respectable.

“The APA vote to normalize homosexuality was driven by politics, not science. Even sympathizers acknowledge this.” The process began in 1970 with a “systematic effort” by a homosexual faction within the APA “to disrupt its annual meetings.” After several years of intimidation, the efforts finally succeeded. In 1973, when the faction met formally with the APA Committee on Nomenclature to discuss removing homosexuality from the list, “the outcome had already been arranged behind closed doors.”

When the APA membership was then polled on the question, the faction sent a letter to more than 30,000 members—secretly paid for by the National Gay Task Force—urging them to “retain the nomenclature change.” A third of the membership responded to the poll and a majority of them supported the change. “The result was not a conclusion based upon an approximation of the scientific truth as dictated by reason, but was instead an action demanded by the ideological temper of the times.”

If a vote by this professional organization is all that is needed to normalize homosexuality, could the same faction-driven process occur with other behavior now considered aberrant, such as pederasty, once a critical mass of politically active practitioners has been reached?

Changing American Attitudes

A change in the attitude of the medical profession accompanied the change in definition, as seen in the American Medical Association’s Complete Medical Encyclopedia and in its “official statement” on homosexuality. The former says that even though “some religious groups condemn homosexuality as morally perverse,” it is, rather, “a normal sexual orientation, not a disorder or a sign of a disorder.” The latter endorses “the physician’s nonjudgmental recognition of sexual orientation and behavior.”

The attitude of the public has been greatly affected by the major media, in which the homosexual movement has great influence. In April 2000, for example, Richard Berke of The New York Times, then its national political, correspondent told the National Lesbian and Gay Journalists Association, “literally three-quarters of the people deciding what’s on the front page are not-so-closeted homosexuals . . ..a real cry from what it was like not so long ago.” . . .

Read the entire article including these sections by Dr. Lehrman at http://www.jpands.org/jpands1003.htm

Destiny or a Choice?

Sexual Orientation

Who is Currently a Homosexual?

Changes in Sexual Orientation over Time.

Is Homosexuality Inborn?

Morbidity, Mortality, and Morality: The Social Impact of Homosexuality

The AMA’s Position

Conclusion:

American concepts and attitudes about homosexuality have changed significantly in recent decades. Most of society and the medical profession now view it as an acceptable alternate lifestyle: a biologically determined, permanent orientation, rather than a learned, experiential, and often changeable choice. The concept of homosexuality as a permanent orientation is, however, without scientific validation; the notion is entirely politically grounded.

One effect of this new view has been to understate the medical and societal harm produced by the promiscuous sexual practices typically associated with homosexuality.

—Bibliography with 37 references

Nathaniel S. Lehrman, M.D., a retired psychiatrist, is former Clinical Director, Kingsboro Psychiatric Center, Brooklyn, NY

Journal of American Physicians and Surgeons Volume 10 Number 3 Fall 2005

Lawrence R. Huntoon, M.D., Ph.D., Editor-in-Chief

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VOM Present Views of What Doctors are Thinking, Saying and Writing about

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9. Book Review:

Deferred: The book review section will resume in 2016 after I recover from Obamacare.

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

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10. Hippocrates & His Kin: Men buying underwear from a female clerk

I’ve always purchased Hanes Briefs with the transverse fly which I felt gave greater security. In the past the local Penney’s store carried them. I was recently in their store refreshing my supply for the year. Their Hanes only had the diagonal fly. Their other brands also had only the diagonal fly. When a clerk saw me checking a number of counters, she came over and asked, “Can I help you?”

I replied I was looking for briefs with a transverse fly. Do you have any?

She looked at me rather quizzically and asked, “How does that work?”

Well, lady I don’t think I’m going to show you how it works here in the store.

Would a woman buy her Lingerie from a man in the Lingerie department?

I normally do not deal with women in the Men’s department.
But I thought this would be a short answer, not a question.

One time I was examining a male and when I got down to the genitalia and prostate, I remarked he had a small wart on his phallus. I proceeded to the rectal and prostate exam, checked the stool on my glove for blood, and as I was taking off my gloves and washing up, the patient asked, “Where you referring to my D**k before?”

Recognition! With apologies to all the Richards out there, I guess that’s the local vernacular. I remember that from the Midwest but had not heard that in a long time.

So his “Richard” had a small wart. I touched it up with 13% ASA solution and told him to keep an eye on it to make sure it disappeared.

He said he would.

Next month I’ll tell you about my Uncle Willie from Kansas.

That reminds of the time I accidently put on my briefs inside out. I didn’t notice anything unusual until I went to the toilet to empty my bladder. I couldn’t get in to my “Richard.” I finally figured out I had to enter from below and probably had my briefs on backward, or rather inside out. On entering from below, I figured out I’d have to make a sharp U-turn once I got to the fly on the other side. Once I got a hold of my “Richard” and pulled him up to the inner fly, I then had to coax him downward to the outer fly. What if he weren’t long enough? But I found out that I could stretch Richard enough to make it to the opening and then I could man handle him with both hands until I had drained my bladder. It worked.

Now should I go back and explain that to the lady at Penney’s?

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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. This month, read the informative ?.

• 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 to which you may subscribe by logging on at www.galen.org. A study of purchasers of Health Savings Accounts shows that the new health care financing arrangements are appealing to those who previously were shut out of the insurance market, to families, to older Americans, and to workers of all income levels.

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

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

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

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

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

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

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

• The Heritage Foundation, www.heritage.org/, founded in 1973, is a research and educational institute whose mission was to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. -- However, since they supported the socialistic health plan instituted by Mitt Romney in Massachusetts, which is replaying the Medicare excessive increases in its first two years, and was used by some as a justification for the Obama plan, which used the same counsel that Obama did, 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 their von Mises Seminars, 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 two million readers each month. Choose recent issues. The last ten years of Imprimis are archived.

• 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."

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

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

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

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

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

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

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

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

Words of Wisdom

APHORISMS of Sir William Osler. “He was a keen observer, a brilliant clinician. His contributions to medicine and medical education were important. He was a great teacher. But his main strength lay in the singular and unique charm of his presence, in the sparkling brilliancy of his mind, in the rare beauty of his character and of his life, and in the example that he set to hi fellows and to his students. He was a quickening spirit . . . He taught us that the treatment of the patient was the most important element in the treatment of disease, that the patient not the disease was the entity.” —Thayer

A large proportion of the work of a medical student should be in the laboratory and in the hospital.

How can we make the work of the student in the third and fourth year a practical as it is in his first and second year? I take it for granted we all feel that it should be. The answer is, take him from the lecture-room, take him from the Amphitheatre—put him in the out-patient department—put him in the wards.

Let us emancipate the student, and give him time and opportunity for the cultivation of his mind, so that in his pupilage he shall not be a puppet in the hands of others, but rather a self-relying and reflecting being.

APHORISMS of Sir William Osler as compiled by William Bennett Bean, MD

Some Recent Postings

In The January Issue:

MEDICAL TUESDAY . NET	NEWSLETTER
Community For Better Health Care	Vol XIV, No 2, Feb, 2015

In Memoriam

Synthesising revolution

Carl Djerassi, the chemist behind the Pill, died on January 30th, aged 91

Del Meyer