1.
Featured
Article: Articulate Autism?
The Truth About Autism:
Scientists Reconsider What They Think They Know
By David Wolman, WIRED, 02.25.08
The YouTube clip opens with a woman facing
away from the camera, rocking back and forth, flapping her hands awkwardly, and
emitting an eerie hum. She then performs strange repetitive behaviors: slapping
a piece of paper against a window, running a hand lengthwise over a computer
keyboard, twisting the knob of a drawer. She bats a necklace with her hand and
nuzzles her face against the pages of a book. And you find yourself thinking:
Who's shooting this footage of the handicapped lady, and why do I always get
sucked into watching the latest viral video?
But then the words "A Translation" appear on a black screen, and
for the next five minutes, 27-year-old Amanda Baggs who is autistic and
doesn't speak describes in vivid and articulate terms what's going on inside
her head as she carries out these seemingly bizarre actions. In a synthesized
voice generated by a software application, she explains that touching, tasting,
and smelling allow her to have a "constant conversation" with her
surroundings. These forms of nonverbal stimuli constitute her "native
language," Baggs explains, and are no better or worse than spoken
language. Yet her failure to speak is seen as a deficit, she says, while other
people's failure to learn her language is seen as natural and acceptable.
And you find yourself thinking: She might have a point.
In My Language
Baggs lives in a public housing project for the elderly and handicapped
near downtown Burlington, Vermont. She has short black hair, a pointy nose, and
round glasses. She usually wears a T-shirt and baggy pants, and she spends a
scary amount of time day and night on the Internet: blogging, hanging out
in Second Life, and corresponding with her autie and aspie friends. (For the
uninitiated, that's autistic and Asperger's.)
On a blustery afternoon, Baggs reclines on a red futon in the apartment of
her neighbor (and best friend). She has a gray travel pillow wrapped around her
neck, a keyboard resting on her lap, and a DynaVox VMax computer propped
against her legs.
Like many people with autism, Baggs doesn't like to look you in the eye and
needs help with tasks like preparing a meal and taking a shower. In
conversation she'll occasionally grunt or sigh, but she stopped speaking
altogether in her early twenties. Instead, she types 120 words a minute, which
the DynaVox then translates into a synthesized female voice that sounds like a
deadpan British schoolteacher.
The YouTube post, she says, was a
political statement, designed to call attention to people's tendency to
underestimate autistics. It wasn't her first video post, but this one took off.
"When the number of viewers began to climb, I got scared out of my
mind," Baggs says. As the hit count neared 100,000, her blog was flooded.
At 200,000, scientists were inviting her to visit their labs. By 300,000, the
TV people came calling, hearts warmed by the story of a young woman's fiery
spirit and the rare glimpse into what has long been regarded as the solitary
imprisonment of the autistic mind. "I've said a million times that I'm not
trapped in my own world,'" Baggs says. "Yet what do most of these
news stories lead with? Saying exactly that."
I tell her that I asked one of the world's leading authorities on autism to
check out the video. The expert's opinion: Baggs must have had outside help
creating it, perhaps from one of her caregivers. Her inability to talk, coupled
with repetitive behaviors, lack of eye contact, and the need for assistance
with everyday tasks are telltale signs of severe autism. Among all autistics,
75 percent are expected to score in the mentally retarded range on standard
intelligence tests that's an IQ of 70 or less.
People like Baggs fall at one end of an array of developmental syndromes
known as autism spectrum disorders. The spectrum ranges from someone with
severe disability and cognitive impairment to the socially awkward eccentric
with Asperger's syndrome.
After I explain the scientist's doubts, Baggs grunts, and her mouth forms
just a hint of a smirk as she lets loose a salvo on the keyboard. No one helped
her shoot the video, edit it, and upload it to YouTube. She used a Sony
Cybershot DSC-T1, a digital camera that can record up to 90 seconds of video
(she has since upgraded). She then patched the footage together using the
editing programs RAD Video Tools, VirtualDub, and DivXLand Media Subtitler.
"My care provider wouldn't even know how to work the software," she
says.
Baggs is part of an increasingly
visible and highly networked community of autistics. Over the past decade, this
group has benefited enormously from the Internet as well as innovations like
type-to-speech software. Baggs may never have considered herself trapped in her
own world, but thanks to technology, she can communicate with the same speed
and specificity as someone using spoken language.
Autistics like Baggs are now leading a nascent civil rights movement.
"I remember in '99," she says, "seeing a number of gay pride Web
sites. I envied how many there were and wished there was something like that
for autism. Now there is." The message: We're here. We're weird. Get used
to it.
This movement is being fueled by a small but growing cadre of neuropsychological
researchers who are taking a fresh look at the nature of autism itself. The
condition, they say, shouldn't be thought of as a disease to be eradicated. It
may be that the autistic brain is not defective but simply different an
example of the variety of human development. These researchers assert that the
focus on finding a cure for autism the disease model has kept science from
asking fundamental questions about how autistic brains function.
A cornerstone of this new approach
call it the difference model is that past research about autistic
intelligence is flawed, perhaps catastrophically so, because the instruments
used to measure intelligence are bogus. "If Amanda Baggs had walked into
my clinic five years ago," says Massachusetts General Hospital
neuroscientist Thomas Zeffiro, one of the leading proponents of the difference
model, "I would have said she was a low-functioning autistic with
significant cognitive impairment. And I would have been totally wrong."
Seventy years ago, a Baltimore
psychiatrist named Leo Kanner began recording observations about children in
his clinic who exhibited "fascinating peculiarities." Just as
Kanner's landmark paper was about to be published, a pediatrician in Vienna
named Hans Asperger was putting the finishing touches on a report about a
similar patient population. Both men, independently, used the same word to
describe and define the condition: autist, or autism, from
the Greek autos, meaning self.
The children had very real deficits, especially when it came to the
"failure to be integrated in a social group" (Asperger) or the inborn
inability to form "affective contact" with other people (Kanner). The
two doctors' other observations about language impairment, repetitive behaviors,
and the desire for sameness still form much of the basis of autism diagnoses in
the 21st century. . .
On the outskirts of Montreal sits a
brick monolith, the H๔pital Rivi่re-des-Prairies. Once one of Canada's most
notorious asylums, it now has a small number of resident psychiatric patients,
but most of the space has been converted into clinics and research facilities.
One of the leading researchers here is Laurent Mottron, 55, a psychiatrist
specializing in autism. Mottron, who grew up in postwar France, had a tough
childhood. His family had a history of schizophrenia and Tourette syndrome, and
he probably has what today would be diagnosed as attention deficit and
hyperactivity disorder. Naturally, he went into psychiatry. By the early '80s,
Mottron was doing clinical work at a school in Tours that catered to children
with sensory impairment, including autism. "The view then," Mottron
says, "was that these children could be reeled back to normalcy with play
therapy and work on the parents' relationships" a gentle way of saying
that the parents, especially the mother, were to blame. (The theory that
emotionally distant "refrigerator mothers" caused autism had by then
been rejected in the US, but in France and many other countries, the view
lingered.)
After only a few weeks on the job, Mottron decided the theories were crap.
"These children were just of another kind," he says. "You
couldn't turn someone autistic or make someone not autistic. It was
hardwired." In 1986, Mottron began working with an autistic man who would
later become known in the scientific literature as "E.C." A draftsman
who specialized in mechanical drawings, E.C. had incredible savant skills in
3-D drawing. He could rotate objects in his mind and make technical drawings
without the need for a single revision. After two years of working with E.C.,
Mottron made his second breakthrough not about autistics this time but about
the rest of us: People with standard-issue brains so-called neurotypicals
don't have the perceptual abilities to do what E.C. could do. "It's just
inconsistent with how our brains work," Mottron says.
From that day forward, he decided to challenge the disease model underlying
most autism research. "I wanted to go as far as I could to show that their
perception their brains are totally different." Not damaged. Not
dysfunctional. Just different. . .
By the mid-1990s, Mottron was a faculty member at the University of
Montreal, where he began publishing papers on "atypicalities of
perception" in autistic subjects. When performing certain mental tasks
especially when tapping visual, spatial, and auditory functions autistics
have shown superior performance compared with neurotypicals. Call it the upside
of autism. Dozens of studies Mottron's and others have demonstrated that
people with autism spectrum disorder have a number of strengths: a higher
prevalence of perfect pitch, enhanced ability with 3-D drawing and pattern
recognition, more accurate graphic recall, and various superior memory skills.
. .
Back in Burlington, Baggs is cueing up
another YouTube clip. She angles her computer screen so I can see it. Set to
the soundtrack of Queen's "Under Pressure," it's a montage of
close-up videos showing behaviors like pen clicking, thumb twiddling, and
finger tapping. The message: Why are some stress-related behaviors socially
permissible, while others like the rocking bodies and flapping arms commonly
associated with autism are not? Hit count for the video at last check: 80,000
and climbing.
Should autism be treated? Yes, says Baggs, it should be treated with
respect. "People aren't interested in us functioning with the brains we
have," she says, because autism is considered to be outside the range of
normal variability. "I don't fit the stereotype of autism. But who
does?" she asks, hammering especially hard on the keyboard. "The
definition of autism is so fluid and changing every few years." What's
exciting, she says, is that Mottron and other scientists have "found
universal strengths where others usually look for universal deficits."
Neuro-cognitive science, she says, is finally catching up to what she and many
other adults with autism have been saying all along.
Baggs is working on some new videos. One project is tentatively titled
"Am I a Person Yet?" She'll explore communication, empathy,
self-reflection core elements of the human experience that have at times been
used to define personhood itself. And at various points during the clip, she'll
ask: "Am I a person yet?" It's a provocative idea, and you might find
yourself thinking: She has a point.
David Wolman (david@david-wolman.com) wrote
about a terrorist attack response drill in issue 16.02.
www.wired.com/print/medtech/health/magazine/16-03/ff_autism
*
* * * *
2. In the News: Flu Economy The Business Side of the Health Equation
Flu Economy Takes Unexpected Turn
The Illness's Unusual Course This Year Has Mixed Results
For Health-Care Companies,
By THEO FRANCIS and ELLEN BYRON, WSJ, April 3, 2008
The surprising course of the
latest flu season -- one of the most unpredictable in years -- has been a
headache for companies from tissue makers to hospital owners.
In recent seasons, the flu has
generally hit hard in December and peaked in February before petering out in
March. But this year it followed a different pattern, getting off to a tamer
start than usual and then roaring back in late February with the strongest
surge in years. One reason: Vaccine planners failed to accurately predict the
strains of the virus that would emerge this winter, making the flu shots most
people got less effective than usual.
This has created a scramble at
companies that count on Americans to sniffle and sneeze. Kimberly-Clark
Corp., maker of Kleenex, blamed the cold-and-flu season's initial weakness for
a 12% reduction in facial-tissue shipments in the quarter ended Dec. 31,
compared with a year earlier.
In January, Walgreen Co.
CEO Jeffrey Rein told a shareholder gathering that December marked the first
time in his 25-year career at the company that cough- and cold-medicine sales
fell during the month. If attendees of the meeting needed to cough, he joked,
they should leave the room and "go to a movie theater or on a bus" to
spread their germs. "We're really hoping for a very strong flu
season," Mr. Rein told the crowd, according to a transcript of his
presentation.
Procter & Gamble Co. said on a conference call in January that quarterly
sales of its Vicks cold medicine had been weak. "Unfortunately, people
have not been getting sick at a rate that we would all like yet," P&G
CEO A.G. Lafley said on the call, with a chuckle.
Of course, each year,
influenza, with its chills, aches and fever, takes a serious toll, killing
about 36,000 Americans and hospitalizing more than 200,000; one government
study pegs lost earnings at $16.3 billion a year. For most people, the flu
season means having to get through a couple of days of fever, achiness and
coughing. Americans bought $4.1 billion worth of cold, flu and allergy remedies
last year, according to market-research firm Mintel International.
However, the flu economy
encompasses more than just the makers and sellers of cold medicines. Even car
insurers can get a financial boost when more drivers get the flu, because at
least some stay off the roads. . .
The surge in flu cases that
began in February probably saved HandClens, a fledgling hand sanitizer made by
Woodward Laboratories Inc., of Aliso Viejo, Calif. It won a big order from Costco
Wholesale Corp. last year only to see crowds of healthy shoppers ignore the
product in January. "We were absolutely in panic mode," says CEO
Kenneth Gerenraich. "We were borrowing from our credit line to pay the bills
and keep ourselves afloat."
As the flu flourished in
February, so did sales. "Now we're paying our bills, and the checks are
flowing in," Mr. Gerenraich says. "Business is good."
Hospitals also rode the roller
coaster of this flu season. Sicker patients often bring higher reimbursement
from insurers or the government, and the flu can cause pneumonia and other
complications. "You have a strong flu season, and the ancillary business
is very profitable," David Dill, chief financial officer of LifePoint Hospitals
Inc., explained to investors at a conference in January. If an elderly flu
sufferer in intensive care needs a tracheotomy, "that turns into higher
acuity business for us," he said. "Or, on the pediatric side, young
kids coming into the hospital, that's a nice margin for us, as well."
LifePoint, a publicly traded
chain based in Brentwood, Tenn., with 49 hospitals in 18 states, reported a
4.2% drop in year-over-year admissions in the fourth quarter of last year,
which analysts and the company said was in large part because of the lack of
flu cases. A LifePoint spokeswoman said admissions rose as flu cases soared in
February and again in late March. . .
A confluence of factors seem to
have contributed to this year's flu season. The strains of flu that have
predominated in the U.S. in recent years are known as H1N1. Health officials
predicted last year that that trend would continue, so pharmaceutical companies
pumped out vaccines to target those strains. But H3N2 strains proved more
prevalent this year. To make matters worse, H3N2 is a particularly nasty
variety of the flu. . .
To read the entire article, go to http://online.wsj.com/article_print/SB120719135290885495.html.
Write to Theo Francis at theo.francis@wsj.com1
and Ellen Byron at ellen.byron@wsj.com2
*
* * * *
3.
International
Medicine: What is Single-Payer
Government Medicine really like?
Lessons from Sweden's Universal Health System: Tales
from the Health-care Crypt
by Sven R. Larson, Ph.D., JAPS, volume 13, No 1,
2008.
You cannot buy a new Lexus
for $20,000. Small budgets cannot buy first-class medical care either. Yet one
of the most persistent arguments for single-payer health insurance is that it
will somehow give everyone gold-plated care at little or no cost.
There are a lot of dry statistics
to prove just how wrong this notion is. But there is a side of this issue that
rarely is told, especially not by advocates of a government medical monopoly.
It is the story of those who pay the price for the serious rationing in a
single-payer system.
Universal
Rationing: Real-Life Examples
Rationing of care is a
reality under universal health insurance.
Yet, its advocates seem universally oblivious to it. In an effort to
unmask the reality of universal coverage, here are some actual case histories
of real people with real experiences. They were reported by Swedish news media,
in some instances numerous times. Sweden has longer experience with socialized
medicine than almost any other country in the world.
In October 2003 Mrs. A.,
who lives in Malmo, Sweden, gave birth to a baby boy. She was signed out from
the hospital after delivering the baby. There are not enough beds, so
delivering a baby without complications is an outpatient procedure. Budget
cuts have eliminated beds and medical staff.
The next day Mr. and Mrs. A. noticed that their baby was weak and did
not want to eat. As is common in Sweden, they did not call a doctor. Instead
they called the tax-paid TeleMedicine service. Nobody advised them to go see a doctor right away. The following
day their baby died of pneumonia.
In May 2006 another couple
lost their three-year-old son to the budget-starved medical system. When Mr.
and Mrs. B.'s son suffered from diarrhea and had been vomiting for almost two
days, they took him to the emergency room at the nearby university hospital. A
doctor ordered a supply of intravenous fluids, and the boy was sent on to the
pediatric clinic to have them administered. When he arrived, the nurses had no
time for him. Mr. and Mrs. B. repeatedly called on the medical staff to ask why
nobody was coming to give their son the intravenous fluids he so desperately
needed. Every time they got the same
answer: nobody has time. They have too many patients and too little staff. Six hours later the three-year-old boy died
of heart failure. You do not have to be
a child to die from denial of care in Sweden.
In April 2005 Mr. C., 61
years old, became concerned about an unusual feeling of fatigue. He went to see
a doctor at the local government-run clinic. The doctor sent him home with some
encouraging words. Mr. C. came back a while later with worsened symptoms. Again
he was sent home after a superficial examination and with more reassurance.
Over the next year and a half Mr. C. visited this tax-paid local clinic a total
of 14 times. He had no choiceall Swedes have to go through a government-run
primary care physician at a tax-paid clinic in order to see a specialist. He
developed blood in his urine. But the doctors refused even to take a blood
test. They told Mr. C. and his son that
they were denying him the blood test because of budget restrictions imposed by
government bureaucrats. When, finally, Mr. C.'s son convinced the doctors to do
one blood test, they found out that Mr. C. had cancer. He was referred to a regional
hospital. There they established that his cancer, originally curable, had
spread throughout his body. There was nothing left to do. He died shortly
after.
Even those who do not die
from encountering denials of care suffer considerably under Sweden's universal
coverage. Mr. D., a multiple sclerosis patient, lives in Gothenburg, a city of
500,000. His doctor told him about a
new medicine that is considered a breakthrough in MS treatment. But, when the
doctor put in a request to have Mr. D. treated with it, the request was denied.
Reason: it would cost 33 percent more than the old medicine, and that was more
than the government was willing to pay.
For most Swedes there are no longer any subsidies for prescription
drugs. People with exceptionally high pharmaceutical costs get some subsidies,
but they have to pay the greater share themselves. When the government denied Mr. D. the new medicine on the grounds
that the subsidies would cost too much, he offered to pay the full cost of the
medicine himself. He was denied the option to pay full cost out of his own
pocket because, the bureaucrats said, it would set a bad precedent and lead to
unequal access to medicine. In Sweden,
there is no way to obtain access to medication outside the government-run system.
There are other absurd
examples. How many times have you gone to see your doctor only to find security
guards posted in the waiting room?
This is reality in Malmo,
Sweden's third largest city. To see a physician the 280,000 residents of Malmo
have to go to one of two local clinics before they can see a specialist. Except
during business hours, only one of the two clinics is open to serve all the
city's residents. As a result the
clinic is severely overcrowded. The security guards serve two functions. They
keep patients from becoming unruly as they sit and wait for hours to see a
doctor, and they keep new patients from entering the center when the waiting
room is considered full.
Opening the second clinic
during off-business hours is considered too costly.
Government control over
medicine also leads to government arrogance. In Gothenburg, a hospital was
blessed with having a talented orthopedist on its staff. Dr. Leif Sward worked
part time for the government-run hospital, part time for a local soccer club at
its private orthopedic clinic, and part time for the British national soccer
team.
You would expect a man with
such credentials and experience to be considered a prized asset in a
tax-supported hospital. But the government bureaucrats were unhappy with the
fact that Dr. Sward was not working full time for them. They considered his
work for the private health clinic competing employmentthe soccer players
should come to the tax-supported hospitals instead so as to increase their
revenues. So they gave Dr. Sward an ultimatum: quit the private sector or leave
us.
Dr. Sward chose the latter.
By giving Dr. Sward this
ultimatum, the medical bureaucrats showed that their priority was to control
and stifle competition and choice, an action contrary to the interests of
patients. . .
Conclusion
If we implement a
universal, single-payer model in America today, the negative effects will
reliably occur about a generation from now. The question that we need to ask
ourselves as we enter the election season is this: Are we willing to send that
bill down the road for our children to pay?
To read more about Sweden's
Health Care and the taxes required to pay for it, go to www.jpands.org/vol13no1/larson.pdf.
Sven R. Larson, Ph.D., is founder and president of The
Hill City Skunkworks, a public policy research firm in Saratoga Springs, N.Y.
www.hillcityskunkworks.com/
Contact: valfardresearch@yahoo.com.
Single-payer
medicine does not give Access to Healthcare, it gives access to a Denial of
Service.
*
* * * *
4. Medicare:
The Economics of Entitlements
Horrors of a 'Crisis' By George F. Will, Washington Post, Sunday, April
13, 2008
During presidential elections, when candidates
postulate this or that "crisis" for which each is the indispensable
and sufficient cure, economic hypochondria is encouraged, so a sense of
suffering is rampant. Recently the Wall Street Journal, like Joseph
Conrad contemplating the Congo, surveyed today's economic jungle and cried,
"The horror! The horror!"
Declines in housing values and the stock market are
causing some Americans to delay retirement. A Kansas City man had been eager to
retire to Arizona, but now, the Journal says, "figures he'll stay put for
another couple of years." He is 59.
So, this is a facet of today's hydra-headed
"crisis" -- the man must linger in the labor force until, say, 62.
That is the earliest age at which a person can, and most recipients do, begin
collecting Social Security.
The proportion of people aged 55 to 64 who are working
rose 1.5 percentage points from April 2007 to February 2008, during which the
percentage of working Americans older than 65 rose two-tenths of one percentage
point. The Journal grimly reported, "The prospect of millions of
grandparents toiling away in their golden years doesn't square with the
American dream."
Oh? The idea that protracted golden years of idleness
are a universal right is a delusion of recent vintage. Deranged by the
entitlement mentality fostered by a metastasizing welfare state, Americans now
have such low pain thresholds that suffering is defined as a slight delay in
beginning a subsidized retirement often lasting one-third of the retiree's
adult lifetime.
In 1935, when Congress enacted Social Security,
protracted retirement was a luxury enjoyed by a tiny sliver of the population.
Back then, Congress did its arithmetic ruthlessly: When it set the retirement
age at 65, the life expectancy of an adult American male was 65. If in 1935
Congress had indexed the retirement age to life expectancy, today's retirement
age would be 75. . .
Yes, in January single-family homes in major
metropolitan areas lost 10.7 percent of their value from last January. To find
such a large decline in a year you must peer back into the mists of prehistory,
all the way back to . . . the 1990s. Furthermore, the vast majority of
homeowners will remain well ahead, even after the market corrects for housing
inflation.
By one measure, between the beginning of 2000 and the
middle of 2006, as the consumer price index was rising 21 percent, average
housing prices rose 93 percent -- and much more in some markets Miami, 180
percent; Los Angeles, 175 percent; Washington, D.C., 150 percent).
Not long ago there was broad agreement that too much
of Americans' wealth was tied up in the nation's housing stock and that the
principal impediment to homeownership was not a scarcity of cheap mortgages but
the prevalence of high housing prices. Hence deflation of housing prices would
be desirable. . .
Subprime mortgages are a small minority of mortgages,
and only a minority of subprime borrowers are not making their payments.
Casting this minority of a minority as victims of "predatory" lending
fits the liberal narrative that most Americans are victims of this or that
sinister elite or impersonal force and are not competent to cope with life's
complexities without government supervision. . .
What next? Adults still burdened with student loans
have not yet announced their entitlement to relief, but as they watch this
subprime drama, they might.
To read the entire OpEd column, go to
www.washingtonpost.com/wp-dyn/content/article/2008/04/11/AR2008041103250_pf.html
or
www.sacbee.com/debate/v-print/story/856123.html
Government is not the solution to our
problems, government is the problem.
-
Ronald Reagan
* * * * *
5. Medical Gluttony: Homeless Living Standards Are Improving
This week, I saw a Medicaid patient who rolled into
the office on a motorized wheelchair (MWC). But this was no ordinary
wheelchair. It had large tires, could go down the corridors dangerously fast,
noiselessly, and could turn in a circle. Despite this mobility, it was a few
inches wider than my office door, which accommodates standard wheelchairs,
including MWC. He had obtained the MWC from Medicaid because of his back
disability. The disability wasn't apparent since he easily got out of the MWC,
walked through the waiting room, down the corridor, and into the office where I
was working. Examination failed to reveal any significant disability of the
back, which had full range of motion (ROM). He stated that he was able to walk
several blocks without difficulty. The MWC allowed him to go shopping down the
street without a car, go to the grocery store to buy food with his food stamps,
and drive to the river for lodging. I noticed a large backpack on the back of
the MWC. He said it carried his sleeping bag, groceries, drinking water and
personal items.
The MWC also provided transportation
to visit the 26 homeless food shelters in the various churches and
organizations in Sacramento. He had visited them all and chose a different one
each day which provided a variety of warm meals on essentially a monthly
rotational basis. He was never asked for his ID or a disability card.
In addition, the MWC provided
transportation to visit his parent's home since they were both retired and away
during frequent world travels. This allowed him a nice warm bath and a place to
keep his wardrobe and sleep most weekends, especially during the inclement
winter months. His cell phone kept him in touch with family and friends.
On a daily basis, he got his MWC
batteries charged at the light rail stops, where there is always an electric
outlet. This gave him a great range of travel. It also allowed him to recharge
his cell phone so he was never out of communication with friends or relatives.
He stated he could always move
indoors if he wished, but he enjoyed his lifestyle for the present. Since he
was in his early 40s, he thought he might keep this up for at least another
five, if not ten years.
*
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6. Medical Myths: Scary Forecasts are Medicare's Little Secrets
Scary Forecasts by John Goodman, PhD, The Expert Who
Explodes Medical Myths.
Today I'm going to let you in on a little secret
about forecasting health care costs:
All the forecasters cheat.
Cheat? Yes, cheat.
There is nothing underhanded about it. For people who read footnotes and
appendices, the information is all there.
But for ordinary mortals, the projections you see are not what you think
they are.
But let's back up.
Why do you even care about forecasts of future health care
spending? The rational reasons
are: (1) to figure out what path we are
currently on, (2) to decide whether the path is acceptable, and (3) if it is
not acceptable, to figure out how to get off of it.
Turns out, however, that the estimators at the
Congressional Budget Office (CBO), the Centers for Medicare and Medicaid
Services (CMS) and the Social Security/Medicare Trustees have already done
tasks (1) and (2) and decided that the future is so terribly awful, they cannot
possibly wait for you or anyone else to do task number (3).
So what we get out of these agencies is not a real
projection of the past into the future but one that has been tempered by ...the
hope? ...the wish? ...the refusal to accept reality? ...or the fanciful belief
that somehow, somewhere, in some totally unexplained way we will ...we must
...we have to ...get off the path we are on.
For example, the Medicare Trustees, after
acknowledging that health spending has been growing at a rate that is 2 to 3
percentage points above GDP growth, assume that the growth rate will decline to
the GDP growth rate over the next 75 years.
The CBO, after acknowledging that health care spending per capita has
been growing at a rate that is 2.1 percentage points faster than GDP per capita
for the past 30 years, assumes much slower rates of growth for Medicare and
Medicaid beginning in 2018 and thereafter.
Will those changes occur? Maybe. Maybe not. It still begs the question: What path are we really on? Note:
even after tempering, all the projections are bad. However, a new CBO www.cbo.gov/ftpdocs/87xx/doc8758/11-13-LT-Health.pdf
contains an untempered projection that implies that:
Within
the next 50 years, by the time today's teenagers reach the retirement age,
health care spending will crowd out every other program of the federal
government.
Well
before that occurs, Medicaid spending at the state level will crowd out every
other function of state government.
To avoid this unpleasant outcome and keep all other
programs in place, we will have to double the size of government! A previous www.cbo.gov/ftpdocs/82xx/doc8295/07-09-Financing_Spending.pdf estimates the needed tax rates at 66% for
middle-income families and 92% for high-income families - assuming no increase
in taxpayer resistance.
That is the path we are on. We will not get off of it with pen and ink.
We will get off of it only with real reform. . .
John
------------------------------------------------------------------------
John
Goodman, President, National Center for Policy Analysis
12770 Coit Rd., Suite 800, Dallas, Texas 75251 www.ncpa.org
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NCPA
is a service mark of the National Center for Policy Analysis. We are an
independent public policy institute and are not affiliated with any other organization,
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Copyright 2003-2008 National Center for Policy
Analysis - All rights reserved
*
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7. Overheard in the Medical Staff Lounge: The Candidates can't get it Right.
Dr Sam:
Looks like all the candidates will sell American Health Care down the river.
Dr. Dave: You're probably right. But McCain is the least
harmful to our patients.
Dr. Yancy: I'm not fighting it any more. Government medicine
will come by fiat or incrementally. We just look like losers trying to fight
it. Just let the people experience it and rebel.
Dr. Rosen: But then it will be too late. Look at all the
anecdotes we have from England, Sweden, Canada and Europe about patients dying
from lack of health care, and they are rebelling loudly. But the bureaucrats
aren't going to let go.
Dr. Sam: You have that right. I'm beginning to think the
bureaucrats take great pleasure in the whole process. They don't think of death
or dying.
Dr. Yancy: They're just following directives. Almost like my family
dying in the holocaust - the soldiers turning on the gas were just following
orders.
Dr. Rosen: Only this is more insidious. Like turning up the heat
to boil a lobster. He doesn't feel it until he's cooked.
Dr. Dave: Look at Mrs. Clinton's plan of 1993. She won. Over
the next decade, the opposition implemented nearly all her items incrementally
and the public doesn't even know it. We have government medicine and people
think it's still private. Even private medicine is controlled by Medicare
regulations.
Dr. Rosen: It's really sad when the opposition, our friends, no
longer see the problem.
Dr. Edwards: Medicare can limit your fees even if you don't
participate in Medicare and patients see you privately.
Dr. Yancy: I don't think the average American can appreciate
the ferocity of the federal government. If they haven't had a run in, they just
think of it as a friendly Uncle Sam.
Dr. Rosen: And our friendly Uncle Sam is showing his age and
loss of fight in the last half century. He is not even winning our external
wars.
Dr. Patricia: Don't you think those wars have been mistakes?
Dr. Sam: Mistakes or not. It's always a greater mistake not
to win the war. If we had let McArthur win the Korean War, we would not have a current
North Korean problem. And then we would most likely not have had a Vietnam
problem. And the current war could be won in 30 days if we just decided to do
it and eliminate all the sources of the insurgents. But Congress would just
have a fit.
Dr. Rosen: I guess we'll have to handle that problem in
November.
Dr. Dave: I don't think the American people have the stomach to
do it.
Dr. Edwards: Maybe this two-hundred year experiment in human
freedom has run its course.
Dr. Rosen: It really only lasted 150 years. For the last 75
years, the government has no longer been our servant. We have been and continue
to be the servants.
*
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8. Voices of Medicine: A Review of Local and Regional Medical Journals
Bulletin of the California Society
of Anesthesiologists, Winter, 2008
In Vino Veritas: Anesthesia & Mystical Truth, By George A. Mashour, M.D., Ph.D.
All the Adventures of a Curious Character
I have known Dr. George Mashour since our overlapping
days at the Massachusetts General Hospital, and as I pen this introduction, I
appreciate anew just why George truly is in a class of his own. Now comfortably
ensconced at the University of Michigan, George is by many measures as curious
a character as the famous Dr. Richard Feynman from whom I have pilfered the
title of this introduction. Beginning with this issue of the Bulletin, we shall
be reprinting a variety of his writings. I can assure you that you will not
want for entertainment. I first met George
when he came to the MGH for his anesthesia residency. Although that institution
sports its fair share of talented souls, George stood out even within that
group. He had, by the time of our first meeting, already completed a Ph.D. in
Neuroscience, a residency in psychiatry, and was one of a small group of
esteemed Fulbright Scholars. When he showed up in our OR and introduced
himself, it was, to quote Bogie's famous old line, the beginning of a
beautiful friendship. Although George may tell audiences that I had a
substantial impact on parts of his career, I would counter that George is the
one who had an impact on mine. He was one of those residents that all academic
faculty dream of finding: bright, energetic, creative and ever so full of the
capacity to do. The opportunity to call him one of my students validated my
fundamental rationale for being in academia. I have made it my habit to sample
each and every one of his writings, some dating from the earliest days of his
residency, each reflecting his truly masterful fluency with classical and
modern learning. It is, however, his first major anesthesia publication dating
from 2004 and a recent talk he gave to my group in Santa Barbara based on a
2005 publication that best reflect the breadth of his intellectual and literary
talents. . .
It is this broad talenthis ability to convey the
mystery of our trade, to stir in us the emotion associated with that mystery,
yet simultaneously making all of us just a bit wiser about our humble and small
place in the eons-long struggle against human sufferingthat makes his works
worthy of our attention. Enjoy!
ท
Jason A. Campagna, M.D.,
Ph.D., Associate Editor
Gentle reader, how
fortunate you are to be living in the great state of California. No, it is not
because of the sunny climes, nor the vast expanses of the fair Pacific, nor
even the sculpted pectoralis majors of your governor. It is, in fact, because
of the editor of the CSA Bulletin: you are unequivocally blessed to have
a wise soul like Dr. Stephen Jackson as the literary ้lan vital of your
Society. Although I have never met the man personally, I became thoroughly
convinced of his exquisite taste and discerning mind when he lauded a series of
essays I penned during my chief residency as most brilliantly written and
vastly entertaining. Here, I said to myself, is a man with vision. Here, I
exulted, is a man with his finger on the pulse of the emerging field of
literary anesthesiology.
Don't get me wrong, people:
I previously have had the experience of submitting articles to other savvy
editors in California. Yet, with no offense to them intended, it seems to me
that they have an almost irrational obsession with trivialities such as
data and proof, expecting me to beat upon my delicate insights with such
blunt instruments as statistics. Indeed, I often comfortably begin my
rebuttal letters with you're just not getting it! Dr. Jackson, on the other
hand, is a man who seems to understand that the deepest truths cannot be taught,
but rather are caught.
On that note, the present
treatise reflects on the topic of anesthesia and mystical truth, a story that
has its origins in antiquity and touches on the deepest quandaries of our
field. One of the fundamental scientific questions in anesthesiology is the
mechanism by which general anesthetics extinguish consciousness, a question
that becomes yet more complex when we consider thatsomewhere along the road to
sweet oblivionanesthetics can also produce heightened, even mystical states
of consciousness.
The Temple of Apollo in
Delphi was among the most sacred sites of Ancient Greece, because within those
hallowed halls was perched the Oracle. The Oracle was typically a woman
from Delphi who underwent a mystical initiation that transformed her into a
prophetic priestess, or Pythia. These seers would induce themselves into
a trance-like state, from which sprung the cosmic truths that guided the lives
of the ancients. The Pythia, however, was not simply high on life. As Strabo
(64 B.C.-A.D. 25) writes:
They say that the seat of the oracle is a cavern hollowed
deep down in the earth, with a rather narrow mouth, from which rises a pneuma
[the ancient Greek word for gas, vapor, or breath] that produces divine
possession. A tripod is set above this cleft, mounting which, the Pythia
inhales the vapor and prophesies.
The vapors emanating from the chasm under the Temple
thus imbued the Pythia with a mystical forceor did they? Around 1900 an
English classicist named Adolphe Oppe visited French archeological excavations
at Delphi and found no evidence of a chasm or any source of gas. The tales of
old appeared to be debunked, and the mysterious vapors of Delphi were regarded
as nothing more than legend throughout the greater part of the 20th century.
A more recent investigation
by John Hale and colleagues revealed that, in fact, there were hidden
faults under the Delphic Temple.1 Analysis of the spring water around the site
of the Oracle identified the gases methane, ethane, and ethylene. It was the
sweet aroma of ethylene that fit Plutarch's ancient description of the Temple's
vapors as expensive perfumes. What finally helped reveal the secret of the
gases were not the records of the historian Plutarch, but rather the
investigation of one of the great women in the history of anesthesiology. In
1899, Isabella Herb was an anesthetist for Charles Mayo at the Mayo Clinic and,
in the 1920s, introduced the anesthetic ethylene into clinical practice.2
(Figure 1) Her publications on ethylene from the 1920s and 1930s indicate that
its administration in lower doses evokes a trance-like state leading to
euphoria and mystical experiences. Occasionally, however, patients under the
influence of ethylene would thrash about uttering incoherent
screamsdescriptions like these fit ancient reports of the Oracles periodically
having violent reactions instead of prophecies. The mystery of Delphi appeared
to be solved.
The relationship of
anesthesia to mystical truth has a more academic manifestation in modernity,
indeed, in the Harvard of the late 19th century. Renowned psychologist William James's
experiments with nitrous oxide influenced one of his greatest works, The
Varieties of Religious Experience.3 (Figure 2) In the midst of a nitrous
reverie, James once scribbled, That sounds like nonsense, but it is pure on
sense! James published more formal reflections of his nitrous experiences in
an 1898 article entitled Consciousness Under Nitrous Oxide. This treatise was
inspired by the work of one who has been called anesthesia's philosopher and
mystic, Benjamin Paul Blood.4 In 1874, Blood published a book entitled The
Anaesthetic Revelation and the Gist of Philosophy, which heavily influenced
the thinking of James. Blood attempted to formulate a foundation for philosophy
based on his 14-year investigation into the mysteries of the mind using ether
and nitrous oxide. Blood regarded the anesthetic experience as a key to
resolving the typical dualistic thinking of Western philosophy. Oscar Wilde,
after receiving anesthesia for a tooth removal, elegantly expressed this
synthetic experience in a letter to William James:
The
next experience I became aware of, who shall relate! My God! I knew
everything. A vast inrush of obvious and absolutely satisfying solutions to
all possible problems
an all-embracing unification of hitherto contending and
apparently diverse aspects of truth took possession of my soul by force
Then,
in a flash, this state of intellectual ecstasy was succeeded by one that I
shall never forget
a state of moral ecstasy. I was seized with an immense
yearning to take back this truth to the feeble, sorrowing, struggling world in
which I had lived.
So it is that anesthesia
conditioned the sense of truth in both the ancient and modern worlds. Perhaps
one day the cognitive neuroscience of anesthesiology will grasp these mystical phenomena
that may seem like nonsense, but in fact are a most intriguing on sense.
To
read the entire article, go to www.csahq.org/pdf/bulletin/mashour_57_1.pdf.
* * * * *
9. Book Review: The Zone Diet by
Barry Sears, PhD
The other day at the nursing station, I observed the
ward clerk reading "Weight Watchers" as she devoured a "Babe
Ruth." . . . I guess that keeps the scales balanced and the economy moving.
It also contributes to the epidemic in America 50-60% of the population are
overweight with 25-33% affected with obesity. We consumed 15% more calories in
1994 than we did in 1970 and today we dine out twice as often. If obesity was
an infectious disease, we would call it a national crisis.
Of all the books that cross my desk, there is at least
one or two each month about dieting. The "diet industry" is
flourishing. But is there really any new information? At one bookstore I
counted 107 different diet books. At another there were over 200 titles. It is
interesting that as this deluge of new books were filling up the shelves, some
"dated" diet books that spoke of revolutionary new medical dietary
evidence were now on sale at 10% of their initial listing.
There are number of diet books written by celebrities.
These authors are obviously without credentials. However, some of these books
are quite basic and meet a need because of a co-author with credentials, e.g.,
MS, PhD or MD, although the latter group may not always be as knowledgeable as
the public assumes.
A brief review of some of these books will describe
this self-perpetuating industry. The questions still remain. Are they of value
to the overweight Americans? Are they helpful to those with other dietary
problems such as hyperlipidemia, coronary artery disease, peripheral vascular
disease, hypertension, or diabetes? Do they provide complete lifelong
nutritional programs? Do they incorporate exercise and stress management? There
are at least three that do.
www.amazon.com/exec/obidos/redirect?link_code=as2&path=ASIN/0722536925&tag=delmeyernet-20&camp=1789&creative=9325
A couple of years ago, my RN-NP introduced
me to The Zone Diet by Barry Sears, PhD. Since then he has written
additional volumes, including Mastering the Zone, which I received in
the current package of audio tapes (Harper Audio, $25). Dr. Sears gives a very
comprehensive nutritional program which is easily put into action. After a
discussion of the ill effects of hyperinsulinism, he presents a system of
balanced eating so one always remains "in the zone." If you're "in
the zone" of normal insulin levels one should not have postprandial
lethargy. The current presentation seems more complete than what I have
encountered in the past. He also states that only in America can one go to a
gym and find valet parking. He advises that one should park at the most remote
regions of a parking lot and walk. He even suggests that we park our cars about
15 minutes from work to provide at least 15 minutes of exercise every morning
and every evening. He sees no need to buy exercise equipment or join a gym or
pay to exercise. As physicians we have people run in place for a two minute
exercise pulse in an eight foot exam room. Americans have a hard time thinking
that anything happens unless they spend money. Much of the world feels we have
too much of that. I found his system very easy to follow and quite effective.
To read the review online,
go to www.delmeyer.net/bkrev_DietsDon'tWork.htm.
To read the others, please go to http://healthcarecom.net/Diets.htm#The%20Zone%20Diet.
Diets: Reviews by Del Meyer, MD
*
* * * *
10. Hippocrates & His Kin: Health Care Reform is Just Around the Corner
Politician:
Health care reform is just around the corner.
Would
someone just tell me around which corner?
Employer: I
know that half of my sales and promotion costs are wasted.
I
just wish I knew which half.
Consumer: I'm going to start walking
more and riding my bike more with gasoline at $4 a gallon.
If
the Gas Prices don't slow down, America will be getting green and Americans
getting healthier!
The side effects of gasoline
seeking market base prices are helping the economy. But are the
environmentalists happy?
The free market is more effective in the greening of
America than Congress could ever hope for. Can we put Congress out on a
Furlough for a few years to let problems decrease?
Naivet้ Reigns Supreme: Evian water 9 oz $1.49 = 21.19 per gallon! $21.19 for WATER
and the buyers don't even know the source.
Evian
spelled backwards is Naive.
To read more HHK, go to www.healthcarecom.net/hhk2001.htm.
To read
more HMC, go to www.delmeyer.net/hmc2002.htm.
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11. Organizations Restoring Accountability in HealthCare, Government and Society: