MEDICAL TUESDAY . NET

NEWSLETTER

Community For Better Health Care

Vol VI, No 2, Apr 24, 2007

 

In This Issue:


1.                  Featured Article: An Unfortunate Blight on American Medicine

2.                  In the News: Jailing of Tuberculosis Patient Sparks Debate

3.                  International Medicine: NHS May Be Restricted to Core Services

4.                  Medicare: What Does "Medicare for All" Really Mean?

5.                  Medical Insurance Gluttony: Blue Cross Cancellations Called Illegal

6.                  Medical Myths: ICD9 Codes Are Necessary to Deliver Appropriate Health Care

7.                  Overheard in the Medical Staff Lounge: Physician-Assisted Suicide - A Worldwide Tragedy

8.                  Voices of Medicine: The Cost of Medicine and Reimbursement

9.                  From the Physician Patient Bookshelf: Is the White Plague Coming Back?

10.              Hippocrates & His Kin: In God We Trust. All Others We Scan for Viruses.

11.              Related Organizations: Restoring Accountability in Medical Practice and Society

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MOVIE EXPLAINING SOCIALIZED MEDICINE TO COUNTER MICHAEL MOORE

Logan Clements, a pro-liberty filmmaker in Los Angeles, seeks funding for a movie exposing the truth about socialized medicine. Clements' strategy is to release the documentary this summer on the same day that Michael Moore's pro-socialized medicine movie "Sicko" is released. This movie can only be made in time if Clements finds 200 doctors willing to make a tax-deductible donation of $5K each. Clements is also seeking American doctors willing to perform operations for Canadians on wait lists. Clements is the former publisher of "American Venture" magazine who made news in 2005 for a property rights project against eminent domain called the "Lost Liberty Hotel."

For more information visit www.sickandsickermovie.com or email logan@freestarmovie.com.

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1.      Featured Article: The Psychology of Sham Peer Review, JPS Editorial by Lawrence R. Huntoon, MD, PhD

As sham peer review has spread across the nation, it has left behind a trail of broken and ruined lives and careers of good physicians. Although each case is unique, there are certain common features underlying the psychology of sham peer review. 

Psychology of the Sham Peer Review Process

Sham peer review is a premeditated process that begins long before the actual sham peer review hearings and formal proceedings. It begins in the minds of those who set out to destroy a targeted physician. Improper motives, having nothing to do with furthering quality care, drive the process.

The process of sham peer review frequently involves a progressive series of small attacks leading up to a final formal proceeding designed to end the targeted physician's medical career.  Sometimes these trial runs may go unnoticed or seem insignificant to the targeted physician. Meanwhile, the hospital often secretly collects, compiles, and even solicits documentation to be used in the final attack at a later date.

The final attack (formal sham peer review proceeding) is often well planned and well choreographed so as to give the appearance of a legitimate, good-faith peer review action. The appearance of due process and fundamental fairness is given top priority, although substantive due process and fundamental fairness are always lacking in sham peer review. To read more, please go to www.medicaltuesday.net/index.asp.

Psychology of the Attackers

Although there are some cases in which one or a few participants in the sham peer review proceedings are lazy and negligent and simply defer to the leaders of the attack in casting their vote against the targeted physician, in most instances those who participate in the sham proceedings know exactly what is going on.

The psychology of the attackers is a combination of the psychology of bullies and that of the lynch mob. The attacks are typically led by one or a few bullies who have gained positions of power over others and who enjoy exercising and abusing that power to attack and harm the vulnerable. Although there is always some improper motive that precipitates the attack, the attack itself often serves to distract attention from the bully's own underlying shortcomings, deficiencies, insecurities, and cowardice.

Sham peer review is by nature a group effort involving collaboration between unethical hospital administrators and unethical physician attackers. The psychodynamics involve both the excitement of the hunt and the raw power of the lynch mob that often develops a life of its own, leading to actions that individuals would likely not take if acting alone. It is the psychology of predators versus prey. Others are drawn into the group hunt via the same type of macabre attraction that often compels people to turn their heads and gawk as they drive slowly by the car wreck, looking for any sign of mangled or dead bodies.

The power to snuff out the career and livelihood of a fellow physician in the blink of an eye provides a certain pathological satisfaction and excitement for some attackers. To share in the "group hunt" is to share in some of the power and excitement. And the nearly absolute immunity the attackers enjoy under the Health Care Quality Improvement Act (HCQIA) and the doctrine of judicial nonintervention further emboldens and enhances the power of the attackers.

Psychology of the Physician Victim

Facing superior power and numbers, the targeted physician soon understands that he is the prey and the hunt is on. The final attack is often unleashed quite suddenly and with great fury. The resultant shock and awe often causes a sudden loss of energy and a mental numbness that impairs the physician victim's ability to defend himself effectively. This often further excites the predators as the deer stands motionless, caught in the headlights. 

Shock and awe is followed quickly by denial and disbelief. This is frequently accompanied by a strong belief that the truth will save the victim and set him free. Meanwhile, the stigma attached to mere allegations of wrongdoing produces an intended isolation of the targeted physician. As a result, the physician victim often shuns contact with colleagues, further assisting the predators in cutting the prey out from the herd in preparation for the kill. 

At this stage, alone and isolated, facing almost certain demise, extreme fear sets in. How will the physician provide for his spouse and children? How will he cope with the bills that are mounting up now that the attack has stopped cash flow? How will he survive? 

Constantly living in an adrenaline-soaked fight-or-flight state further depletes the victim's energy and is often accompanied by significant depression, complete with severe sleep disturbance (too much or too little), weight loss, and a pervasive feeling of helplessness and hopelessness. The risk of "death by stress" or suicide is very real at this stage.

Anger emerges as the physician victim comes to recognize that the truth and the facts do not matter at all in sham peer review since the proceedings are rigged and the outcome predetermined. The procedural presumption is that the physician is "guilty" and the burden is shifted to the physician to prove his innocence—a burden that the attackers will never allow him to meet. Anger is often accompanied by a consuming desire to hold the attackers accountable for their evil deeds. This not infrequently leads to many years of litigation, further depleting the victim's energy and resources, and consuming the lives of the ruined physician and his family. 

Chronic fear and anger often take a heavy toll on the physician's physical and mental well-being, and on his relationship with family and others. The resulting downward spiral often leaves the physician devastated, still alive physically, but invisible or "dead" to former colleagues and to the profession of medicine. It is a cold and lonely pit that no one could have envisioned upon entering the profession of medicine.

Psychology of the Enablers

Enablers are those physician bystanders who are aware that the sham peer review attack is taking place, but who stand by and do nothing to object or to stop it. It is the psychology of the herd that stands placidly by while one of its own is cut out from the herd and killed. Enablers are like the timid sheep who huddle close together, keeping their heads down, in the hope and belief that the predator's appetite will be satisfied with the "kill," leaving the rest of the herd to graze in peace.

In many instances, a few vocal physician bystanders may be all that it would take to stop the bully's attack. Expressing objections to individual physicians could also destroy the psychodynamics that impel a lynch mob.

Although bullies who launch vicious attacks against physician colleagues may be beyond redemption, renewal of professional ethics through education, and urging of the physician bystanders to get involved, may help to stop the spread of sham peer review. It may be the only hope.

Unless ethical physicians stand up and object, and hold the unethical physicians accountable for their actions, the spreading moral malignancy of sham peer review will irreparably harm patient safety, medical excellence, and the integrity of the medical profession.

Lawrence R. Huntoon, M.D., Ph.D., is a neurologist practicing in New York and serves as Chairman of the AAPS Sham Peer Review Committee. www.jpands.org/jpands1201.htm

To read a press report, go to www.louisianamedicalnews.com/news.php?viewStoryPrinter=934.

For more reading on this important topic, please click on the following:

Hippocrates Modern Colleagues, www.delmeyer.net/HMCPeerRev.htm.

Center Peer Review Justice Inc, www.peerreview.org, Dr Richard B Willner, President.

Semmelweis Society International Annual Meeting, May 13-15, 2007, Washington D.C. The agenda can be found at www.semmelweis.org/. Also, see the Semmelweis Society for extensive Peer Review and Whistleblower retaliation at www.Semmelweissociety.net.

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2.      In The News: Jailing of Tuberculosis Patient Sparks Debate

A 27-year-old man in Phoenix is locked in a jail cell with negative-pressure ventilation, perhaps for life, because he failed to heed doctors' instructions to wear a mask in public. He is infected with an extensively drug resistant strain of tuberculosis, XDR-TB, which is considered virtually untreatable.

He told the Associated Press he was treated worse than a jail inmate, kept all alone inside four walls. He said he had not even seen his own reflection in months.

Only one other person has been detained in Phoenix in the past year. Texas has placed 17 patients in the past year in an involuntary detention facility in San Antonio.

XDR-TB is apparently a new strain that is found throughout the world, including pockets in the former Soviet Union and Asia.

In the U.S., there were a total of 13,767 cases of tuberculosis reported in 2006 (Arizona Daily Star 4/3/07). To read more, please go to www.medicaltuesday.net/news.asp.

According to a report from the Pima County Health Department to the Public Health Committee of the Pima County Medical Society, the case rate in Arizona, which ranks 11th in tuberculosis morbidity nationwide, rose to 5.0 per 100,000 in 2006, a 9% increase, after declining from 7.2/100,000 in 1995 to 4.6/100,000 in 2005. Foreign-born individuals accounted for 57% of the 2006 cases, and 67% of the infected foreign-born individuals were from Mexico.

Legal immigrants are screened in their country of origin as long as 2 years before entry. The proportion of the problem attributable to illegal aliens is not known.

Arizona has the highest percentage of tuberculosis cases diagnosed in correctional facilities. Forty percent of all inmates in Arizona detention centers are Mexican nationals who entered illegally (Newsmax.com 3/15/07).

A pilot project by the Arizona Department of Health Services found the Arizona Department of Corrections to be mostly in compliance with the pertinent recently revised rules.

www.cdc.gov/mmwr/preview/mmwrhtml/mm5511a2.htm

http://jama.ama-assn.org/cgi/content/full/296/23/2792

www.who.int/tb/xdr/faqs/en/print.html

Additional information:

·         "Illegal Aliens and American Medicine," by Madeleine Pelner Cosman, J Amer Phys Surg, Spring 2005.

·         Before the antibiotic age, radiation therapy was used for many infectious diseases, including "glandular tuberculosis," with the most impressive results seen in gas gangrene. When antibiotics became available, this treatment fell completely out of favor. In a patient who otherwise faces life imprisonment and early death, cautious consideration might be given to older modes of therapy. See: Kelly JF, Dowell DA. Roentgen Treatment of Infections. Chicago, Ill.: Year Book Publishers; 1942. Also Berk LB, Hodes PJ. Roentgen therapy for infections: an historical review. Yale J Biol Med 1991;64:155-165.

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3.      International Medicine: NHS May Be Restricted to Core Services by Nicholas Timmins, www.FT.Com, March 20, 2007 

The prospect that the National Health Service might provide only core 198 services, with patients forced to pay for any other treatment or meet it from private insurance, was raised by the government yesterday.

News that ministers were examining the possibility of defining the services that the NHS is obliged to provide free to everyone was disclosed in the small print of the public services policy review launched yesterday by Tony Blair, the prime minister, and Gordon Brown, the chancellor.

It says the government should "look at the possibility of drawing up a package of services that all users are entitled to". NICE, the National Institute for Health and Clinical Excellence, could be asked to do that.

The  health department confirmed it was "looking at the possibility in the normal process of policy development" and agreed that deciding what everyone was entitled to would also involve deciding "what they are not entitled to.". . .  To read more, please go to www.medicaltuesday.net/intlnews.asp.

Anna Dixon, deputy director of policy at the King's Fund think-tank, and a specialist on international health systems, said: "It sounds like establishing a core package of benefits that the NHS will fund – and that is something that has long been debated in academic circles. But politicians. . .  have always shied away from being more explicit about entitlements."  

Social insurance systems tended to be much more explicit about what was and was not covered, with private insurance markets developing to cover excluded treatments, she said.

Tub she warned that when lists of exclusions were drawn up, "they often do not feel right to the public". It was "a very difficult exercise" and one that, if undertaken, "is going to be very controversial".

To read more as well as other Nicholas Timmons articles, (subscription required) please go to http://search.ft.com/search?queryText=Nicholas+Timmins&aje=true&dse=&dsz=&x=15&y=6.

The NHS does not give timely access to healthcare, it only gives access to a waiting list.

After 60 years of reworking the NHS, the entitlement is getting smaller.

Can governments ever admit to making a mistake in the original plan?

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4.      Medicare: What Does "Medicare for All" Really Mean?

John Edwards Will Give You Free Health Care, By William F. Buckley Jr., NR Editor-at-Large.

The word among professional Democrats is that John Edwards has set the stakes on the matter of health care, and no one who wants to be president can offer less than he is offering, which is — of course — guaranteed health. That is to say, guaranteed free health care.

Mr. Edwards's primary complaint is that 47 million Americans do not have health insurance. In a free society, one scans this datum in search of its component parts.

If health insurance were without cost, one assumes that everyone would have health insurance. A corollary of this is that everyone, in a society of allegedly free health care, would actually be paying the collective costs of health care. The political challenge lies in disguising the cost. To read more, please go www.medicaltuesday.net/medicare.asp.

When a commodity is quantifiably measurable, yet universally available, like air, one can talk about its being "free." Only people in submarines need to measure air, and to pay the cost of supplying it. Health care, unlike air, can't be free, because doctors and nurses and drugs are not in infinite supply. So can we generate what amounts to a public subsidy by reducing the costs of health care?

To look that problem in the face, we search out relevant figures. One set of these reveals that the cost of health care for an American is twice what it is for a Western European. If in Germany it costs $100 per day per patient at a hospital, while a comparable hospital stay in the United States costs $200, one reaches for an explanation. Is it that American health care is twice as expensive because it is twice as comprehensive, twice as resourceful? Or is it simply that, for other reasons, doctors and nurses and drugs cost twice as much in the United States?

In any case, how do we go about reducing these costs? Either you pass a law that doctors and nurses and drug companies have to slash the cost of their services and products by one-half — a proposal nowhere hinted at by Mr. Edwards — or else we need to reduce the number of people entitled to receive that health service. How do you do that?

Not by going in the direction proposed by Candidate Edwards, but by going in the opposite direction. His proposal is that more people should be covered. But if more people are insured, they will increase their consumption of health care, and therefore increase the total U.S. expenditure on health care.

But John Edwards calls for something different — a fiscal frumpery by which the cost of health care is somehow dissipated. This is done by obscuring the agent by which health care is provided. It has frequently been noticed by social philosophers that from about 1943, when income taxes were first collected so to speak at the source, via withholding, the average worker does not think of himself as being taxed — because the instrument by which the money is taken is so automatic as to be more or less invisible. . .

Mr. Edwards speaks grandly about health coverage for 47 million people who do not now have it. But unless there is a diminution in the cost of health services, they will be paid for by somebody. If it is so that the 47 million without insurance are the identical 47 million who are the nation's poorest, then it might be said that all we are really engaging in is more redistribution. There is a case to be made for this, and indeed, redistribution has been accepted for years. The wealthiest 5 percent of Americans pay 54 percent of all taxes, which means they are paying taxes that would otherwise be paid by the 95 percent of Americans whose tax rates are lower. . .  To read the entire column, please go to

http://article.nationalreview.com/?q=MDdhYTI5ZmI5YjFmNWVmNDZmNmYxMjk4NTBhODAxZWQ.

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

- Ronald Reagan

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5.      Medical Insurance Gluttony:  Blue Cross Cancellations Called Illegal

The health insurer 'routinely' dropped the policies of pregnant or ill clients, an agency finds. The company disputes the charge. By Lisa Girion. Los Angeles Times Staff Writer, March 23, 2007

Blue Cross of California "routinely" violated state law when it canceled individual health insurance coverage after policyholders got pregnant or sick, making no attempt to determine whether they did anything to merit such "harsh" treatment, according to a state investigation of practices that appear to be industrywide.

State regulators plan similar investigations of other health plans in California, and the findings against Blue Cross ratchet up the risk of liability for other insurers, many of whom face lawsuits from consumers who claim they were illegally dumped and subjected to substantial hardships.

As a result of its unprecedented investigation, the Department of Managed Health Care on Thursday said that it had fined Blue Cross $1 million — an amount immediately criticized by canceled policyholders and consumer advocates as too small to matter to an insurer whose parent company, WellPoint Inc., earned $3.1 billion in profit last year on revenue of $57 billion. . . To read more please go to www.medicaltuesday.net/gluttony.asp.

The state investigation found that Blue Cross used computer programs and a dedicated department to systematically investigate and cancel the policies of pregnant women and the chronically ill regardless of whether they intentionally lied on their applications to cover up preexisting medical conditions — a standard required by state law for canceling individual policies.

Regulators examined 90 randomly selected cases of policy cancellations — out of about 1,000 a year in California — and found violations in each one. . .

The state report said the legal standard for cancellation was high because it put plan members at great risk — financially and medically — and because it left physicians and hospitals holding the bag for services rendered in good faith and often with prior authorization from the insurer.

"Rescission is the harshest possible punishment," Department of Managed Health Care Director Cindy Ehnes said. "It leaves providers unpaid and it leaves the enrollee uninsurable." .. . .

To read the entire article, go to

www.latimes.com/business/la-fi-health23mar23,1,6559553,print.story,  lisa.girion@latimes.com.

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6.      Medical Myths: ICD-9 Codes are Necessary to Deliver Appropriate Health Care

The AMA's Physician ICD-9-CM 2007 Volumes 1 & 2 are here!  With significant changes made yearly, you'll want to order your copy now to stay up-to-date with the most recent ICD-9-CM code changes.

My inbox is peppered with ads from the AMA trying to sell me books on coding, how to code appropriately, how to code your bills to get reimbursed (a lot of the codes change every year), and how to code for maximum reimbursement (or how to soak your insurance carrier and Medicare for more money). The hidden message is that if we help the AMA make more money from their publications, we will also get more money (with which to pay AMA dues. Some sources say that the publications bring in more revenue than the diminishing number of dues-paying members). Forcing payment for billing codes to bill Medicare and MediCal is an interesting twist since a private concern exists between the government and the provider of services in order to bill the government CMS programs. Usually such items are provided at cost by the government printing office. But to change the codes to totally different meanings suggests an ulterior motive if it requires doctors and billing services to purchase code books from this private concern in order to provide services.  To read more, please go to www.medicaltuesday.net/myths.asp.

All providers of services have to use the codes. The laboratories frequently decline to do lab tests if the code is not detailed enough, sometimes to the fifth digit or two digits to the right of the decimal point. Patients get a statement of charges due from the laboratory if their doctors don't provide a detailed enough code. What difference could it possibly make to obtain a glycohemoglobin on a 250.00 diabetic vs a 250.01 diabetic? Or what possible difference could it make in how much to pay for an office call if it is a 250.00 vs a 250.01 diabetic? Office calls within a specialty are about the same as office calls by most doctors in that specialty, and to split hairs just adds to the cost of healthcare. But the 30 minutes to an hour a day a physician spends looking up detail codes is never figured into the healthcare cost equation.

Now with pharmacy reimbursement plans, the rules have again changed. For diabetes type 2 or 250.00, all the digits to the hundredth place no longer matter. Reimbursement only matters if there is one of four complications; whether there is DM with renal disease, with peripheral vascular disease, with peripheral neuropathy, or with retinopathy. This seems to confirm that the previous five digit coding was totally irrelevant. These new codes for 2007 will only be valid until the government buys enough physicians to come up with more detailed policing mechanisms, further mandates and increasing regimentation.

The hidden message is that the government needs unnecessary information in order to control us—to make us fall into line. In other spheres, this would simply be called harassment. When will it have the same impact as these other forms of harassment by individuals? When a patient comes to see a doctor for an office call, it doesn't make any difference what the reason is. It is his or her prerogative to see the doctor and no insurance company or even Medicare will prevent that. Can we give the patient the full 20 minutes and not reduce it by the three or five or seven minutes needed for harassment management, which adds nothing to the quality of care?

Fact: ICD-9 codes have nothing to do with quality of care, only with bureaucratic control of care.  If it does affect quality, it will only be to diminish it.

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7.      Overheard in the Medical Staff Lounge: Physician-Assisted Suicide – A Worldwide Tragedy

Dr. Rosen: There is sure a lot of news about Physician-Assisted Suicide in the papers and now even in the medical press. How can a healing profession even consider being the messengers of death?

Dr. Sam: The party of death is now in power and they feel they have superior wisdom and understanding, including the ability to make decisions of life and death?

Dr. Milton: Yes, we are always involved in those decisions, but it is usually in the context of when to turn life support off, when to discourage heroic measures, and when to tell the family that a number of vital organs are failing and saving a failing heart will not save the failing kidney or failing liver.

Dr. Michelle: There are so many areas in which we can shed light on the issues of life and death that it would jeopardize all trust our patients have in us to even recommend hastening or causing a death.

Dr. Milton: How can a patient ever be comfortable with trusting us as the healers in white when we might be the executioners in black? To read more, please go to www.medicaltuesday.net/lounge.asp.

Dr. Del: Even some of the regional medical journals have articles this month not only on whether or not it's OK to be involved in Physician-Assisted Suicide but even supporting it. I've eliminated all of them from consideration for my "Voices of Medicine" column in Sacramento Medicine. I wouldn't want to be caught highlighting such a travesty on our profession.

Dr. Patricia: But the public is getting confused on these mixed messages from our profession. How do we regain their trust?

Dr. Sam: I'm not optimistic with the current crowd in DC. They are putting a very populist twist on this as a humanitarian effort. Maybe rephrasing their sentences: The kindest thing you can do for your Aunt Liz with cancer is to kill her?

Dr. Patricia: We have to continue to point out that with modern pain therapy, no one has to suffer.

Dr. Milton: Sometimes it's the family that is suffering more than the patient. I've seen family members of cancer patients squirm in pain while the patient is lying very comfortably and free of pain.

Dr. Rosen: I've even seen a nurse suffer more than the patient. I once made a home visit on a patient with cancer of the pancreas and went over his pain management plan. He clearly stated that the patches were very effective in keeping him relatively free of pain. A few hours later, I received a call from the visiting nurse wanting to double the size of the pain patches. I told her that I was just out there and he wasn't complaining of any significant pain. She responded, "Doctor, don't you know his diagnosis?" That nurse was experiencing more pain than the patient for whatever reason, which went beyond the empathy we expect from our nurses.

Dr. Sam: We have a very assertive legislature out here in California. They passed a law that makes us take pain management courses and demands that all pain will be relieved. They are unable to understand that much of human pain is not the kind that is delivered by pain fibers to the brain. There is so much variation in pain thresholds that it's difficult to compare one patient with the next. How do we keep the medical incompetent lawmakers from practicing medicine?

Dr. Rosen: Looks like our profession has challenges on all fronts. And our best and brightest better get busy with astute dialogue on all fronts before it's too late.

Dr. Del: In reviewing the local and regional small medical society journals, I find it to be a it's really a tragedy that only a small number have articles written by physicians. Most articles are written by administrative staff that hasve very little comprehension of the real issues, which are usually unrelated to the issues that the administrators running the societies keep before the public.

Dr. Rosen: And to make matters worse, many medical societies do not allow the public to read their articles on the web. They only allow their members to read them. We need the widest dissemination of information from the captains of the health-care team.

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

MOHAMMED ARAIN, MD, writes about the cost of medicine and reimbursement in the President's Message February 2007 issue of Vital Signs, the Official Publication of the Fresno-Madera Medical Society.

 

The costs of practicing medicine are on the rise. Decreased reimbursements for the services provided by doctors of all specialties by Medicare and other insurers combined with higher liability insurance costs mean more hours that we have to work just to stay afloat.  Health care issues are among America's biggest national concerns. Thirty-two percent of Americans feel that the U.S. health care system is not meeting the needs of them and their families, 68 percent feel the current system does not meet the needs of most Americans. Ninety percent feel Congress must address the changes needed in the health care system, and 95 percent said national health care reform is needed. 

I want to tell our patients and politicians that all we want to do is take care of our patients, and we can't do that if we're being undermined and cut. You can't diminish reimbursement and expect access to care to increase. Medicine is, in essence, a moral enterprise, and physicians are expected to promote the interests of those they serve. This, sadly, has not always been the case when economic, commercial, and political agendas so often take precedence over ethical obligations. History reflects a constant tension between self-interest and ethical ideals that has never been resolved. Today this problem is greater than ever. This conflict is eroding the moral foundations of all professionals, not only in medicine, but in law, education, and even the ministry.  To read more, please go to www.medicaltuesday.net/voicesofmedicine.asp.

Physicians are facing an ever increasing cost to stay in practice. The license fee used to be $65 about 25 years ago and now it is $985. With emergence of HMO's even the PPO insurance have reduced the payments to near Medicare level. Reimbursements for services have become about 25 percent of what they used to be. In this medico-legal environment, paperwork has tremendously increased, and it takes five to six people to do the same work which used to be done by two. Malpractice insurance, workman's comp insurance, employees overhead expenses, increased cost of utilities compounded with reduced reimbursements have forced physicians to work 12-14 hour days. 

There is no other profession in which physicians are nearly 40 years old by the time they get into practice and pay back their loans. The average work life of physicians is 20 years.

Governor Schwarzenegger's health reform plan is promising to provide insurance for all. This may make it easy for the emergency rooms across the state to get better coverage from the physicians. His program is to please the public sector by providing guaranteed health benefits, increasing hourly wages and workers' compensation. This should not be done at the cost of further asking sacrifices from physicians and hospitals. 

The maximum temporary total disability (TTD) rate will increase to $881.66/week as of January 1, 2007. This marks the first year the TTD rate will be affected by a change in the state average weekly wage (SAWW) – which increased 4.96% from the previous year Also increasing is the rate that insurance carriers and employers must pay for mileage.  The mileage rate for medical and medical-legal travel expenses will increase to 48.5 cents per mile effective January 1, 2007. This rate must be paid for travel on or after this effective date, regardless of the date of injury.

There is no other profession in which one is forced to provide services without any return. There are laws such as EMTALA to punish physicians.  We find no appreciation, recognition or sympathy for us from the power pillars of the state. Everyone takes advantage of physicians. The least which the physicians could get for emergency services for the uninsured is to get tax benefits for our services. For this we need to work with CMA and AMA. To achieve anything we need to have a larger membership and a strong voice. While fighting for our rights, we must continue the good patient care and our pledge for service to humanity.

The entire article can be found by clicking on Newsletter at http://www.fmms.org/.

To read other VOM, please go to www.healthcarecom.net/voicemed.htm.

To read HMC, please go to www.delmeyer.net/HMC.htm.

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9.      Book Review: Bargaining for Life - A Social History of Tuberculosis, 1876-1938 by Barbara Bates, MD

The University of Pennsylvania Press is publishing a series with the general topic of Studies in Health, Illness, and Caregiving in America under the general editorship of Joan E. Lynaugh.  Dr. Bates' book is the seventh in that series.

Bates introduces tuberculosis as the most common cause of death in the United States and in Western Europe throughout the nineteenth century.  During the last decade of the nineteenth century, there emerged a new optimism about the disease and more aggressive attempts to deal with it.  In 1882, Robert Koch discovered the tubercle bacillus, and as physicians and social leaders recognized that consumption was infectious, they promulgated new laws, educational programs, and institutions with which to combat it.  In 1885, Edward L. Trudeau opened the first successful sanatorium in the United States.  It was thought that, if TB was infectious, controlling the patients' behavior and separating the afflicted from their families and from the rest of society could stop the spread of the disease. To read more, please go to www.medicaltuesday.net/bookreviews.asp.

Bates notes that historians have traditionally focused on either the medical knowledge of tuberculosis or on the social movement to control the disease.  The protagonists are usually physicians or social reformers who led the campaign against tuberculosis.  The story of the experiences of the patients, their families, and those who took care of the sick has been told in part.  A collection of letters preserved by Dr. Lawrence F. Flick, a tubercular himself, and his family helps to correct this deficiency.

Bates shows how anti-tuberculosis activities convinced both physicians and the public to support tuberculosis institutions through such methods as the Christmas Seal Campaign and films like The White Terror.  She also points out with graphs that the campaigns to control TB had little impact on the disease.  Henry P. Phipps, a steel industrialist, funded an institute in Philadelphia in 1903 that included a dispensary.  Dr. Flick, who had a life-long commitment to provide care for poor patients with TB, was its medical director and was able to serve a broader city community.  In 1910, Phipps became convinced that his institute could be properly run only by an elite research-oriented university.  When he transferred it to the University of Pennsylvania, Flick lost his position as director, and the institute gradually lost its commitment to patient care.

Dr. Bates, an internist and historian at the University of Pennsylvania, examines the development of scientific medicine, the growth of health-related institutions and voluntary organizations, the development of trained nursing, the calls upon government to provide medical care, and a highly competitive society in which opportunity was stratified by class, race and gender.  In this microcosm, she develops the interplay among individual experiences, family relationships, professional behaviors and interests, values, politics and social structure.

In a TB sanatorium, the patients always put on a mask when a doctor or nurse entered the room without a mask.  This stops the spread of TB in that room and is less intimidating to the patient who can see the faces of all visitors.  In this community, some hospitals require gown, gloves and boots in examining a tubercular patient.  It takes a long time to change behavior, as Dr Bates points out.  Let's hope this excellent, well-researched book with nearly 100 pages of endnotes and bibliography will help dispel some of the witchcraft around TB.

[In view of the current increase in tuberculosis even in our prisons, we bring you this review from our archives at www.delmeyer.net/bkrev_BargainingForLife.htm.]

To read other reviews, please go to www.delmeyer.net/PhysicianPatientBookshelf.htm. To search topically, please go to www.healthcarecom.net/bookrevs.htm. 

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10.  Hippocrates & His Kin: In God We Trust: All Others We Scan for Viruses.

If the AMA is making as much money from their publication division as they are from their membership, maybe before too long the AMA won't need doctor members.


If Blue Cross can eliminate rate payers with a computer program, that certainly takes the wind out of the sails of Robin Cook, MD, Michael Crichton, MD, and others who made fortunes out of a more direct approach to eliminate the high-risk insured. www.healthcarecom.net/bkrev_MedThrillers.htm

To read more, please go to www.medicaltuesday.net/hhk.asp.


Maybe this physician-assisted suicide is not entirely bad. What if we had Michael Moore as a patient? Would we have the courage to improve society?


My Dear Wormwood: Our work as Temptress of the world is getting easier all the time. The plan devised by Our Father Below, is working so well that before long we won't have to lift our fingers to get people on the wide path to spend eternity with us. The lawmakers are working so well with us that not only is killing the pre-born legal, soon it will be legal to kill the defective born, the disabled, the cancer patients, the pain patients, all those that suffer, those wanting to die, and before long, those that don't want to die but society has determined that they should die. Your loving uncle, Screwtape.  (After CS Lewis)

To read more vignettes, please go to www.healthcarecom.net/hhkintro.htm.

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

1. 

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Physicians Restoring Accountability in Medical Practice, Government and Society:


 

John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?" go to www.healthplanusa.net/AE-AreYouReallyInsured.htm.


•                       

PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.emergiclinic.com. To read more on Dr Berry, please click on the various topics at his website.

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. I also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. 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. To read Dr. Huntoon's recent article on Sham Peer Review, please go to www.louisianamedicalnews.com/news.php?viewStoryPrinter=934.

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" at www.northernurology.com/articles/healthcarereform/administrativectomy.html.

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

•                      John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?" go to www.healthplanusa.net/AE-AreYouReallyInsured.htm.

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

•                      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. I also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. 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. To read Dr. Huntoon's recent article on Sham Peer Review, please go to www.louisianamedicalnews.com/news.php?viewStoryPrinter=934.

•                      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" at www.northernurology.com/articles/healthcarereform/administrativectomy.html.

•                      Dr Vern Cherewatenko concerning success in restoring private-based medical practice which has grown internationally through the SimpleCare model network. Dr Vern calls his practice PIFATOS – Pay In Full At Time Of Service, the "Cash-Based Revolution." The patient pays in full before leaving. Because doctor charges are anywhere from 25–50 percent inflated due to administrative costs caused by the health insurance industry, you'll be paying drastically reduced rates for your medical expenses. In conjunction with a regular catastrophic health insurance policy to cover extremely costly procedures, PIFATOS can save the average healthy adult and/or family up to $5000/year! To read the rest of the story, go to www.simplecare.com. 

•                      Dr David MacDonald started Liberty Health Group. To compare the traditional health insurance model with the Liberty high-deductible model, go to www.libertyhealthgroup.com/Liberty_Solutions.htm. There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.

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

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

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

To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to www.semmelweissociety.net.

Semmelweis Society International Annual Meeting

May 13-15, 2007, Washington D.C.

•                      Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), is making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals. For more information, go to www.sepp.net.

•                      Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column at NewsMax. Please log on to review the last five weeks' topics or click on archives to see the last two years' topics at www.newsmax.com/pundits/Medicine_Men.shtml. This week's column, Research Backs the Dangers of Lawsuit Tax, is found at www.newsmax.com/scripts/printer_friendly.pl?page=http://www.newsmax.com/archives/articles/2007/4/9/124636.shtml.

•                      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 scroll down on the left to departments and click on News of the Day in Perspective: Supreme Court rules that building block for all life is a "pollutant" Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. This month, be sure to read "HANDS OFF OUR KIDS." Scroll further to the official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. www.jpands.org/. There are a number of important articles that can be accessed from the Table of Contents page of the current issue. Don't miss the excellent articles on Restoring True Insurance or the extensive book review section which covers six great books this month.

            Be sure to put the AAPS 64th Annual Meeting to be held on October 10-13, 2007, in Cherry Hill, NJ, on your planning calendar.


 

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Del Meyer             

Del Meyer, MD, Editor & Founder

DelMeyer@MedicalTuesday.net

www.MedicalTuesday.net

6620 Coyle Avenue, Ste 122, Carmichael, CA 95608

Words of Wisdom

Primum non nocere – First do no harm. The first responsibility of a professional was spelled out clearly, 2,500 years ago, in the Hippocratic Oath of the Greek physician. No professional, be she doctor, lawyer, or manager, can promise that she will indeed do good for her client. All she can do is try. But she can promise that she will not knowingly do harm. And the client, in turn, must be able to trust the professional not knowingly to do the client harm. Otherwise he cannot trust her at all. Primum non nocere is the basic rule of professional ethics, the basic rule of an ethics of public responsibility.

Edward Langley, Artist 1928-1995: What this country needs are more unemployed politicians.

Some Recent or Relevant Postings

HEALTH CARE CRISIS - The Search for Answers, Edited by Robert I Misbin, MD, Bruce Jennings, MA, David Orentlicher, MD, JD, and Marvin Dewar, MD, JD. http://healthcarecom.net/bkrev496.htm Don't miss John H. Fielder, PhD, who has a chapter on Abusive Peer Review and Health Care Reform and what it means for American Medicine.

HPUSA April 2007 Newsletter:    www.healthplanusa.net/April07.htm

HPUSA January 2007 Newsletter:  www.healthplanusa.net/January07.htm

In Memoriam

Paul Lauterbur, father of MRI, died on March 27th, aged 77.,

THE whole history of modern science, Paul Lauterbur once joked, might be written on the basis of papers turned down by academic journals. His own experience was a case in point. In 1971 he sent a paper to Nature; it was rejected. The Nature folk were especially unimpressed by the fuzziness of the pictures that accompanied the piece. Never mind that they showed the difference between heavy water (with deuterium atoms) and ordinary water (with hydrogen atoms) in a way that no image had done before. Never mind that nuclear magnetic resonance (NMR) had been used for the first time to make those images, and could henceforth be used, with just a little development, to make non-invasive pictures of brains and spinal cords. Never mind that this technique, in 2003, was to win Mr Lauterbur a joint share in the Nobel prize for medicine. It did not yet look professional enough. . .

There was always something serendipitous, even wild, about Paul Lauterbur's approach to science. As a boy in the Ohio countryside he trespassed widely in search of terrapins, fish and birds; as a teenager he built his own lab in the basement of his house, entranced by the strange vials in his chemistry set and by the stink of burning sulphur. His greatest joy, he reported, was to be left alone to explore the world or to experiment. His chemistry teacher at school was understanding, allowing him to lark around with apparatus, just within the limit of danger and expulsion, at the back of the class. His army superiors were kind when he was drafted in the 1950s, letting him spend his time setting up and running an early NMR machine; by the end of his service, when his colleagues had nothing but a cropped head to show for it, he had produced four scientific papers. . .  To read the entire Obit, please go to www.economist.com/obituary/displaystory.cfm?story_id=8954439.

On This Date in History – April 24

The first regularly issued American newspaper, the Boston News Letter, began publishing on this date in 1704. Newspapers have always done very well in America and, in general, they have also done very well by America in helping to inform us, educate us and wrap our packages. Greater versatility we cannot ask. To read more historical vignettes, please go to www.medicaltuesday.net/org.asp.

Jacob Ebert and George Dulty received the first patent for a great American Institution, the soda fountain, on this date in 1833. Ours is a soda fountain civilization, whose major advance has been to put the soda in cans and bottles. Did you ever stop to think that soda, or soft drinks, is one of the ways America has colonized—some have said Coca Colonized—the world? In our formative years, when we are too young for beer and too old for just plain milk, it is the soda fountain psychology that shapes our social life and development. In a peculiar way, soda pop is a sort of bottled youth, the elixir of the young masses, the symbol of our times—involved in everything from ecological disputes over bottle and can disposal to arguments about synthetic flavors, dyes and preservatives. Yes, the soda fountain is producing more gas all the time.

After Leonard and Thelma Spinrad

On this date in 1894, Heinrich Dietrich Wilhelm Meyer, my father, was born. I owe my inquisitiveness, my sense of humor, and the direction of my life's journey into medicine to his guidance. Although he only had an eighth-grade education, his generosity and goal setting gave my brothers, my sister, and me no alternative except to go to college so that we wouldn't have to be farmers and would be able to choose our careers. This encouraged all of us to not only achieve a college education but also obtain advanced degrees and make significant contributions to society. I reflect on the fact that hismy father, born in 1864, escaped Bismarck's socialized Germany for freedom in all spheres of human life, including medicine. I will spend my life keeping his adopted country from falling into that failed system of government control all industrialized countries have adopted to their detriment. RIP DAD. Looking forward to seeing you along with Mom, St Peter and Moses and the boys upstairs. Love, DEL.