MEDICAL TUESDAY . NET

NEWSLETTER

Community For Better Health Care

     Vol IX, No 2, April 27, 2010

 

In This Issue:

1.                  Featured Article: How the Brain Keeps Tabs on Two Tasks at Once

2.                  In the News: Sex Hormone Boosts Thinking in Some Women

3.                  International Medicine: NHS bosses earn large bonuses on top of their six-figure salaries

4.                  Medicare: Medicare's Chief Actuary releases his evaluation of ObamaCare

5.                  Medical Gluttony: Patient Gluttony because no Doctor or Nurse explained it to the patient

6.                  Medical Myths: Only politicians can get away with subterfuge

7.                  Overheard in the Medical Staff Lounge: MUDA, MURA, MURI

8.                  Voices of Medicine: Life Without Lawyers by Philip Howard

9.                  The Bookshelf: The More, The Better

10.              Hippocrates & His Kin: Three sources of income, but Uncle Sam can only find two of them

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

Words of Wisdom, Recent Postings, In Memoriam . . .

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Always remember that Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, or any single payer initiative, was born for the benefit of the state and of a contemptuous disregard for people's welfare.

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1.      Featured Article: How the Brain Keeps Tabs on Two Tasks at Once                                      

Motivated Multitasking: How the Brain Keeps Tabs on Two Tasks at Once, By Katherine Harmon, Scientific American, April 15, 2010

New research shows that rather than being totally devoted to one goal at a time, the human brain can distribute two goals to different hemispheres to keep them both in mind--if it perceives a worthy reward for doing so

The human brain is considered to be pretty quick, but it lacks many of qualities of a super-efficient computer. For instance, we have trouble switching between tasks and cannot seem to actually do more than one thing at a time. So despite the increasing options—and demands—to multitask, our brains seem to have trouble keeping tabs on many activities at once.

A new study, however, illustrates how the brain can simultaneously keep track of two separate goals, even while it is busy performing a task related to one of the aims, hinting that the mind might be better at multitasking than previously thought.

"This is the first time we observe in the brain concurrent representations of distinct rewards," Etienne Koechlin, director of the cognitive neuroscience laboratory at the French National Institute for Health and Medical Research (Inserm) in Paris and coauthor of the new study, wrote in an email to ScientificAmerican.com . . .

For the study, 32 right-handed subjects were asked to match letters while their brain activity was recorded with functional magnetic resonance imaging (fMRI). Subjects were motivated by a monetary reward they would receive based on how many letters they matched without error. During this baseline test, both hemispheres of the brain's medial frontal cortex (which is involved in motivation) appeared active. However, when the researchers introduced a second task, where the subjects had to match like uppercase letters in addition to matching like lowercase letters with separately accruing reward tallies, Koechlin and his coauthor Sylvain Charron (of the same institution) found that the subjects' brains divided the two reward-based goals between the two sides of the region. The results were published online April 15 in Science.

The area of the brain that was highly active in the observed multitasking behavior, the frontopolar cortex (which organizes pending goals while the brain completes another task), is "especially well developed" in humans, Koechlin says. It helps organize tasks and the order in which their components should be completed (as highlighted by patients who have damaged this part of the brain and are especially poor at multitasking, he notes). This area's lesser development in other primate species leads Koechlin to think that the ability to hold more than one goal in mind at once might be unique to our species.

The new work does not, however, show that the brain can actually execute two distinct tasks, such as letter matching, at precisely the same time, Paul Dux a psychology lecturer at the University of Queensland in St. Lucia, Australia, noted in an email to ScientificAmerican.com. The data reveal that though separate goals might be running concurrently in the brain, "there are still large dual-task costs" when people have to switch between two tasks making for "non-efficient multitasking," cautioned Dux, who was not involved in the new research but has also studied attention in the brain. (Some commonplace activities, such as driving and talking on a cell phone frequently go hand-in-hand, but the brain is likely switching its main focus quickly between the two activities, perhaps a reason the pairing has been so dangerous.)

Although the letter-matching tasks were simple, Koechlin says that the same hemisphere split would also likely be observed in subjects performing more complex tasks. "Task complexity itself does not prevent from dual-tasking," he explains. "People should be able to switch back and forth between two complex tasks (by postponing one while executing the other one), provided that the incentive of pursuing each task is large enough." If one of the tasks sparks too many unrelated thoughts, however, "your frontal lobes should lose track of one task," he notes (perhaps providing more evidence for the hazards of distracted driving).

Within the results of Koechlin's work is an explanation for why people tend to prefer binary options, such as yes-or-no questions and if-then statements. "This finding further suggests that the frontal function cannot keep track of more than two goals/tasks at the same time," Koechlin explains. "Humans have problems deciding between more than two alternatives….  A possible explanation is that they cannot keep in mind and switch back and forth between three or more alternatives."

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2.      In the News: The sex hormone boosts thinking in some women, impairs it in others
By Erik Vance, Scientific American, April 2010

Big test coming up? Having trouble concentrating? Try a little estrogen.

Neuroscientists at the University of California, Berkeley, report in a recent study that hormone fluctuations during a woman's menstrual cycle may affect the brain as much as do substances such as caffeine, methamphetamines or the popular attention drug Ritalin.

Scientists have known for decades that working memory (short-term information processing) is dependent on the chemical dopamine. In fact, drugs like Ritalin mimic dopamine to help people concentrate. Researchers have also had evidence that in rats, estrogen seems to trigger a release of dopamine. The new study from Berkeley, however, is the first to show that cognition is tied to estrogen levels in people—explaining why some women have better or worse cognitive abilities at varying points in their menstrual cycles.

The Berkeley team examined 24 healthy women, some of whom had naturally high levels of dopamine and some of whom had low levels, as indicated by genetic testing. As expected, those with the lower levels struggled with complicated working memory tasks, such as repeating a series of five numbers in reverse order. When the test was repeated during ovulation, however, when estrogen levels are highest (usually 10 to 12 days after menstru­ation), these women fared markedly better, improving their performance by about 10 per­cent. Surprisingly, those with naturally high dopamine levels took a nosedive in their ability to do complicated mental tasks at that point in their cycle . . .

"There are pretty important differences," Jacobs says. "And until we figure out how they differ in a normal state, we can't predict how they differ in a diseased state." [For more on sex hormones in the brain, see "Different Shades of Blue) (Women get sad. Men get mad. Depression comes in many hues)

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3.      International Medicine: NHS boss earned £68,000 in bonuses - on top of six-figure salary

Liberal Democrat probe forces bodies to reveal 'scandalous' bonus culture in NHS
Denis Campbell and Eleanor Harding,
TheObserver – Guardian.co.uk

NHS bosses are earning annual bonuses of tens of thousands of pounds on top of their six-figure salaries, the Observer can reveal today. Anna Walker, chief executive of the Healthcare Commission, got £68,000 in bonuses.

Hundreds of chief executives, departmental directors and board members of hospitals and other NHS organisations have received extra payments of as much as £32,000 – the largest single year's bonus unearthed by freedom of information requests submitted by the Liberal Democrats. . .

Anna Walker, who was chief executive of the Healthcare Commission until it was disbanded last year, earned the largest combined amount in the past three years – £68,150 on top of her six-figure salary. She received £22,375 in 2006-07, £23,000 in 2007-08 and £22,775 in 2008-09 for running the then NHS watchdog in England.

Norman Lamb, the Lib Dems' health spokesman, condemned the payments as shocking. "These bonuses are utterly scandalous. People will be disgusted by the extent to which fat cats in the public sector have been enriched at a time when the NHS has denied people drugs that they need and access to treatments such as in mental health," he said. "We thought it was just in banking, but the unacceptable bonus culture appears to be alive and kicking in the upper echelons of the NHS."

This is the first time both the number of bonuses and their size has been disclosed. The Lib Dems sought information from every hospital trust, primary care trust (PCT), mental health trust and ambulance service in England, as well as other NHS bodies such as strategic health authorities. While some pay no bonuses, many do. However, the figures do not reveal the full picture because some refused to disclose theirs and a few simply gave their chief executive's salary band. . .

South Essex trust spokeswoman Maxine Forrest, said: "In 2008-09, to recognise the trust's exceptional performance in national ratings, a one-off bonus was paid. Dr Patrick Geoghegan is chief executive of one of the most successful and highest-performing NHS organisations in the country.". . .

The chief executive of the Royal Berkshire hospital trust received £54,611 in bonuses over three years in 2007-09, while the chief executive of the Human Tissue Authority was given £37,895 in 2006-09.

Many chairmen, divisional directors and both executive and non-executive directors of NHS bodies also receive bonuses. The Royal Berkshire hospital trust spent £240,728 on bonuses in 2007-09, more than any other NHS body that provided figures. Eight executive directors shared another £186,117, as well as the £54,611 payment to the chief executive.

Large payments to senior figures in those three years were also made by the Healthcare Commission (£215,550), the London Ambulance Service (£130,646), the Hertfordshire Partnership mental health trust (£122,465) and Portsmouth Hospitals (£105,000).

All three main parties have pledged to slash NHS management and bureaucracy. "This is the first real analysis of the bonus culture at the top of the NHS, and it's shocking," said Lamb. "Bonuses of £20,000 or more are more than many NHS staff receive as their full year's salary."

■ Two out of three people believe patient care will suffer if the NHS in England has to make the £20bn of savings it has been told to find over the next few years.

A new poll on attitudes to the NHS also reveals that the public see it as the third-most important area for spending by the next government. The economy emerged as the top priority (49%), then immigration (12%) and health (11%), ahead of law and order (7%) and education (6%), according to a poll of 4,486 UK adults conducted by YouGov for the Royal College of Nursing. All three main parties have pledged to protect NHS frontline services, although NHS chief executive Sir David Nicholson has warned that £20bn will have to be saved in England between 2011 and 2014 CN's general secretary, said: "We are already seeing short-sighted cuts, for example in vital specialist nurse posts."

Lib Dems call for tighter rules on foreign doctors
 
17 Sep 2008

Liberal Democrats conference: Government in 'conspiracy of silence' over mental health
12 Sep 2008

guardian.co.uk © Guardian News and Media Limited 2010

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Government medicine covers up scandals for years before the taxpayers find out

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4.      Medicare: Medicare's Chief Actuary releases his evaluation of ObamaCare

Health Alert | Obama Administration Report is a Devastating Critique of ObamaCare

by John Goodman, Apr 26, 2010

Rick Foster is my hero. Over the past year, he has proved over and over that he cannot be bullied, intimidated, threatened, cajoled, browbeaten, buffaloed, hornswaggled, seduced, tricked, duped, bamboozled, bribed, blackmailed, coerced or bought off. In a place like Washington, D.C., this means that most days he probably eats lunch alone. It's amazing that he still has his job.

Rick Foster is the Chief Actuary of Medicare, and his office has just released a devastating critique of the Administration's health reform law.

Before getting to details, let me say there is nothing in the report that is surprising to independent health economists. The conclusions are consistent with everything The Lewin Group and other private estimates have been saying for months. What is surprising is that one of the most respected agencies of the U.S. government is completely undermining the Alice-in-Wonderland fables being spun by the White House, on Capitol Hill and in the mainstream media. To wit:

In other words, the Chief Actuary is simply saying reality is reality. Economics is economics. A is A. Here are the salient findings (with page numbers in the Actuary's report):

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

- Ronald Reagan

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5.      Medical Gluttony: Patient Gluttony because no Doctor or Nurse explained it to the patient

A patient we had seen in the 1970s called last week because she was unable to contact her personal pulmonologist in order to obtain oxygen. After two consecutive evening ER visits, where she was told she did not need oxygen, she was hopeful that I would be able to help her obtain it.

She said she had eight specialists to take care of every organ of her body. But she was unable to get any help from any of the eight.

From experience, it is well known that patients do not think physiologically that there may be other causes of shortness of breath. It's a knee-jerk reflex that if you're short of breath, you need oxygen. Did she have asthma? She said no.

I consented to see her the next morning. When she came in, my staff already had obtained copies of the ER visits that indicated that her oxygen saturation was 97%, her chest x-ray and CT of the chest were unremarkable. Her oxygen saturation was 97% again, but her lungs revealed some wheezing. A whiff of albuterol promptly reversed that symptom.

She then brightened up. "That's the first good breath I've had in nearly a week. Won't you be my doctor again?"

I had to beg off. With eight doctors already, she should see if one of them would take care of her whole body, not just one organ. She was advised that if she wanted a Personal Pulmonologist and another appointment in our office, she would have to dismiss her other eight physicians. It would be difficult to give appropriate medical care with eight doctors each writing prescriptions.

Only with Government Medicine, whether Medicare or Medicaid, as this patient had, can you have eight doctors to treat every organ and not one to take care of the entire person.
Only with a personal physician that you pay personally will you have a doctor you can depend on.
That's the reason government health care is up to eight times as expensive as personal health care.
And that's why your taxes are going through the roof with ObamaCare.

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Medical Gluttony thrives in Government and Health Insurance Programs.

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6.      Medical Myths: Only politicians can get away with subterfuge

AAPS Myth 19: The American people are demanding "health care now."

Spokesmen for the Democrats' "health care reform" proposals say that all those ordinary-appearing Americans waving hand-made signs are either operatives of powerful vested interests, especially insurance companies, or "political enemies" bent on destroying the Obama presidency.

Even people in conservative Montana are strongly supportive, and continue to adulate the President, according to mainstream media coverage of a forum he held in Belgrade, MT.

But poll numbers suggest otherwise. The percentage of people with "very negative" feelings about Obama has tripled since the beginning of the year, hitting 20% nationally, 23% in those older than 65 (Jonathan Weisman, Wall St J 8/20/09). Congressional approval ratings sit at 30% (Daniel Henninger, Wall St J, 8/20/09). A poll conducted Aug 4-9 found that 49% disapproved of Obama's handling of health care, and 43% approved (Washington Examiner 8/14/09). Read more . . .

Although the Obama campaign made extensive, skillful use of the internet and social networking, David Axelrod, Senior Advisor to the President, sent an email on White House letterhead complaining of "viral emails that fly unchecked and under the radar, spreading all sorts of lies and distortions."

The White House launched its own "chain email" and a new website, http://www.WhiteHouse.gov/realitycheck. AAPS has been hearing complaints from people who received "spam" from the White House, wondering how the White House got their email address. After a "riotous" response to the snitch mailbox for "fishy" misinformation, flag@whitehouse.gov, the government disabled it. "Reality check" might serve the same purpose.

Who is pushing the Democrats' proposals? The people with the bullhorns and professionally made signs appear to be bussed-in, paid agitators from unions or left-wing advocacy groups. The town-hall meetings held by the Administration look "utterly stacked," writes Peggy Noonan (Wall St J 8/15-16/09).

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Medical Myths Originate with Government Playing Politics.

Myths Disappear When the Voices of Ordinary People are Heard.

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7.      Overheard in the Medical Staff Lounge: MUDA, MURA, MURI

MUDA is a traditional Japanese term for an activity that is wasteful, doesn't add value or is unproductive.

MURA is a traditional general Japanese term for unevenness, inconsistency.

MURI is a traditional Japanese term for overburden, unreasonableness or absurdity.

Dr. Rosen: Today I observed my office assistant spending four hours making copies of a number of office charts, each spanning two or three years, to send to the insurance carrier.

Dr. Dave: I wouldn't do that. I'd tell the company to fly a kite.

Dr. Rosen: My assistant says they have a legal right to request copies of up to ten charts a year so they can review the quality of care and determine if the payment is appropriate. If they want more, they obtain a service to do the copying. So, they always request less than ten records because they get the copies for free.

Dr. Dave: You must work for an HMO. I don't take that kind of a patient.

Dr. Edwards: I'd say several different insurance companies are requesting them under the HIPAA (Health Insurance Privacy and Accountability Act) laws where patients, ironically, lost their privacy, the "P" in HIPAA.

Dr. Rosen: Doctors lost the ability to keep patients' records confidential when patients had the feeling that if it weren't for the government protecting their privacy, doctors might even publish a patient's record.

Dr. Sam: These medical bureaucrats have no idea how confidentiality and privacy are drilled into every medical student so that it becomes their middle name.

Dr. Paul: Don't you think that it is important that records are kept private?

Dr. Sam: Yes I do. But HIPAA didn't do it. The medical records were more confidential before HIPAA.

Dr. Paul: How do you figure?

Dr. Sam: Before HIPPA, no one got the patient's record unless the patient signed for it. Now, every government agency, Medicare, Medicaid, and every insurance company has access to the patient's record. Some even request that we not tell the patient we made copies of their record. That just creates problems we'd rather avoid.

Dr. Edwards: Before HIPAA, doctors who were involved in caring for the patient were able to obtain the patient records as needed for care. Now it’s not unusual the doctors that care for the patient have to obtain the patient's permission to obtain records from the hospital after discharge since the hospitalist takes over the inpatient care.

Dr. Rosen: All of this unnecessary work falls so neatly into the Japanese term, MUDA, that describes most bureaucratic work - extra totally unproductive work producing waste.

Dr. Sam: When are doctors going to rise up and say enough is enough!

Dr. Rosen: When we have our professional societies with enough backbone to say so. But national, state and local medical societies frequently have socialistic staff that keeps the wheel greased for the government takeover of medicine.

Dr. Sam: And then the patients will have lost their last real advocate.

Dr. Milton: There will have to be a quiet revolution in medicine. We have to do it before we become even more fragmented as more sections in medicine give up their resistance to the government takeover.

Dr. Rosen: That will be the day that MUDA, MURA and MURI totally paralyzes us with busy, non-productive work that adds no value to health care, is wasteful, inconsistent, unreasonable, and totally eliminates the beneficial aspects of what we do in life. Then we'll be back in the fifteenth century, having to start over along the road to freedom.

Dr. Milton: Another 500-year journey that doesn't need to be.

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The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.

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

Sonoma Medicine, an award-winning quarterly magazine. Volume 66, Number 2 - Spring 2010

A Country Burdened by Law By John Toton, MD
Dr. Toton, a Healdsburg orthopedic surgeon, serves on the SCMA Editorial Board

Life Without Lawyers by Philip Howard, 225 pages, Norton, $16.

The title Life Without Lawyers will catch your browsing eye, but the subtitle is more to the author's point: Liberating Americans From Too Much Law.

Philip Howard, JD, is a partner in Covington & Burling, a legal firm in New York City, and a graduate of Yale University and the University of Virginia School of Law. . .  He is also a leading advocate of legal reform, and writes and speaks extensively on the topic of "Too much law is suffocating America."

Life Without Lawyers is Howard's third book, following The Death of Common Sense (1995) and The Collapse of the Common Good (2002). His recent article in the Wall Street Journal (15 October 2009), "Why Medical Malpractice Is Off Limits," speaks directly to the $200 billion spent annually on "defensive medicine." In the article, Howard focuses on the trial lawyers' arguments that they alone are "the bulwark against ineffective care." They have lobbied so effectively with the party in power that malpractice reform, even pilot projects such as specialized health courts, is off the table.

Life Without Lawyers, however, focuses not on medical reform, but rather on the deep legal hole we've gotten ourselves into, in every walk of life. 

In America, says Howard, teachers cannot teach. Attempting to teach demands that teachers spend almost half their time and effort trying to control an unruly class or student. Teachers have little or no authority to enforce discipline: a student cannot be "touched" and commonly cannot even be removed from the classroom. As a result, one student can subvert the learning experience of the other 20 to 30. School principals are ineffective, paperwork overwhelms, and fear of lawsuits brings the teaching profession to its knees. As Howard asks, "What has become of the common good, when one disruptive student has the effect of paralysis in the education of the many?"

Outside the classroom, observes Howard, many playgrounds, swimming pools and parks are closed because someone might get hurt and sue the school, the church, the city or the state. Ironically, even as we focus on childhood obesity, we are removing swings, slides, monkey bars and see-saws from playgrounds for reasons of "potential harm." Both children and adults can recognize that "there's no fun there" anymore. Children are limited from exploring their neighborhoods and expanding their boundaries because there might be evil, trouble and certainly risk in such unprotected activity. Need we wonder why our children are becoming couch potatoes?

Howard laments how the character of America has changed, both the politics and the nature and expectations of the people. As a nation we are no longer the independent, individualistic risk takers who made our land a place to which people immigrated for the opportunities and freedoms of self-expression. The country that Alexis de Tocqueville so admired in the 1800s no longer exists. It has been replaced with a persistent concern that our "free speech" might insult someone, that we might suffer some offence, intended or not, and that our daily lives are driven to protect ourselves from some accusation that would bring us into the legal system. 

"Encounters with the American justice system are a nightmare," Howard writes. "Litigants live for years under the dark cloud of hyperbole and accusation. Justice, American Style, is a formula for exhaustion and fear, not trust." A 2005 survey found that only 16% of Americans trust the justice system's ability to resolve a baseless claim or accusation appropriately in their favor. . .

Howard offers an agenda for change, embodied in his Principles for Daily Freedom:

Howard speaks out for real change in both our litigious society (the most litigious in the world) and our leaders who no longer lead. In his view, American culture is deteriorating as we look out for our self-interest and are unwilling to take personal and civic risk, especially in our interaction with others, fearing the threat of law. We clearly have too much law, controlling our every action. This is not the America Howard wishes on himself or on us. 

Howard presents a compelling book that encourages our thoughtful consideration. I encourage all to read it. It will keep you turning the pages, no matter your starting point on this issue.

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VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about.

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9.      Book Review: The More, The Better, By Nick Schulz, WSJ, March 24, 2010

The Next Hundred Million, By Joel Kotkin, (Penguin Press, 308 pages, $25.95)

A gloomy mood might seem to be justified at the moment. Unemployment is nearing 10%. We have just witnessed a bitter financial crisis, a series of debt-deepening bailouts and a bruising fight over health care. Conservatives fret that we're running out of time to tackle the entitlement crisis. Liberals fret that we're running out of time to tackle the climate crisis. Roughly 60% of poll respondents say that America is on the wrong track. Meanwhile, China has resumed its torrid economic growth and has become for the U.S. what Japan was in the 1980s—the seemingly unstoppable Asian force that will soon leave America's economy behind. . .

"In stark contrast to its rapidly aging rivals," Mr. Kotkin writes in "The Next Hundred Million," "America's population is expected to expand dramatically in coming decades." He points to a slowly rising birth rate and to the continuing in-migration of young workers from poorer countries. Most of America's population growth between 2000 and 2050, he notes, "will be in its racial minorities, particularly Asians and Hispanics, as well as in a growing mixed-race population." No other developed country, he says, "will enjoy such ethnic diversity."

For Mr. Kotkin, population growth translates into economic vitality—the capacity to create wealth, raise the standard of living and meet the burdens of future commitments. Thus a country with a youthful demographic, in relative terms, enjoys a big advantage over its global counterparts. In the next four decades, Mr. Kotkin observes, "most of the developed countries in both Europe and Asia will become veritable old-age homes" because of stagnant population growth. And the economies of these countries, already devoted to a vast welfare-state apparatus, will face crushing pension obligations—but without the young workers to defray the cost.

Inevitably, Europe and Asia will decline, Mr. Kotkin predicts, and America will thrive. Indeed, the U.S. will emerge, he says, "as the most affluent, culturally rich, and successful nation in human history." What about the billion-person behemoth across the Pacific? Not to worry. Mr. Kotkin thinks that, by midcentury, China's one-child policy will cause it, too, to suffer from the burdens of an aging population. . . .
Mr. Kotkin's vision of America's next four decades—expanding, browning, adapting and thriving—is largely convincing. He's no Pollyanna, however. He worries especially that upward mobility is more difficult than it once was and that class polarization is a real possibility, because a knowledge economy like America's tends to widen class divisions. The result is "an expanding affluent class of the highly educated, a stubbornly impoverished population, and a shrinking middle class."

Here is one area where Mr. Kotkin might have said more. The collapse of the family in America's underclass persists—with more families than not headed by single mothers. Mr. Kotkin is delighted to report that the family in America is taking ever new shapes, adapting and "resurging" in different forms. This claim may well be true for the broad middle class. But in that stubbornly impoverished sector, the family isn't resurging at all. America's relatively high birthrate—a source of national strength generally, as Mr. Kotkin says—contains a large percentage of out-of-wedlock births. In some urban neighborhoods, the rate stands close to 70%. The most "successful nation in human history" still has some work to do.

Mr. Schulz is editor of American.com, the Journal of the American Enterprise Institute, and co-author of "From Poverty to Prosperity" (Encounter, 2009).
Printed in The Wall Street Journal,March 24, 2010, page A15

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

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10.  Hippocrates & His Kin: Three sources of income, but Uncle Sam can only find two of them

Staff, pay cut despite new funds

By Christina Jewett and Agustin Armendariz, California Watch, Monday, April 19, 2010.
California's nursing homes have received $880 million in additional funding from a 2004 state law intended to help hire more caregivers and boost wages. But 232 homes did just the opposite. They either cut staff, paid lower wages or let caregiver levels slip below a state-mandated minimum, a California Watch investigation has found. The homes that made these cuts collected about $236 million through 2008, the last year of available data. That's more than a quarter of the total Medi-Cal funding increase shared by the state's nursing homes.
The Report: www.sacbee.com/2010/04/19/2688050/staff-pay-cut-despite-new-funds.html#ixzz0nD9iox1J

Free money seldom benefits the intended - only those that obtained the contracts.


Three sources of income but Uncle Sam can only find two of them.

A retired military patient, when giving his employment during an internal medicine history, stated that he was an appraiser, but did all his work only for cash. Why only cash? Since he was a retired military officer on a pension plus Social Security, he just couldn't afford to pay more taxes.

Looks like the underground economy is booming!


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Hippocrates and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Today & Tomorrow

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11.  Professionals 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.

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

                      PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist, practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.patmosemergiclinic.com/ To read more on Dr Berry, please click on the various topics at his website. To review How to Start a Third-Party Free Medical Practice . . .

                      PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. (http://home.earthlink.net/~doctorlrhuntoon/) Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. 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. 

                      FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder, www.westandfirm.org, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance. Read Lin Zinser's view on today's health care problem:  In today's proposals for sweeping changes in the field of medicine, the term "socialized medicine" is never used. Instead we hear demands for "universal," "mandatory," "singlepayer," and/or "comprehensive" systems. These demands aim to force one healthcare plan (sometimes with options) onto all Americans; it is a plan under which all medical services are paid for, and thus controlled, by government agencies. Sometimes, proponents call this "nationalized financing" or "nationalized health insurance." In a more honest day, it was called socialized medicine.

                      Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis."

                      Dr 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.

                      Madeleine Pelner Cosman, JD, PhD, Esq, who has made important efforts in restoring accountability in health care, has died (1937-2006). Her obituary is at www.signonsandiego.com/news/obituaries/20060311-9999-1m11cosman.html. She will be remembered for her important work, Who Owns Your Body, which is reviewed at www.delmeyer.net/bkrev_WhoOwnsYourBody.htm. Please go to www.healthplanusa.net/MPCosman.htm to view some of her articles that highlight the government's efforts in criminalizing medicine. For other OpEd articles that are important to the practice of medicine and health care in general, click on her name at www.healthcarecom.net/OpEd.htm.

                      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.

                      ReflectiveMedical Information Systems (RMIS), delivering information that empowers patients, is a new venture by Dr. Gibson, one of our regular contributors, and his research group which will go far in making health care costs transparent. This site provides access to information related to medical costs as an informational and educational service to users of the website. This site contains general information regarding the historical, estimates, actual and Medicare range of amounts paid to providers and billed by providers to treat the procedures listed. These amounts were calculated based on actual claims paid. These amounts are not estimates of costs that may be incurred in the future. Although national or regional representations and estimates may be displayed, data from certain areas may not be included. You may want to follow this development at www.ReflectiveMedical.com. During your visit you may wish to enroll your own data to attract patients to your practice. This is truly innovative and has been needed for a long time. Congratulations to Dr. Gibson and staff for being at the cutting edge of healthcare reform with transparency. 

                      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, who 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.

                      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, who wrote an informative Medicine Men column at NewsMax, have now retired. Please log on to review the archives. He now has a new column with Richard Dolinar, MD, worth reading at www.thenewstribune.com/opinion/othervoices/story/835508.html.

                      The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to read News of the Day in Perspective:  Dr. Richard Amerling presents a proposal that if the mandate to buy insurance survives constitutional challenges, individuals should consider defying the mandate and not purchasing insurance.  Why is opting out a sound idea for patients? All third party payers limit options.  Limitations will by necessity become more stringent as the system expands. The idea that "universal coverage" will make everything available to everyone is absurd. Care is a finite resource and it will be heavily rationed. Trading liberty for the illusion of "free" care is a fool's bargain. 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: Is the Individual Mandate Constitutional? An individual mandate is essential to proposed reform. Funding depends on forcing the young and healthy to pay enough to subsidize high-risk individuals, and insurance industry support depends on the prospect of millions of unwilling new customers. "Mandatory insurance is unconstitutional," write attorneys David B. Rifkin, Jr., and Lee Casey (Wall St J 9/18/09). If Congress can "tax" someone for being uninsured, it could also tax anyone who failed to follow an order of any kind, they argue. If the mandate "falls within Congress's power to tax and spend, no other constitutional authority is necessary," writes Jack Balkin of Yale Law School (N Engl J Med 2/11/10). Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents.

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Del Meyer, MD, Editor & Founder

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Words of Wisdom

"Your whole idea about yourself is borrowed - borrowed from those who have no idea of who they are themselves." - Osho: Was an Indian mystic, guru, and philosopher

Slavery begins with mandatory volunteering.

"When you realize that prosperity is your divine heritage, you should persist in claiming it." - Catherine Ponder: Author of books in the prosperity field

Some Recent Postings

Read the HealthPlan that will reduce health care costs and save Medicare for our seniors . . .

In Memoriam

Wilma Mankiller, first woman chief of the Cherokee Nation, died on April 6th, aged 64

From The Economist print edition | Apr 22nd 2010

ALL through her life, white people tried to help Wilma Mankiller. As she walked to school, two miles down the hilly, narrow lanes of north-eastern Oklahoma, women in big cars would stop and offer her a ride. She didn't want one. The same women would appear sometimes at the wood-frame house, where her family of 11 lived in three rooms, burning coal-oil and hauling water from the spring, and offer them second-hand clothes. She would run away. If they caught her, they would pat her on her black-haired, Indian head. "Bless your little heart," they murmured.

In 1956, when she was ten, white people suggested her family should move from their farm at Mankiller Flats to San Francisco. The government, having forced her ancestors in 1838 along the Trail of Tears from eastern Tennessee to Indian Territory, now promised them a better life even farther west. They caught the passenger train from Stilwell; she wept Cherokee tears all the way to California. No one had forced them out this time. But they ended up in a drab, violent housing project where her father found back-breaking work in a rope-factory and she was mocked at school for her stupid name. She knew it meant "guardian of the settlement"; but that all seemed far away and irrelevant now.

Many years later, when she was principal chief of the Cherokee Nation, a white woman offered money for college scholarships for Indians. She said she wanted to "give pride back" to them. Ms Mankiller had never heard such arrogance. Yes, her tribe needed schools, clinics, day care, Head Start programmes, and all these she was busy procuring for them. But it did not need the patronising charity of white people. Under Ms Mankiller, the Cherokee were learning to rely on themselves again.

It had taken time. Over the years the tribe had been absorbed until almost everything was lost. In 1907 the tribal lands in Oklahoma had been broken up into allotments, one of which was given to Ms Mankiller's grandfather at Mankiller Flats; and nothing did more damage to the tribe, she believed, than that loss of commonalty and spiritual, as well as physical, interdependence. Her family had tried to preserve it, bartering with and working for other people. But the Cherokee could not easily find their sense of oneness again.

She herself was almost lost to the tribe for a while, married to a Latino at 17, having two daughters early, living a middle-class Californian life. But the San Francisco of the late 1960s gradually radicalised her. The stiletto heels were swapped for sandals; the husband was sidelined; the two small daughters were taken by boat to be part of the Native-American reclamation of the prison-island of Alcatraz; and in 1976 she went back with them in a U-Haul van to Mankiller Flats. There, on the land that was still her family's, they camped under the stars and learned to tell the time by the sun, Cherokee-fashion. Nine years later she was chief of the Cherokee Nation. . .

Read the entire obituary . . .

On This Date in History - April 27

On this date in 1822, Ulysses Simpson Grant, was born in Point Pleasant, Ohio. He was born Hiram Ulysses Grant and entered West Point mistakenly listed as Ulysses S. Grant and kept that name and went on to fame for the rest of his life. He commanded the winning army in the Civil War and was elected President of the United States in 1868. History records his Presidency as, to put it kindly, undistinguished. Afterwards, in private life, he was bilked by an investment company and spent the rest of his life writing the memoirs that brought in enough money to pay off his debts and make provision for his family. He was an honest man who reinforced the latent American belief that good generals don't necessarily make good Presidents. It was 66 years before another professional soldier, a man named Eisenhower, again lived in the White House.

On this date in 1937, the U.S. Social Security System made its first benefit payments. No one then or perhaps even now fully understood the reversal of the Bill of Rights, which protected us from the power of government abuse over millennia, to a reversal of those rights to life, liberty and the pursuit of happiness into Civil Rights, where the government usurps those rights, limiting and destroying our freedom. We only have a brief window of opportunity to reverse this trend and save our freedom for which our forefathers gave their lives or we'll become like Europe, the land from which our forefathers fled.

After Leonard and Thelma Spinrad