1.
Featured Article: How To Remember Before You Forget
2.
In the News: A Modern Bugbear, HIV Transmission
3.
International
Medicine: Health Care and Social Security in the Bosporus
4.
Medicare: Social Security and Medicare Projections: 2008
5.
Medical Gluttony: Assistive Devices
6.
Medical Myths: We Need Government to Control Price of Pharmaceuticals
7.
Overheard in the Medical Staff Lounge: Managed Care
Meetings
8.
Voices of
Medicine: Everyone I Know
9.
From the Physician Patient Bookshelf: DIETS STILL DON'T
WORK
10.
Hippocrates
& His Kin: MISTAKES - Can We Avoid Them or Just Cover Them Up?
11.
Related Organizations: Restoring Accountability in Medical
Practice and Society
MOVIE EXPLAINING SOCIALIZED
MEDICINE TO COUNTER MICHAEL MOORE's SiCKO
Logan Clements,
a pro-liberty filmmaker in Los Angeles, seeks funding for a movie exposing the
truth about socialized medicine. 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.
* * * * *
1.
Featured Article:
How To Remember Before You Forget
Want to
Remember Everything You'll Ever Learn? Surrender to This Algorithm
By Gary Wolf, WIRED, 04.21.08
The winter
sun sets in
mid-afternoon in Kolobrzeg, Poland, but the early twilight does not deter
people from taking their regular outdoor promenade. Bundled up in parkas with
fur-trimmed hoods, strolling hand in mittened hand along the edge of the Baltic
Sea, off-season tourists from Germany stop openmouthed when they see a tall,
well-built, nearly naked man running up and down the sand.
"Kalt?
Kalt?" one of them calls out. The man gives a polite but vague
answer, then turns and dives into the waves. After swimming back and forth in
the 40-degree water for a few minutes, he emerges from the surf and jogs
briefly along the shore. The wind is strong, but the man makes no move to get
dressed. Passersby continue to comment and stare. "This is one of the reasons
I prefer anonymity," he tells me in English. "You do something even
slightly out of the ordinary and it causes a sensation."
Piotr
Wozniak's quest for anonymity has been successful. Nobody along this string of
little beach resorts recognizes him as the inventor of a technique to turn
people into geniuses. A portion of this technique, embodied in a software
program called SuperMemo, has enthusiastic
users around the world. They apply it mainly to learning languages, and it's
popular among people for whom fluency is a necessity - students from Poland or
other poor countries aiming to score well enough on English-language exams to
study abroad. A substantial number of them do not pay for it, and pirated
copies are ubiquitous on software bulletin boards in China, where it competes
with knockoffs like SugarMemo.
SuperMemo is
based on the insight that there is an ideal moment to practice what you've
learned. Practice too soon and you waste your time. Practice too late and
you've forgotten the material and have to relearn it. The right time to
practice is just at the moment you're about to forget. Unfortunately, this
moment is different for every person and each bit of information. Imagine a
pile of thousands of flash cards. Somewhere in this pile are the ones you
should be practicing right now. Which are they?
Fortunately,
human forgetting follows a pattern. We forget exponentially. A graph of our
likelihood of getting the correct answer on a quiz sweeps quickly downward over
time and then levels off. This pattern has long been known to cognitive
psychology, but it has been difficult to put to practical use. It's too complex
for us to employ with our naked brains.
Twenty years
ago, Wozniak realized that computers could easily calculate the moment of
forgetting if he could discover the right algorithm. SuperMemo is the result of
his research. It predicts the future state of a person's memory and schedules
information reviews at the optimal time. The effect is striking. Users can seal
huge quantities of vocabulary into their brains. But for Wozniak, 46, helping
people learn a foreign language fast is just the tiniest part of his goal. As
we plan the days, weeks, even years of our lives, he would have us rely not
merely on our traditional sources of self-knowledge - introspection,
intuition, and conscious thought - but also on something new: predictions about
ourselves encoded in machines.
Given the
chance to observe our behaviors, computers can run simulations, modeling different
versions of our path through the world. By tuning these models for top
performance, computers will give us rules to live by. They will be able to tell
us when to wake, sleep, learn, and exercise; they will cue us to remember what
we've read, help us track whom we've met, and remind us of our goals.
Computers, in Wozniak's scheme, will increase our intellectual capacity and
enhance our rational self-control.
The reason
the inventor of SuperMemo pursues extreme anonymity, asking me to conceal his
exact location and shunning even casual recognition by users of his software,
is not because he's paranoid or a misanthrope but because he wants to avoid
random interruptions to a long-running experiment he's conducting on himself.
Wozniak is a kind of algorithmic man. He's exploring what it's like to live in
strict obedience to reason. On first encounter, he appears to be one of the
happiest people I've ever met. . .
How Supermemo Works
SuperMemo is a program that keeps track of discrete bits of information you've
learned and want to retain. For example, say you're studying Spanish. Your
chance of recalling a given word when you need it declines over time according
to a predictable pattern. SuperMemo tracks this so-called forgetting curve and
reminds you to rehearse your knowledge when your chance of recalling it has
dropped to, say, 90 percent. When you first learn a new vocabulary word, your
chance of recalling it will drop quickly. But after SuperMemo reminds you of
the word, the rate of forgetting levels out. The program tracks this new decline and waits longer to quiz you the next time.
However, this technique never caught on. The spacing effect is "one of the
most remarkable phenomena to emerge from laboratory research on learning,"
the psychologist Frank Dempster wrote in 1988, at the beginning of a typically sad
encomium published in American Psychologist
under the title "The Spacing Effect: A Case Study in the Failure to Apply
the Results of Psychological Research." The sorrrowful tone is not hard to
understand. How would computer scientists feel if people continued to use slide
rules for engineering calculations? What if, centuries after the invention of
spectacles, people still dealt with nearsightedness by holding things closer to
their eyes? Psychologists who studied the spacing effect thought they possessed
a solution to a problem that had frustrated humankind since before written
language: how to remember what's been learned. But instead, the spacing effect
became a reminder of the impotence of laboratory psychology.
As a student
at the Poznan University of Technology in western Poland in the 1980s, Wozniak
was overwhelmed by the sheer number of things he was expected to learn. But
that wasn't his most troubling problem. He wasn't just trying to pass his
exams; he was trying to learn. He couldn't help noticing that within a few
months of completing a class, only a fraction of the knowledge he had so
painfully acquired remained in his mind. Wozniak knew nothing of the spacing
effect, but he knew that the methods at hand didn't work.
The most
important challenge was English. Wozniak refused to be satisfied with the
broken, half-learned English that so many otherwise smart students were stuck
with. So he created an analog database, with each entry consisting of a
question and answer on a piece of paper. Every time he reviewed a word, phrase,
or fact, he meticulously noted the date and marked whether he had forgotten it.
At the end of the session, he tallied the number of remembered and forgotten
items. By 1984, a century after Ebbinghaus finished his second series of
experiments on nonsense syllables, Wozniak's database contained 3,000 English
words and phrases and 1,400 facts culled from biology, each with a complete
repetition history. He was now prepared to ask himself an important question:
How long would it take him to master the things he wanted to know?
The answer:
too long. In fact, the answer was worse than too long. According to Wozniak's
first calculations, success was impossible. The problem wasn't learning the
material; it was retaining it. He found that 40 percent of his English
vocabulary vanished over time. Sixty percent of his biology answers evaporated.
Using some simple calculations, he figured out that with his normal method of
study, it would require two hours of practice every day to learn and retain a
modest English vocabulary of 15,000 words. For 30,000 words, Wozniak would need
twice that time. This was impractical. . .
The problem
of forgetting might not
torment us so much if we could only convince ourselves that remembering isn't
important. Perhaps the things we learn
- words, dates, formulas,
historical and biographical details
- don't really matter. Facts can
be looked up. That's what the Internet is for. When it comes to learning, what
really matters is how things fit together. We master the stories, the schemas,
the frameworks, the paradigms; we rehearse the lingo; we swim in the episteme.
The
disadvantage of this comforting notion is that it's false. "The people who
criticize memorization - how happy would they be to spell out every
letter of every word they read?" asks Robert Bjork, chair of UCLA's
psychology department and one of the most eminent memory researchers. After
all, Bjork notes, children learn to read whole words through intense practice,
and every time we enter a new field we become children again. "You can't
escape memorization," he says. "There is an initial process of
learning the names of things. That's a stage we all go through. It's all the
more important to go through it rapidly." The human brain is a marvel of
associative processing, but in order to make associations, data must be loaded
into memory.
Once we drop
the excuse that memorization is pointless, we're left with an interesting
mystery. Much of the information does remain in our memory, though we cannot
recall it. "To this day," Bjork says, "most people think about
forgetting as decay, that memories are like footprints in the sand that
gradually fade away. But that has been disproved by a lot of research. The
memory appears to be gone because you can't recall it, but we can prove that
it's still there. For instance, you can still recognize a 'forgotten' item in a
group. Yes, without continued use, things become inaccessible. But they are not
gone." . . .
During the
years that Wozniak struggled to master English, Bjork and his collaborator,
Elizabeth Bjork (she is also a professor of psychology; the two have been
married since 1969), were at work on a new theory of forgetting. Both were
steeped in the history of laboratory research on memory, and one of their goals
was to get to the bottom of the spacing effect. They were also curious about
the paradoxical tendency of older memories to become stronger with the passage
of time, while more recent memories faded. Their explanation involved an
elegant model with deeply counterintuitive implications.
Long-term
memory, the Bjorks said, can be characterized by two components, which they
named retrieval strength and storage strength. Retrieval strength measures how
likely you are to recall something right now, how close it is to the surface of
your mind. Storage strength measures how deeply the memory is rooted. Some
memories may have high storage strength but low retrieval strength. Take an old
address or phone number. Try to think of it; you may feel that it's gone. But a
single reminder could be enough to restore it for months or years. Conversely,
some memories have high retrieval strength but low storage strength. Perhaps
you've recently been told the names of the children of a new acquaintance. At
this moment they may be easily accessible, but they are likely to be utterly
forgotten in a few days, and a single repetition a month from now won't do much
to strengthen them at all.
The Bjorks
were not the first psychologists to make this distinction, but they and a series
of collaborators used a broad range of experimental data to show how these laws
of memory wreak havoc on students and teachers. One of the problems is that the
amount of storage strength you gain from practice is inversely correlated with
the current retrieval strength. In other words, the harder you have to work to
get the right answer, the more the answer is sealed in memory. Precisely those
things that seem to signal we're learning well
- easy performance on drills,
fluency during a lesson, even the subjective feeling that we know
something - are misleading when it comes to predicting whether we will
remember it in the future. "The most motivated and innovative teachers, to
the extent they take current performance as their guide, are going to do the
wrong things," Robert Bjork says. "It's almost sinister."
The most
popular learning systems sold today
- for instance, foreign language
software like Rosetta Stone - cheerfully defy every one of the
psychologists' warnings. With its constant feedback and easily accessible
clues, Rosetta Stone brilliantly creates a sensation of progress. "Go to
Amazon and look at the reviews," says Greg Keim, Rosetta Stone's CTO, when
I ask him what evidence he has that people are really remembering what they
learn. "That is as objective as you can get in terms of a user's sense of
achievement." The sole problem here, from the psychologists' perspective,
is that the user's sense of achievement is exactly what we should most
distrust.
The battle
between lab-tested techniques and conventional pedagogy went on for decades,
and it's fair to say that the psychologists lost. All those studies of human
memory in the lab - using nonsense syllables, random numbers,
pictures, maps, foreign vocabulary, scattered dots - had so little influence
on actual practice that eventually their irrelevance provoked a revolt. In the
late '70s, Ulric Neisser, the pioneering researcher who coined the term
cognitive psychology, launched a broad attack on the approach of Ebbinghaus and
his scientific kin.
"We have
established firm empirical generalizations, but most of them are so obvious
that every 10-year-old knows them anyway," Neisser complained. "We
have an intellectually impressive group of theories, but history offers little
confidence that they will provide any meaningful insight into natural
behavior." Neisser encouraged psychologists to leave their labs and study
memory in its natural environment, in the style of ecologists. He didn't doubt
that the laboratory theories were correct in their limited way, but he wanted
results that had power to change the world.
Many
psychologists followed Neisser. But others stuck to their laboratory methods.
The spacing effect was one of the proudest lab-derived discoveries, and it was
interesting precisely because it was not obvious, even to professional
teachers. The same year that Neisser revolted, Robert Bjork, working with
Thomas Landauer of Bell Labs, published the results of two experiments
involving nearly 700 undergraduate students. Landauer and Bjork were looking
for the optimal moment to rehearse something so that it would later be
remembered. Their results were impressive: The best time to study something is
at the moment you are about to forget it. And yet - as Neisser might have
predicted - that insight was useless in the real world. Determining the
precise moment of forgetting is essentially impossible in day-to-day life.
Obviously,
computers were the answer, and the idea of using them was occasionally
suggested, starting in the 1960s. But except for experimental software, nothing
was built. The psychologists were interested mainly in theories and models. The
teachers were interested in immediate signs of success. The students were
cramming to pass their exams. The payoff for genuine progress was somehow too
abstract, too delayed, to feed back into the system in a useful way. What was
needed was not an academic psychologist but a tinkerer, somebody with a lot of
time on his hands, a talent for mathematics, and a strangely literal temperament
that made him think he should actually recall the things he learned.
The day I
first meet Wozniak, we go for a
7-mile walk down a windy beach. I'm in my business clothes and half comatose
from jet lag; he's wearing a track suit and comes toward me with a gait so
buoyant he seems about to take to the air. He asks me to walk on the side away
from the water. "People say that when I get excited I tend to drift in
their direction, so it is better that I stand closer to the sea so I don't push
you in," he says.
Wozniak takes
an almost physical pleasure in reason. He loves to discuss things with people,
to get insight into their personalities, and to give them advice -
especially in English. One of his most heartfelt wishes is that the
world have one language and one currency so this could all be handled more
efficiently. He's appalled that Poland is still not in the Eurozone. He's
baffled that Americans do not use the metric system. For two years he kept a
diary in Esperanto.
Although
Esperanto was the ideal expression of his universalist dreams, English is the
leading real-world implementation. Though he has never set foot in an
English-speaking country, he speaks the language fluently. "Two words that
used to give me trouble are perspicuous and perspicacious,"
he confessed as we drank beer with raspberry syrup at a tiny beachside
restaurant where we were the only customers. "Then I found a mnemonic to
enter in SuperMemo: clear/clever. Now I never misuse them."
Wozniak's
command of English is the result of a series of heroic experiments, in the
tradition of Ebbinghaus. They involved relentless sessions of careful
self-analysis, tracked over years. He began with the basic conundrum of too
much to study in too little time. His first solution was based on folk wisdom.
"It is a common intuition," Wozniak later wrote, "that with
successive repetitions, knowledge should gradually become more durable and
require less frequent review."
This insight
had already been proven by Landauer and Bjork, but Wozniak was unaware of their
theory of forgetting or of any of the landmark studies in laboratory research
on memory. This ignorance was probably a blessing, because it forced him to
rely on pragmatic engineering. In 1985, he divided his database into three
equal sets and created schedules for studying each of them. One of the sets he
studied every five days, another every 18 days, and the third at expanding
intervals, increasing the period between study sessions each time he got the
answers right. . .
All of his
early work was done on paper. In the computer science department at the Poznan
University of Technology, "we had a single mainframe of Polish-Russian
design, with punch cards," Wozniak recalls. "If you could stand in
line long enough to get your cards punched, you could wait a couple of days
more for the machine to run your cards, and then at last you got a printout,
which was your output."
The personal
computer revolution was already pretty far along in the US by the time Wozniak managed
to get his hands on an Amstrad PC 1512, imported through quasi-legal means from
Hamburg, Germany. With this he was able to make another major advance in
SuperMemo - computing the difficulty of any fact or study item and adjusting
the unique shape of the predicted forgetting curve for every item and user. A
friend of Wozniak's adapted his software to run on Atari machines, and as
access to personal computers finally spread among students, so did SuperMemo.
After the
collapse of Polish communism, Wozniak and some fellow students formed a
company, SuperMemo World. By 1995, their program was one of the most successful
applications developed by the country's fledgling software industry, and they
were searching for funding that would allow them to relocate to Silicon Valley.
That year, at Comdex in Las Vegas, 200,000 people got a look at Sony's new DVD
technology, prototypes of flatscreens, and Wozniak's SuperMemo, which became
the first Polish product shown at the great geek carnival, then at the height of
its influence. In Europe, the old communist experiment in human optimization
had run its course. Wozniak believed that in a world of open competition, where
individuals are rewarded on merit, a scientific tool that accelerated learning
would find customers everywhere. .
. .
"Piotr
would never go out to promote the product, wouldn't talk to journalists, very
rarely agreed to meet with somebody," Biedalak says. "He was the
driving force, but at some point I had to accept that you cannot communicate
with him in the way you can with other people."
The problem
wasn't shyness but the same intolerance for inefficient expenditure of mental
resources that led to the invention of SuperMemo in the first place. By the
mid-'90s, with SuperMemo growing more and more popular, Wozniak felt that his
ability to rationally control his life was slipping away. "There were 80
phone calls per day to handle. There was no time for learning, no time for
programming, no time for sleep," he recalls. In 1994, he disappeared for
two weeks, leaving no information about where he was. The next year he was gone
for 100 days. Each year, he has increased his time away. He doesn't own a
phone. He ignores his email for months at a time. And though he holds a PhD and
has published in academic journals, he never attends conferences or scientific
meetings. . .
The Baltic
Sea is dark as
an unlit mirror. Wozniak and I walk along the shore, passing the wooden snack
stands that won't be open until spring, and he tells me how he manages his
life. He's married, and his wife shares his lifestyle. They swim together in
winter, and though Polish is their native language, they communicate in
English, which she learned with SuperMemo. Wozniak's days are blocked into
distinct periods: a creative period, a reading and studying period, an exercise
period, an eating period, a resting period, and then a second creative period.
He doesn't get up at a regular hour and is passionate against alarm clocks. If
excitement over his research leads him to work into the night, he simply shifts
to sleeping in the day. When he sits down for a session of incremental reading,
he attends to whatever automatically appears on his computer screen, stopping
the instant his mind begins to drift or his comprehension falls too low and then
moving on to the next item in the queue. SuperMemo graphs a distribution of
priorities that he can adjust as he goes. When he encounters a passage that he
thinks he'll need to remember, he marks it; then it goes into a pattern of
spaced repetition, and the information it contains will stay in his brain
indefinitely.
"Once
you get the snippets you need," Wozniak says, "your books disappear.
They gradually evaporate. They have been translated into knowledge."
As a science
fiction fan, I had always assumed that when computers supplemented our
intelligence, it would be because we outsourced some of our memory to them. We
would ask questions, and our machines would give oracular - or
supremely practical - replies. Wozniak has discovered a different
route. When he entrusts his mental life to a machine, it is not to throw off
the burden of thought but to make his mind more swift. Extreme knowledge is not
something for which he programs a computer but for which his computer is
programming him. . . .
By projecting
the achievement of extreme memory back along the forgetting curve, by provably
linking the distant future - when we will know so much - to
the few minutes we devote to studying today, Wozniak has found a way to
condition his temperament along with his memory. He is making the future
noticeable. He is trying not just to learn many things but to warm the process
of learning itself with a draft of utopian ecstasy.
Contributing
editor Gary Wolf (gary@aether.com) wrote about
futurist Ray Kurzweil in issue 16.04.
To read the entire article, go to www.wired.com/print/medtech/health/magazine/16-05/ff_wozniak.
* * * * *
2.
In the News: A Modern
Bugbear, HIV Transmission, The Economist, April 10th 2008
Using the law to contain infections may do more harm
than good.
AT FIRST blush the bigwigs at the Health Protection Agency,
which monitors diseases, could have told a rosier story. On March 28th they
reported that sexual-health clinics diagnosed 8% fewer HIV infections last year
than in 2006. But Britain's epidemic is not fading, they insisted. New
infections among gay men and straight people are close to all-time highs;
falling infections among heterosexuals who caught the virus in Africa account
for almost all of the decline (see chart).
There are more ominous trends than these. Britons'
understanding of the risks has gradually worsened over the past decade or so.
In January a poll by Ipsos MORI found that more than two out of five Londoners
do not know that sex between men carries a chance of transmitting HIV. Lately,
says Yusef Azad of the National AIDS Trust, a charity, the proportion of gay
men having unprotected sex who give blood for a syphilis test but refuse to do
so for a HIV test has gone up.
Is this complacency or dread? Mr Azad worries that
some gay men may shirk free HIV checks because they fear a positive result
could incriminate them in future. Since 2001, 13 people in Britain have been
convicted of reckless grievous bodily harm (reckless injury in Scotland) for
spreading HIV to their partners. Because recklessness involves taking a known
risk, eschewing knowledge of the danger probably averts a court case.
Doctors and campaigning groups such as the National
AIDS Trust say that the legal system creates muddled disincentives for public
health. One man without a biochemical diagnosis of his status has been convicted
after he ignored advice from a clinician and his South African wife that he
should get one. But because a court in Liverpool also found him guilty of
bigamy and fraud, with all the charges bundled together, his case provides an
iffy precedent, if one at all.
The World Health Organisation has branded British
police tactics "objectionable" and bemoaned the courts' feeble
understanding of virology. Until 2006 prosecutors bedazzled defendants into
pleading guilty by waving lab reports of the genetic similarities between the
virus in their blood and in their accuser's. Yet such data cannot rule out
other possibilities, for example that the accuser really infected the accused
or a third party infected both. Sarah Porter, one "AIDS assassin", as
the tabloid press often brands those found guilty, may have been wrongly
convicted, reckons Matthew Weait, a law lecturer who has written a book on the
criminalisation of HIV transmission.
Chaos might be expected given that the law employed in
such cases was written before doctors fully grasped that germs caused
contagious diseases. It is also why the Crown Prosecution Service recently
provided formal guidance. A policy statement published on March 14th makes
clear that genetic data will always form part but never the entirety of case
evidence. Moot points remain, such as whether someone who does not tell a
partner about having HIV and transmits the virus when a condom splits is
reckless.
Using the law to punish reckless disease-transmission
runs the danger of doing more harm than good. Tellingly, HIV is the only bug
ever to have prompted a criminal conviction in England and Wales. And the
sentences so far meted out have been more than twice as long as those for the
violent whacking and clobbering involved in other grievous-bodily-harm crimes.
Yet living with HIV in Britain is less dangerous than living with hepatitis C,
another sexually transmitted virus.
www.economist.com/world/britain/displaystory.cfm?story_id=11024358
* * * * *
3.
International
Medicine: Health Care
and Social Security in the Bosporus
A Tale of Three Cities: Istanbul, Athens and San
Mateo, San Mateo County Medical Association Bulletin, September 2007, By James R. Missett, M.D., SMCMA
President
From Gocek, a
small seaport town of about 2,000 in southwestern Turkey on Republic Day,
Monday, October 29, 2007: the 84th anniversary of the 1923
Proclamation of the Turkish Republic.
Istanbul is a city of 17 million that straddles both
of the eastern and western shores of the Bosporus (or "cow crossing")
that flows south from the Black Sea to empty eventually into the Aegean
Sea. Almost one in four of the 76
million citizens of Turkey live within greater Istanbul. All Turks are covered
by one of three general health insurance plans for which everyone (theoretically)
pays out of his or her income. Tax collection remains a national problem to
which the current government is energetically addressing itself, but with mixed
results.
In fact, it is the government's level of confidence in
its health care contribution collections that determines the level of benefit
that an individual in a given class of employees will receive. In other words,
the more certain the government is that the individual class has paid its
complete premiums, the higher and the broader the range of benefits are for
recipients.
The best and widest range of services is made
available to government employees. These include the employees and instructors
in public schools, colleges, and universities.
Some might look askance at government workers getting the best deal and
the broadest coverage with respect to their health insurance, but government
workers are also a class of employees whose income is best and most accurately
known to the tax collectors.
Better health care coverage means that a Turkish
government employee is permitted to receive covered medical care in any private
or public university medical facility without any co-payment. . .
Turkey is currently applying for membership in the
European Economic Union (EU). The widespread belief is that the real reason for
the postponement of their acceptance into full membership by the EU is based on
the fact that Turkey is not a Christian country. In contrast, Greece is a
member of the European Economic Union.
Like the Turks, the average Greek worker contributes
approximately 40 percent of his or her total income to a combination of health
care insurance and social security insurance. Approximately 15 percent of an
individual's total income goes for health care coverage, while approximately 25
percent of an individual's total income goes for social security cuts.
However, unlike Turkey, Greece does not allocate
benefits based on a government versus non-government basis. Nor does Greece
give any of its 11 million population access to the better public university
health care physicians, clinics, and hospitals.
Greece, however, does continue to struggle with EU
demands for retirement eligibility age to be raised from its current levels of
30 years of work for a man and 25 years of work for a woman, to approximately
40 or 45 years of work for a man and 35 to 40 years of work for a woman. The current retirement schedule allows for
retirement as early as age 45 for some people.
The EU wants to increase the age of eligibility for
retirement benefits to at least 55, but the Greeks are resisting. Of the 11
million Greeks, half live in Athens.
This means it is largely the Athenians that are resisting the demands of
the EU for raising the retirement age.
This is taking place at the same time that the Turks
are beating plaintively and fruitlessly on the doors of the EU to subject their
citizens to the same restrictions that the Greeks do not want. . .
To read San Mateo and the
rest of the article, go to www.smcma.org/Bulletin/BulletinIssues/Oct07issue/BULLETIN-0710-President.pdf.
Can You Believe People Are
Paying Medicare And Social Security Taxes Of 40 Percent?
* * * * *
4.
Medicare: Social
Security and Medicare Projections: 2008, by Pamela
Villarreal, NCPA
The 2008 Social Security and Medicare Trustees Reports show the combined unfunded liability of these two
programs has reached $101.7 trillion in today's dollars! That is more than
seven times the size of the U.S. economy and 10 times the size of the
outstanding national debt. The unfunded liability is the difference between the
benefits that have been promised to retirees and what will be collected in
dedicated taxes and Medicare premiums. Last year alone, the size of the debt
rose by $11.5 trillion. If no other reform is enacted, this funding gap can
only be closed in future years by substantial tax increases, large benefit cuts
or both.
Social Security versus
Medicare. Social Security's projected deficit receives the bulk
of attention from politicians and the media, but Medicare's future liabilities
are far more ominous. The numbers in the nearby table are especially
interesting in light of President Bush's efforts to reform Social Security.
Note that:
- Medicare's total unfunded liability is more than
five times larger than that of Social Security.
- Further, the Bush administration's newly added
prescription drug benefit (Part D) has an unfunded liability greater than
Social Security!
Future Payroll Tax Burdens. Currently, Social Security and Medicare Part A
(Hospital Insurance) benefits are funded by a 15.3 percent payroll tax on
wages - 12.4 percent for Social Security and 2.9 percent for Medicare. But
if payroll tax rates rise to meet unfunded obligations:
- When today's college students reach retirement,
Social Security alone will require a payroll tax of 16.55 percent,
one-third greater than today's rate.
- When Medicare Part A (hospital insurance) is
included, the payroll tax burden will rise to 25.25 percent -
more than one of every four dollars workers will earn that year.
- If Medicare Parts B and D are included, the
burden of Social Security and all of Medicare will climb to 33.6 percent
of payroll by 2054 - one in three dollars of taxable
payroll, and twice the size of today's payroll tax burden!
- Thus, one-third of the wages workers will earn in
2054 will need to be committed to pay benefits promised under current law.
That is before any bridges or highways are built and before any teachers'
or police officers' salaries are paid. . .
Impact on Federal Revenues. Total health care spending in the United States has
historically grown 2.5 percentage points faster than per capita Gross Domestic
Product (GDP). In particular, Medicare spending may rise even faster than the
Trustees report estimates. According to the Congressional Budget Office (CBO),
if Medicare spending continues to grow at the historical growth rate of total
health care spending:
- Social Security, Medicare and Medicaid (the
health care program for the poor) will consume nearly the entire federal
budget by 2050.
- By 2082 Medicare spending alone will consume
nearly the entire federal budget.
Can Higher Taxes Solve the
Problem? The CBO also found that if federal income tax rates
are adjusted to allow the government to continue its current level of activity
and balance the budget:
- The lowest marginal tax bracket of 10 percent
would have to rise to 26 percent.
- The 25 percent marginal tax bracket would
increase to 66 percent.
- The current highest marginal tax bracket (35
percent) would have to rise to 92 percent!
Additionally, the top corporate income tax rate of 35
percent would have to increase to 92 percent.
Pay-As-You-Go. Social Security and Medicare are in trouble precisely
because they are based on pay-as-you-go financing. Every dollar of payroll
taxes is spent. Nothing is saved, and nothing is invested. The payroll taxes
contributed by today's workers pay the benefits of today's retirees. However,
when today's workers retire, their benefits will be paid only if the next
generation of workers agrees to pay even higher taxes.
What about the Trust Funds? Like other government trust funds (highway,
unemployment insurance and so forth), the Social Security and Medicare Trust
Funds exist purely for accounting purposes: to keep track of surpluses and
deficits in the inflow and outflow of money. The accumulated Social Security
surplus actually consists of paper certificates (non-negotiable bonds) kept in
a filing cabinet in a government office in West Virginia. These bonds cannot be
sold on Wall Street or to foreign investors. They can only be returned to the
Treasury. In essence, they are little more than IOUs the government writes to itself.
Every payroll tax check signed by employers is written
to the U.S. Treasury. Every Social Security benefit check comes from the U.S.
Treasury. The trust funds neither receive money nor disburse it. Moreover,
every asset of the trust funds is a liability of the Treasury. Summing over all
three agencies (both trust funds and the Treasury), the balance is zero. For
the Treasury to write a Social Security check, the government must first tax or
borrow.
Conclusion. The Social Security and Medicare deficits are on a
course to engulf the entire federal budget. If our policymakers wait to address
these growing debts until they are out of control, the solutions will be
drastic and painful.
To review the graphs and read the entire report, go to
www.ncpa.org/pub/ba/ba616/.
Government
is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
5.
Medical Gluttony:
Assistive Devices
In the 1960s, when people needed assistive devices
because of weakness, strokes, emphysema, obesity, arthritis and other ailments
of aging, they went out and purchased what they needed. When Medicare was
foisted on America, the seniors gradually realized, "Why should we
purchase a cane when Medicare will pay for it?" So they waltzed over to
their doctors and for a $20 office call obtained a prescription for a cane,
which in those days was called a walking stick and sold for one or two dollars.
The math is straightforward, spend $20 to save $2, but was not understood when
the $20 and the $2 were both covered by Medicare. Of course, the $2 cane
disappeared very quickly when the sale went from the corner drug and hardware
store to Medical Supply Houses. Obviously, one could not put in a Medicare
Claim for $2 when the paper work exceeded that. So the price of canes went up
500 percent to $10 and then 1000 percent to $20 to cover the billing and
administrative costs of Medicare billing.
But the Medicare Gluttony didn't stop with canes. My
father purchased his first wheelchair, as I recall, for about $10. When he had
Medicare, the cost jumped immediately to about $50. A chair with a reclining
back was about twice that. Government money was never seen as taxpayer's money.
Just another 1000 percent increase in cost. No one seemed to care. My father
predicted the government would eventually run out of money from such a Ponzi
scheme. The news headlines seem to vindicate him.
The current fad is "why should my family have to
push my wheelchair when Medicare pays for electric wheelchairs?" The
reason no longer is "My left side is paralyzed and so the cane won't do
it," but "your other patient in the waiting room does not look as
sick as I am and, therefore, I should be allowed to have one also. Besides,
they are such fun to drive. Maybe I can sell my car and make a few extra
thousand dollars since Medicare is providing my transportation to the corner
drug and market." To go from a $50 wheelchair to a $5000 first class
electric wheelchair is a hundred fold increase in cost or a 10,000 percent
increase in health care costs.
What's next? "Maybe one of these new small
Minicars so I can travel to Nevada. It's so demanding to ride those Casino
buses to Reno. Wears me out before I even get to the slots to gamble the half
of the pension or social security checks I reserve for this. Aren't we supposed
to enjoy our golden years?"
In this newsletter, we have seen people say we should
reduce the exorbitant fees that doctors get from Medicare. They think that
would solve the health care problem. However, none other than Ewe Reinhardt,
professor at Princeton, remarked that we could cut doctors fees by 20 percent
and it would have only a 2 percent effect on health care costs. Obviously eliminating
doctors from the health care team entirely would not begin to balance the 1000
to 10,000 percent increase in costs that Medicare patient gluttony causes.
The only way to stem this gluttony and reduce health
care costs is to have a significant deductible and a significant co-payment on
every service. It also has to be a percentage so every patient will police his
or her own health care costs. If the Medicare patient had to pay the 20 percent
co-payment the initial law required and not be allowed to purchase any
supplements, the cost of canes would have stopped at $5 or $10 rather than go
to $50; the cost of wheelchairs would have stopped at $40 or $50. But insurance
companies are still bragging about no co-payments in some policies and
services. Thus, there are no breaks on generalized health care gluttony.
Human Greed Is Never Based On Medical Necessity.
* * * * *
6.
Medical Myths: We
Need Government to Control the Price of Pharmaceuticals
Wal-Mart Widens Drug Discounts, By ANN
ZIMMERMAN, WSJ, May 6,
2008
In another expansion of its
cut-rate prescription-drug program, Wal-Mart Stores Inc. said it will
sell 90-day supplies of more than 300 generic drugs for only $10, taking aim at
the burgeoning mail-order pharmacy business by undercutting their prices on some
drugs and speeding delivery.
In addition, the
Bentonville, Ark.-based retailer said it is adding a second pricing tier to the
heavily discounted program for more-expensive medications geared toward women's
health. It is adding $9 generic prescriptions for up to a 30-day supply on a
handful of drugs for treating osteoporosis, breast cancer, menopause and
hormone deficiency.
For instance, alendronate,
the generic version of osteoporosis medication Fosamax, will be added to the
list. Pharmacies in Wal-Mart Supercenter, Sam's Club and Neighborhood Market
stores will offer 30-day prescriptions of alendronate for $9 and a 90-day
supply for $24, compared with the previous price of $54 and $102, respectively,
the company said. Tamoxifen, a breast-cancer treatment, will sell for $9 for a
30-day supply.
Wal-Mart for the first time
is now selling over 1,000 over-the-counter medications at $4, including its
private-label Equate brand versions of drugs such as Zantac and Claritin, as
well as its Spring Valley private label prenatal vitamins. The price is about
50% lower than at many other national-chain drugstores and supermarkets,
Wal-Mart said, citing internal research. The selection represents about a third
of Wal-Mart's over-the-counter drug offerings.
![[chart]](./Apr2908_files/image003.gif)
Since launching its $4
generic prescription drug program in September 2006, Wal-Mart has seen pharmacy
sales grow as a percentage of its overall sales. In the fiscal year to Jan. 31,
health and wellness sales, including prescription and over-the-counter drugs,
accounted for 9% of its U.S. sales of $239.5 billion, up from 8% two years
before. Analysts estimate that drugs account for about half of those sales. The
majority of the 350 generic drugs that Wal-Mart sells for $4 will be available
at $10 for a 90-day supply.
Wal-Mart expects some
competitors to again match these programs. Late Monday, Target Corp.
said it plans to match all facets of Wal-Mart's discount prescription and
over-the-counter drug plan.
Go to http://online.wsj.com/article/SB121002048022568563.html.
Looks like free enterprise is far more effective in
lowering drug costs than any government program, which usually increases
prices. Isn't the answer to pharmaceutical costs obvious? Or is Medicare Part D
eliminating innovation and reform again?
* * * * *
7.
Overheard in the
Medical Staff Lounge: Managed Care Meetings
Editor's Note: In the past, our medical societies met
on Tuesday evenings, which then became known as "Medical Tuesdays." Mondays
and Fridays are busy days in any practice, which precludes evening meetings on
those days. Many doctors take a half-day off on Wednesdays or Thursdays in
order to compensate for working the nights and weekends required to cover their
practice. Hence, that left Tuesdays for colleagueal and professional meetings.
In our community, the Medical Society met on the third Tuesday of each month.
Huge turnouts occurred, filling the largest meeting room at the convention
center, to discuss the professional and practice issues of the day. The
Internal Medicine Society met on the fourth Tuesdays to discuss their unique
problems; the family physicians, surgeons, pediatricians and
obstetric-gynecologists also met on Tuesdays.
As Managed Care became more assertive in
telling doctors how to practice, the agenda at the medical society meetings
changed and attendance dropped. Meetings were reduced from monthly to
quarterly. Patterns were broken. Doctors could no longer rely on meeting times
or the month that meetings were scheduled. Gradually, the professional
meeting began to disappear. It was counter-productive to the interests of
Managed Care for doctors to assemble and discuss issues since it increased
resistance to compliance. On two occasions in the past several years, the
medical society, in a community of more than 3,000 physicians, had less than 30
attendees (1%). Effective physician leadership disappeared. The once noble
profession was gradually being de-professionalized.
Meanwhile, Managed Care Organization
(MCO) meetings took over the vacuum and were required for all doctors to attend
or their reimbursements would drop. Five, ten and even 25 percent of their
payments were with held and paid out at the end of the quarter. This payment
was based on your attendance at the meetings, your holding the line on
referrals, writing prescriptions for the lowest price pharmaceuticals, and
writing your prescriptions on line. The MCO came into your office and copied
the charts, reviewed them and gave you a grade on your cost performance. The
notice of their coming into your office included a notation to not tell the
patient since by the HIPAA statute, they have a right to review the
confidential patient records without the patient being aware of it. Thus HIPAA,
touted as necessary to force confidentiality, caused wide disbursement of the
private medical record to the government, insurance industry, and made the
sharing of patient records among the physicians caring for the patient more difficulty.
Thus HIPAA was another perverse infringement on medical privacy.
Dr. Edwards: We
had our Managed Care Organization meeting last night and received the
directives for our practice for another month.
Dr. Ruth: Well,
how did it go?
Dr. Edwards: We were
told to do a psychological survey of our patients to determine how many were
depressed. Then there was a lecture on which drugs to use, whether SSRI or
SNRI.
Dr. Dave: I
asked the people at my tables for examples of the latter and none knew any.
Dr. Ruth: So
it's one of those situations that the speaker thought he was talking everyone's
language and everyone was reticent to speak up and show his ignorance.
Dr. Edwards:
That's probably accurate.
Dr. Dave: I
think another reason was a distinct lack of interest. Don't do anything to
delay the end of the meeting.
Dr. Edwards: We
were also told of the Medicare Rule to sign our degree after our name. We were
requested to review our charts since January first and put MD or DO behind
every signature.
Dr. Dave: Some
of us took that as another rule that if it wasn't followed exactly, would allow
them to withhold more money and pay us even less at the end of the quarter.
Dr. Sam: We
were also given notice to upgrade our billing codes to the max to earn more Medicare
money.
Dr. Edwards: Isn't
it interesting in the efforts to reduce health care costs, they throw carrots
at us which are primarily for the public to chew on to make them think we are
getting paid even more.
Dr. Sam: But
upgrading has some serious down side risks. Remember we had a doctor go to jail
in our community who thought an office visit was one code and Medicare said it
should have been another.
Dr. Ruth: Yes I
remember that one. After he apologized and said he was unaware of it and
wouldn't do it again, the federal attorney had him sign an affidavit to his
admission, and then had the judge call the bailiff to take the doctor to jail
where he stayed for two years.
Dr. Yancy: See
I've told you all dozens of times, "Never trust the government in anything.
They are never your friend. Don't even
talk to your congressman or senator. You'll just incriminate yourself."
Dr. Sam: Now
that's sound advice you can take to the bank.
Dr. Dave: If you
must deal with your Medical Board of any branch of the government, have your
attorney make the contact and write the response. The $2,000 legal fee per
response letter is a bargain considering the alternative.
* * * * *
8.
Voices of
Medicine: A Review of Local and Regional Medical Journals
Bulletin of the California Society of
Anesthesiologists, Fall, 2007
On Your Behalf … Legislative and Practice Affairs
Division
Everyone I Know By Jason A. Campagna, M.D., Ph.D.,
Associate Editor, and Marco S. Navetta, M.D.
In 1968, after losing the general election to Richard Nixon,
George McGovern and his supporters were stunned and visibly shaken. To them,
the loss seemed inexplicable. The country was mired in a highly unpopular war,
and McGovern's platform of withdrawal from Vietnam had such popular appeal that
the Republicans were also in support of ending the war. Such observations
bolstered so-called "Popular Wisdom," which foretold a McGovern win
by landslide. In this case, of course, Popular Wisdom turned out to be terribly
wrong. Our purpose here, however, is not to dissect this loss, but rather to
use it as an instrument to learn about what such collective "Wisdom"
says about the future of our own profession, and how much faith, if any, to put
in that wisdom.
Regardless of the specific source of one's
information, the future of anesthesiology is painted in some color palate that
includes multiple shades of gray and black. Dire warnings about collapsing
compensations, the dearth of academic productivity, the encroachment by nurses
and other paraprofessionals - all collectively create a popular notion that the
future of anesthesia looks bleak. . .
Sadly, as Mr. McGovern learned in 1968, Popular Wisdom is a fickle
companion, and throughout history, her reassuring and seductive siren has lured
many to their peril. Such Wisdom pays no mind to the emotional investments we
may make in it, nor does it much care for our grand plans based upon such
investments. What can we learn, then,
from Mr. McGovern and his certain win that can perhaps help us to better
prepare for our own future?
Shortly after the general election had ended, the New
York Times printed an interview with a prominent New York socialite,
philanthropist, and ardent McGovern supporter. In that interview, a
well-heeled, well-connected, and well-known woman expressed shock, disbelief,
anger, and fear over the fact that her candidate, the certain winner, had
in fact, lost. "[I] never saw it coming," she was quoted as saying
and more interestingly, "Everyone I know voted for him, how could
he have lost!" . . . What this
woman was making clear was that she, and other McGovern supporters (her friends
and socialite companions), were living, and speaking, in an echo chamber.
Everyone she knew agreed with her; therefore, they must be in the
majority. No doubt this woman, and her cohort, committed an intellectual error
of enormous proportions. How sad, we say, as we mock this woman for her
seclusion; nay, her ignorance. . . How
many people do we - readers of the CSA Bulletin, members and directors
and leaders of the CSA - know, and how many are in our echo chamber? . . .
During the meeting, The ASA Associate Director for
Federal Affairs (ADFA) was speaking and he was simultaneously boasting of
strong membership across the CSA and the ASA, while also informing us of our
poor political representation in state (GASPAC) and national (ASAPAC) political
action committees. . . .
The
following morning we were having breakfast with this very bright, very
motivated and very passionate ADFA, and he again reminded us how fewer than 15 percent
of anesthesiologists nationally make political contributions to anesthesia
related PACs. We, then, having heard this number the day before, asked him:
"What about the other 85 percent? Why aren't they giving?" His
silence was all the answer we needed because it served to crystallize for us
our fears of the night prior. This was the perfect example of George McGovern's
agony in slow, forward motion. The 15 percent of like-minded persons all
talking, to one another! Our passion, our emotion, our efforts, our
anger, our certitude of our cause - and no one to disagree with us. What is the
lesson here? Like Dewey in '46 and
Kerry in '04, and all the others in between, regardless of how much we might
think we are right, we are, in fact, the minority. The lesson for our
profession: we will lose as well. . . .
Some may argue, at this juncture, that in fact we are
wrong because a small, vocal minority can indeed effect change and perhaps even
win. . . Such an outcome, short of the
use of force, can only be true under one condition: that a majority eventually
agrees with that minority. The
minority, regardless of their passions and emotions and certitude, affect
nothing unless the majority comes to agree with them. . . What is the
"lesson" here for our profession? Obviously, our political
organizations have yet to craft a message that speaks to the whole. Crafting
that message is beyond the scope of this article; but highlighting the need for
such a message is not. There will be no forward progress until the minority
engages the majority. If physicians cannot engage their own, how can they
expect to sway the public? We are losing the war of sound bites within our
ranks and outside them. Stepping outside our echo chamber is imperative. We
better find out what those other 85 percent are thinking. We had better talk
more to them and less to ourselves, and learn that, "Everyone I
Know" is very, very far indeed from Everyone.
To read the entire OpEd, go to www.csahq.org/pdf/bulletin/issue_18/LPAD_56_3.pdf.
Marco Navetta, M.D., is an anesthesiologist with the
Anesthesia Medical Group of Santa Barbara, California. Dr. Navetta completed
his residency at the University of California, Los Angeles in 2002. Prior to
his residency, Dr. Navetta completed his Bachelors Degree in Biological
Sciences and his Medical Degree at the University of California, Irvine.
* * * * *
9.
Book Review: DIETS STILL DON'T WORK
DIETS STILL DON'T WORK by Bob Schwartz,
PhD, Breakthru Publishing, Houston, Texas, 202 pp, $9.95 © 1990, by Robert M.
Schwartz, ISBN: 0-942540-04-2. Review by Del Meyer,
MD
The Really Bad News
Dr. Bob Schwartz summarizes a lot of his first book, Diets
Don't Work, (some thought this was a joke book) written in 1982 (with
several subsequent editions), in the first chapter of the present book. He
owned twenty-six health clubs in the west and southwest during his thirties. He
had been on a hundred different diets during that ten-year period and was
successful every time at reaching his weight-loss goal. But his weight always
returned once he stopped dieting. He had lost more than 2000 pounds during that
decade but ended up weighing more.
One day as he was looking through the monthly weight
and measurement files in his health clubs, he ran across an old record of one
of his members who had been dieting and exercising for 20 years. Comparing her
present day records with those of 20 years earlier, he discovered that her
present day weight and measurements were bigger than when she had first started
dieting and exercising. An idea began to form in his head.
Some people go to a health club to gain weight. What
would happen if he were to put underweight people on the same diet that
overweight people were on to lose weight? Would they also gain weight?
The program was a hit. He found many volunteers and
they all gained weight.
Why?
Doctor Schwartz discovered two basic reasons for this
phenomenon. One is that diets lower your metabolism, or the rate at which your
body burns food. When the amount of food that your body has been receiving
drops drastically, your body figures that the planet has temporarily run out of
food and your metabolism slows down in order to compensate. The problem is that
when you go back to normal eating, your metabolism does not seem to pop right
back up to where it started. It moves up very cautiously. Some people have
dieted so often that they can actually starve and not lose any weight at all.
The other reason why diets don't work, however, seems
to be the more important. He discovered that ANYTHING THAT HUMAN BEINGS ARE
DEPRIVED OF, THEY BECOME OBSESSIVE ABOUT. Diets are supposed to have you think
less about food, but just the reverse happens. We begin to think about food all
of the time. We even have dreams about eating.
Part Two of his first book, Diets Don't Work,
is on "Dismantling the Dysfunctional Diet Mentality." After this book
was published, Schwartz received countless letters from readers who were
thrilled that they were losing weight without dieting. They were most grateful,
however, because they had finally lost their obsession about food. They were
amazed that this longtime problem had vanished.
The Secret of Naturally Thin People
Dr. Schwartz then started studying in greater depth
the naturally thin people who had never had a weight problem. He found that
some of them had a high metabolic rate. But they were young and he knew their
metabolism would eventually slow down at which time they would probably have a
weight problem.
Surprisingly he found that as these naturally thin
people grew older and their metabolism slowed down, their eating slowed down.
How did they do it?
He would ask these naturally thin people questions
that every fat person knows the answers to, such as, "How many calories
are in (whatever food they were eating)?" To Schwartz' amazement, they had
no clue. He finally saw the light. Only fat people knew about calories.
How did the naturally thin people avoid putting more
food in their bodies than needed? That would be the secret to weight loss and
keeping it off. The naturally thin people had different eating habits. Some ate
well-balanced meals while others ate mostly fast foods. Some exercised
regularly, but some did not exercise at all. Some ate three meals a day, some
ate one, and some ate six times a day. What was the secret?
The Results of Schwartz' Research
1. For
almost everyone, being thin is a natural state.
2. It can
be as easy and as natural to lose weight as it is to gain it.
3. Naturally
thin people do four simple things that fat people don't, and they never diet.
(See below)
4. People
gain and keep weight for specific reasons and there are specific ways to get
and keep weight off.
5. It's
not weight that's the real problem - it's the mentality behind it. Get rid of
the mentality, and the weight comes off by itself, as quickly and as naturally
as it was put on.
How Thin People Think and Eat: The Real Secret
Schwartz recognizes the ultimate secret sounds
deceptively simple, but don't be fooled. It may be the most difficult challenge
you've ever faced. The fundamentals of naturally thin people are as follows:
1. They
don't eat unless their body is HUNGRY.
2. They
eat EXACTLY what they want - EXACTLY what will satisfy them.
3. They
don't eat unconsciously; they ENJOY every bit of what they are eating and they
are aware of the effect the food is having on their bodies.
4. They
STOP eating when their bodies are no longer hungry.
To read the rest of the book review, please go to
www.delmeyer.net/bkrev_DietsStillDon'tWork.htm.
To read other diet reviews, please go to www.healthcarecom.net/bkrev_Health.htm#Diets.
* * * * *
10. Hippocrates & His Kin: MISTAKES - Can We
Avoid Them or Just Cover Them Up?
It's been said that doctors can bury their mistakes; attorneys
can lock up their mistakes; but architects can only advise their clients to
grow bushes and vines.
John Stossel, also
on 20/20, reports on the Congressional Record, an alleged verbatim
report, that the record is mostly Fake. In fact, it can be changed if the
congressman doesn't like the first Fake record or find that it has MISTAKES in
it to make it a more acceptable Fake. They conclude that Congress is wasting
$469 per page and doesn't seem to be able to keep from wasting with anything
they touch... If we ever let congress destroy the health care we provide our
patients, it would be the most critical of all MISTAKES, one that cannot be
buried or even covered with bushes and vines.
A lady called one of our surgeons recently requesting
a brochure on hernia repair to send to her brother in Norway. He had been on
the waiting list for a hernia repair for two years and called to see how he was
progressing up the list. He was told there were still over 2,000 ahead of him.
When they asked his age he was told that he probably would not be able to have
the hernia repair in his lifetime. . . We always knew that government medicine
had a secret way of dealing with cost containment.
Marc S. Micozzi, MD, PhD, a physician and anthropologist who directs the National
Museum of Health and Medicine in Washington, D.C., recently brought from Berlin
the exhibition, "The Value of the Human Being: Medicine in Germany
1918-1945." He notes that socially minded physicians placed great hope in
a new health care system, calling for a single state agency to overcome
fragmentation ... Medical concerns changed from the private domain of the
nineteenth century to a concern of the state... The physician transformed into
a functionary of state-initiated laws and policies. He states that it is one
thing to see oneself as responsible for the "nation's health" and
quite another to be responsible for an individual patient's health. The
mentally ill having been released from their chains in the nineteenth century
and placed in community and family contact, were returned to state institutions
to become the ultimate victims of state "solutions."
The exhibit continues with a pamphlet, The
Sanctioning of the Destruction of Life Unworthy of Living, published in
1922 by Alfred Hoche, a neuropathologist, and Karl Binding, a lawyer.
This set the stage for the mentally ill and the mentally retarded to be
sterilized and subjected to euthanasia in large numbers... And to think that
doctors supported all this with their desire for a single-payer health system!
To read more medical vignettes, please go to www.healthcarecom.net/hhkintro.htm.
To read HMC, go to www.delmeyer.net/HMC.htm.
* * * * *
11. Physicians Restoring Accountability in Medical
Practice, Government and Society:
