MEDICAL TUESDAY . NET

NEWSLETTER

Community For Better Health Care

Vol VII, No 2, April 29, 2008

 

In This Issue:


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

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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.

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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.

How Supermemo Works


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.

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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

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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?

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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:

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:

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:

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:

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

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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.

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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]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?

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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.

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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.

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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.

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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.

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


 

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


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

                      PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. http://home.earthlink.net/~doctorlrhuntoon/. Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. I also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.

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

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

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

                      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.

                      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, write an informative Medicine Men column at NewsMax. Please log on to review the last five weeks' topics or click on archives to see the last two years' topics at www.newsmax.com/pundits/Medicine_Men.shtml. This week's column is on "A Solution for Global Warming" and can be found at www.newsmax.com/medicine_men/global_warming_solution/2008/04/09/86586.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 scroll down on the left to departments and click on News of the Day in Perspective. Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site, which provides valuable information on a monthly basis. Read Leveling. Scroll further to the official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. www.jpands.org/. There are a number of important articles that can be accessed from the Table of Contents page of the current issue. Don't miss the special articles, commentaries, medical controversies, or the extensive book review section which covers the relevant great books this month.


 

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Del Meyer

Del Meyer, MD, Editor & Founder

DelMeyer@MedicalTuesday.net

www.MedicalTuesday.net

6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608

Words of Wisdom

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

Peter F. Drucker, on Business & Professional Ethics: "Primum non nocere - 'First do no Harm.'" The first responsibility of a professional was spelled out clearly, 2,500 years ago, in the Hippocratic Oath of the Greek physician: "above all, not knowingly to do harm." No professional, be she doctor, lawyer, or manager, can promise that she will indeed do good for her client. All she can promise that she will not knowingly do harm. And the client, in turn, must be able to trust the professional not knowingly to do the client harm. Otherwise, he cannot trust her at all.

C. S. Lewis: (1944) Democracy demands that little men should not take big ones too seriously; it dies when it is full of little men who think they are big themselves.

Some Recent Postings

DIETS DON'T WORK by Bob Schwartz, PhD www.delmeyer.net/bkrev_DietsDon'tWork.htm

DIETS STILL DON'T WORK by Bob Schwartz, PhD, Breakthru Publishing www.delmeyer.net/bkrev_DietsStillDon'tWork.htm

In Memoriam

Ollie Johnston, Apr 24th 2008, From The Economist

IF YOU interviewed Ollie Johnston in the last years of his life, sooner or later he would start to change. The trim body, lean as a whippet's, would begin to prowl and strut, then round on you with an accusing, pointing arm, just like the evil prosecutor in "Toad of Toad Hall". Or he would cock his head, gyrate it, fidget and twitch, for all the world like the rabbit Thumper as he explains to Bambi why he doesn't like clover greens. He would skip and stumble to play little Penny carrying a slithering cat in "The Rescuers", or tilt stiffly from side to side like a waiter-penguin from "Mary Poppins".

All these vignettes, performed in his 80s with a young man's grace, had come from decades of observation. For the plump, elderly Good Fairies in "Sleeping Beauty" (1959) Mr Johnston and Frank Thomas, his lifelong friend and fellow animator, would lurk behind little old ladies in the supermarket, noting how they bounced as they walked and how they pinned up their hair. For "101 Dalmatians" (1961), in which he drew the parent-dogs Pongo and Perdita, he studied every nuance of ears, noses, flanks and tails. Dog-nous had helped him too in his first job as an assistant animator, "Snow White and the Seven Dwarfs" (1937), in which Dopey's paw-flapping stupidity was based on hound behaviour.

Ollie Johnston, last of Disney's elite animators, died on April 14th, aged 95

 

Reuters

Reuters

 

Of the elite animators Walt Disney gathered round him in the 1930s, the "Nine Old Men" as he called them, it was generally agreed that there was none like Mr Johnston. His background was suitable enough for the work: middle-class Californian, Stanford University art department, Chouinard art school in Los Angeles, until in 1935 he was hired, at $17 a week, by the studios in Burbank. But his approach was different. Where his colleagues focused on the "extremes", the beginning or end of an action, he worked like an "in-betweener", filling in with his quick, clear lines the smallest progressions of movement in a cheek, a hand or a leg, finding and sustaining the inner rhythm of the character.

The trouble with noses

What mattered for him was not movement, but the emotions behind it. "What is the character thinking, and why does he feel that way?" was the question he asked himself as he sat down to draw. As a student he had dreamed of being a magazine illustrator, producing portraits so alluring that buyers would feel they had to read the stories. Here his portraits could actually move and breathe. They could touch hands. He wanted to know the whole track of their lives to that moment, so that the way Sneezy blew his nose, or the delight of first-mate Smee as he sucked the liquor from his thumb in "Peter Pan" (1953), or the shambling dance of the bear Baloo in "The Jungle Book" (1967) would be informed by a universe of experience.

Some characters were harder than others. Mr Johnston could never find the spark in Lewis Carroll's Alice, with her prim hairband and her white apron, and thought the film a failure. In "Bambi", where he excelled himself with the pathos of the fawn discovering his mother dead in the snow, or acknowledging with a slight, shy droop of the head the magnificence of his father, or stumbling through the forest on legs as thin as the grass, he found the face too bland, and the nose too short, to register as much as he wanted. He had more nose to work with in "Pinocchio" in 1940; but there, typically, he drew just the beginning of the transformation, as the puppet-boy, "who doesn't know a darn thing", was suddenly, astonishingly confronted by the Blue Fairy and his own lies. The six-foot-long nose, with a bird's nest swaying at the end of it, was somebody else's thought.

The work of a Disney animator, as the studios roared from strength to strength, could be as numbing as the daily grind on any other production line. The constant perusal of the storyboards pinned along the wall; the mute challenge of the pile of medium-grade bond paper and the pencil-sharpener full of shavings; the exposure-sheet tacked to the drawing-board, giving the exact times allotted to the scene and the dialogue; the knowledge that 30 feet of drawings, at 16 drawings a foot, would have a running time of merely 20 seconds. But Mr Johnston made light of it, adoring the work and passing on his expertise enthusiastically to others. The only thing he possibly loved more was the inch-scale hand-built railway that ran round his garden, which with huffing and panting and articulated pistons moved much like an ideal cartoon character: everything functional, everything with a purpose.

Those who came to see him in the studios might find him acting, rather than drawing. Disney routinely brought in actors to help the animators, but their bodies and faces seldom matched up to the ones Mr Johnston had in his mind, with their flowing capacity to squash, stretch and rebound. He could sometimes give the idea better himself, by getting up and doing. When his characters had to speak he would draw with a mirror beside him, giving them the lines of his own mouth making letters and his own eyebrows rising and falling. "You get an idea, your eyes begin to widen," he noted. "Your cheeks start to come up; your whole face moves...The entire pose should express the thought." Small wonder that so much of his own life got into his drawings, and so much of their life into him.

www.economist.com/obituary/displaystory.cfm?story_id=11081964

On This Date in History - April 29

On this date in 1894, Jacob S. Coxey, an Ohioan, led a group of 400 unemployed on a march to Washington, DC. Coxey was arrested for trespassing at the Capitol and the "army" broke up. The name "Coxey's Army" became a symbol for raggedy groups and parades on behalf of lost causes. Coxey wanted the government to finance a public works program of some half a billion dollars to provide work for the unemployed. He thought the government could do this simply by printing that amount of new money. Coxey may be gone; but similar proposals keep popping - and every one still seems to look to Uncle Sam for help. But it only took FDR forty years later to completely destroy the American Dream and Ambition. How tragic to have bred this degree of dependency - which in other instances would be termed a mental condition.

On this date in 1863, William Randolph Hearst was born in San Francisco. Only a few years after Coxey's army went into history, William Randolph Hearst was helping to raise an Army to fight a war some historians think he helped mightily to start. That was the Spanish American War, which Hearst's newspaper, the New York Journal, kept calling for until it was declared. The war was a success for the country and for Hearst. But in later years, the Hearst chain of newspapers began to shrink, and the lands whose liberty from Spain had been won in the Spanish-American War did not prove to be islands of serenity and happiness. The war for circulation between Hearst and Joseph Pulitzer in New York produced a whole era of sensationalist journalism. It was sardonic that this kind of journalism later had one of its greatest field days in reporting the kidnapping and Symbionese Liberation Army days of William Randolph Hearst's granddaughter, Patty Hearst. The world seemed to have come a long way from the time of the grandfather to the time of the grandchild. It makes one wonder with what perspective our grandchildren will look back at what we are doing today.

After Leonard and Thelma Spinrad