MEDICAL TUESDAY . NET
Community For Better Health Care
Vol VII, No 9, Aug 12, 2008
In This Issue:
The Annual World Health Care Congress, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study data. The 3rd annual conference was held April 17-19, 2006, in Washington, D.C. One of the regular attendees told me that the first Congress was approximately 90 percent pro-government medicine. The third year it was 50 percent, indicating open forums such as these are critically important. The 4th Annual World Health Congress was held April 22-24, 2007 in Washington, D.C. That year many of the world leaders in healthcare concluded that top down reforming of health care, whether by government or insurance carrier, is not and will not work. We have to get the physicians out of the trenches because reform will require physician involvement. The 5th Annual World Health Care Congress was held April 21-23, 2008 in Washington, D.C. Physicians were present on almost all the platforms and panels. This year it was the industry leaders that gave the most innovated mechanisms to bring health care spending under control. The solution to our health care problems is emerging at this ambitious congress. Plan to participate: The 6th Annual World Health Care Congress will be held April 14-16, 2009 in Washington, D.C. The World Health Care Congress - Asia was held in Singapore on May 21-23, 2008. The 5th Annual World Health Care Congress – Europe 2009 will meet in Brussels, May 23-15, 2009. For more information, visit www.worldcongress.com. The future is occurring NOW.
To reread our reports of the last Congress, please go to the archives at www.medicaltuesday.net/archives.asp and click on the June 10, 2008 and July 15, 2008 Newsletters.
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1. Featured Article: What Makes Pancreatic Cancer So Deadly? Scientific American August 2008 By Melinda Wenner
Gene Upshaw, the executive director of the National Football League Player's Association—the union for NFL players—died late Wednesday evening of pancreatic cancer while vacationing in California's Lake Tahoe. Doctors diagnosed the 63-year-old Hall of Fame offensive lineman with the disease just four days earlier.
Upshaw was a guard for the Oakland Raiders from 1967 to 1981. He played in seven Pro Bowls and three Super Bowls. He served as head of the NFL player's union for 25 years.
According to Bloomberg News, Upshaw's wife, Terri, took him to a hospital on Sunday, August 17th, because he was having trouble breathing. A biopsy revealed, much to everyone's surprise, that he had advanced pancreatic cancer.
In March, actor Patrick Swayze—star of the hit 1980s film Dirty Dancing—revealed he had been diagnosed with the illness in January. Doctors' reports indicated they had caught his cancer relatively early.
The pancreas secretes hormones and enzymes to digest our fats. One of those hormones is insulin, which prompts the body to use sugar in the blood rather than fat as energy. Its levels are low in diabetic patients, who suffer from abnormally high blood sugar.
Only one fifth of Americans diagnosed with pancreatic cancer survive for a full year, according to the American Cancer Society, and it is the fourth leading cause of cancer death in the country.
How does the disease develop without noticeable symptoms and then kill so quickly?
To find out, ScientificAmerican.com called Allyson Ocean, an oncologist at NewYork- Presbyterian Hospital/Weill Cornell Medical Center, who specializes in gastrointestinal cancers including pancreatic cancer. An edited transcript follows:
Why does pancreatic cancer kill so
Pancreatic cancer is typically diagnosed at a late stage because it doesn't cause symptoms until it's too late. Weight loss, abdominal pain, jaundice [a yellowing of the skin due to toxic buildup in the liver]—those are the most common symptoms. They usually start after the tumor is a significant size. By then, chances are, it has metastasized [or spread to other parts of the body].
Only about 10 to 15 percent of pancreatic cancers are diagnosed when they could be considered for surgery. And the prognosis is poor even in patients who do have surgery, because it comes back about 85 percent of the time. At best, 25 to 30 percent of patients are alive five years after surgery.
When doctors do pancreatic cancer surgery, they take out 95% of the pancreas, including the tumor, and then they leave a small remnant of the pancreas in there that serves [the insulin-producing] functions.
If a person can live without a fully functional pancreas, then what, ultimately, kills most pancreatic cancer patients?
When most patients die of pancreatic cancer, they die of liver failure from their liver being taken over by tumor.
What precludes doctors from performing
surgery on late-stage patients like Upshaw?
We don't do surgery if the tumor has already spread outside the pancreas, because there's no survival benefit in removing the tumor. We also sometimes can't do surgery [when the tumor] involves the great blood vessels, the superior mesenteric vein and superior mesenteric artery. Those are the main vessels that come off of the aorta, the main artery in our body. If the tumor is wrapped around those blood vessels, then we can't take it out.
Why is this particular cancer so aggressive?
Because of the nature of the tumor cells. They escape the treatments, they hide out and then they come back. And they grow again and they affect the liver and then they kill people.
What are the biggest risk factors for
The biggest known risk factors are smoking and family history—it can be a hereditary disease. Then there are some other more obscure risk factors, such as defects in the anatomy of the pancreas, but that's very rare.
What factors affect how early a person
Depending on where the cancer is diagnosed in the pancreas, it can affect how soon it's diagnosed. For instance, if the cancer is in the head of the pancreas, which is close to the common bile duct, and it grows and it causes obstruction of the common bile duct, a patient can get jaundiced. And then they could [show symptoms] sooner than someone whose pancreatic cancer is in another part of the pancreas, like the tail. They would not present with jaundice, so we would not have a clue that there was necessarily anything wrong with them.
What are some of main symptoms as the
Unexplained weight loss, abdominal pain, nausea, vomiting. Back pain is another one, because the pancreas is very posterior in the body. Back pain is also the most common complaint that patients go to an emergency room for, and most of the time it's just muscle pain—it's not pancreatic cancer.
The press reported that Upshaw's wife brought him to the hospital because he was having trouble breathing. What might have caused that?
It could be for a number of reasons, such as if the disease has spread to the lungs. If he was so run down from having lost a significant amount of weight, and he was weak and fatigued, he could have had difficulty breathing, too. It's hard to say.
Another important thing with pancreatic cancer is that it it's one of the cancers that is frequently associated with blood clots. He could have had a blood clot in the lung, called a pulmonary embolism. It's possible that that's what killed him. . . .
For further reading and references, go to www.sciam.com/article.cfm?id=experts-pancreatic-cancer-gene-upshaw&print=true.
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2. In the News: My View: Here's an earful about the new cell phone law. by Kevin Miller - Published Friday, August 1, 2008
My friend called me the first day we became "hands free."
"I avost cost n agsidend!" he said.
"What?" I replied.
I heard him speaking again from underwater, "N agsidend! I ast cost un cuzuv m bootoov!"
As I hung up, tore my "hands free" device from my ear and threw it at the dashboard, I almost caused an accident. I pulled over to call him back. He explained that he had called to tell me that he almost caused an accident because of his "hands free" device.
Because of my anger at having to merge back into freeway traffic after stopping to hear my friend, I almost caused an "agsidend."
I saw in my mind the state Legislature and the governator proudly slapping each other on the back after signing the legislation that would save so many lives. (Do we have a budget yet?)
Don't they remember the excellent driver's training courses we took as teenagers, where we learned to drive a stick shift while holding a Big Gulp (no cup holders back then), changing our cassettes and watching for cops? No "hands free" devices back then, if I recall correctly.
Let me tally the ways my driving has improved by trying to keep the "hands free" device from falling out of my ear, or from reaching to grab it off the passenger's-side floorboard after an unsuccessful attempt at catching it.
I wonder if our lawmakers considered that holding the phone to your ear while driving is the easy part. Last I saw, my "hands free" device did not make the call for me. It also does not tell me who is calling, so I still have to pick up my phone to look at the incoming number.
Maybe the great state of California should tell me the foods that are safe to eat while driving or tell me I should not reach down to change my radio station.
Last I checked, my "hands free" device did none of this for me.
Since July 1, with my "hands free" device in my ear, I have almost caused accidents while staring in disbelief at the drivers next to me who were applying makeup, shaving and even reading a newspaper (probably this one) while driving.
Why did my "hands free" device not warn me about rubbernecking at someone changing a tire at the side of the road while traffic in front of me came to a stop to do the same thing? Maybe the "hands free" devices should be equipped with a brake-light warning device so we can avoid these very types of accidents.
The other day, I had to turn down the volume of that sexy British voice on my GPS system so that I could make out what my client was trying to tell me through my "hands free" device. After the phone call I realized that my GPS had tried several times to recalculate where I was, and I decided to punch in the new coordinates of my next stop and come back later to the place I passed up several miles back.
While performing this task on Interstate 5, my "hands free" device fell from my ear and this time landed under the gas pedal. Having to take my foot off the gas to reach underneath, my foot accidentally rested on the brake pedal, slowing me down exponentially and causing me to bump my ear (the same ear that holds my "hands free" device) on the steering wheel.
I sat back up and found my left ear was too swollen for the "hands free" device. As I was twisting the earpiece to now fit into my right ear and reaching into my lunch bag for the ice pack, I saw that many empathetic drivers (having obviously encountered similar situations) were now staring at me instead of the road and extending to me the finger of understanding. Evidently, their "hands free" device does not do this for them.
This all just happened a few minutes ago, and since I already had my laptop out on the passenger seat and my wireless card plugged in, I decided to log on to Sacbee.com to write this letter to share my story. It looks like traffic may be slowing ahead, so I had better keep one eye on the road and get back to RSVPing to my 20-year reunion with my other – yet another thing my "hands free" device does not do for me.
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Filthy NHS wards are being plagued by pests - with maggots found in slippers and rats in maternity units, it was revealed last night.
Hospitals are so dirty that pest controllers were called out to 20,000 infestations in the past two years.
Experts warned that the appalling levels of hygiene added to the danger to patients from the deadly superbugs MRSA and C. diff, which multiply in the same environments as pests.
Official figures obtained by the Tories show that 80 per cent of NHS trusts reported problems with ants, 66 per cent with rats and 77 per cent with mice.
Cockroaches were reported at 59 per cent of trusts, biting insects or fleas at 65 per cent, and bed bugs at 24 per cent.
There were infestations of maggots at a further 6 per cent of trusts. And many of the pests were in clinical areas.
The data, revealed under the Freedom of Information Act, shows that, on average, every trust in the country calls out pest controllers once a fortnight.
At one hospital, a horrified patient awoke to find maggots in her slippers. At another, expectant mothers were dismayed to find the ward overrun with rats, while at a third hospital, a store for sterile materials was infested with mice.
More than two-thirds of trusts had to call out pest controllers 50 or more times between January 2006 and March 2008.
At one trust alone - Nottingham University Hospital - there were no fewer than 1,070 pest incidents between 2006 and 2008.
Last year's report into the deaths of 270 patients from C. diff at a Kent hospital trust found poor hygiene was directly responsible for the outbreak.
Conservative health spokesman Andrew Lansley said: 'Labour have said over and over again that they will improve cleanliness in our hospitals but these figures clearly show that they are failing.
'It is difficult for Health Service estates to maintain a completely pest-free environment but the level and variety of these infestations is concerning.
'We need greater transparency in NHS infection control, and publishing data like this is one way in which we can drive up overall hygiene standards.'
The data reveals that Ipswich hospital had repeated infestations of ants in the dental unit, eye clinic, radiotherapy unit, chest clinic, rheumatology and physiotherapy.
There were biting insects and cockroaches in the X-ray unit, while cockroaches were found in the eye clinic and an antenatal unit. Flies infested the maternity wards.
Mid-Cheshire trust, which runs hospitals in Crewe and Northwich, reported that wards had been ' overrun' with ants, and mice were 'all over' several wards.
Wards also experienced infestations of rats, bed bugs and biting insects. One ward had a wasps' nest. There were fleas in the orthopaedic department.
Salisbury hospital reported rodent droppings in the sexual health clinic - and a wasps' nest.
Trafford hospital said one ward had 14 separate infestations of ants, while there were also problems with fleas and crickets on other wards.
Mid-Essex trust, which runs hospitals around Chelmsford, reported rats in a maternity unit and wasps in operating theatres.
Dudley hospitals reported repeated infestations of ants in the eye clinic.
Michael Summers, of the Patients Association, said: 'It is outrageous that this should happen in our hospitals in the 21st century. 'It's a great worry to patients, and does nothing to speed recovery.
'If you're lying in hospital with an open wound, the last thing you want to worry about is rats and cockroaches in the vicinity.'
Despite millions being ploughed into the NHS since New Labour came to power in 1997, many hospital buildings are still dilapidated.
The information collated by the Conservatives amounts to a roll call of failure to improve hygiene in England's hospitals. And the number of infestations is likely to be greater because only three-quarters of trusts responded to the Freedom of Information requests.
Clive Boase, of Pest Management Consultancy, said insects such as flies, ants or cockroaches can be carriers of superbugs.
He added: 'These infective insects disperse through the hospital, possibly into clinically sensitive areas. . .
Christine Braithwaite, of watchdog the Healthcare Commission, said: 'Cleanliness and hygiene are of critical importance to patients and the public. We are inspecting every hospital trust this year.'
She added: 'If we were concerned that the safety of patients was at risk, through poor hygiene standards or in any other way, we would take immediate action.'
Last night health minister Ivan Lewis said: 'There is more than a whiff of hypocrisy in these comments from Andrew Lansley.
'It is the Conservatives who oppose Labour's hospital deep-cleaning programme. (sic)
'They also oppose our demanding targets on healthcare-acquired infections which have proved so effective in tackling MRSA and C. diff.'
To read the entire story along with the pictures of the filth, go to
The NHS does not give timely access to health care; it only gives access to a waiting list for a filthy infested hospital.
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4. Medicare: Single-Payer Redux, The Galen Institute, Grace-Marie Turner, Founder, June 27, 2008
Problems in Canada and the UK: There is mounting evidence that centrally-controlled, government-dominated, taxpayer-financed, rule-driven health care systems are failing. We found a surprising number of articles this week about problems in paradise -- aka, British and Canadian single-payer health care systems. We've written summaries of them in the articles round up below.
Even the godfather of the Canadian system, Claude Castonguay, now acknowledges that it is in crisis, as the Manhattan Institute's David Gratzer reports. "We thought we could resolve the system's problems by rationing services or injecting massive amounts of new money into it," Castonguay said. But he now believes the solution is to bring private sector forces into play, with greater freedom of choice for patients.
Now if only we could get American political leaders to see the light BEFORE they go down this futile road.
The Center for Medicine in the Public Interest held a reception at the National Press Club on Monday evening to preview a new film that counters, with actual patient stories, the SiCKO fiction. And they launched a new website called BigGovHealth.org to provide easy access to articles, videos, and testimonials about the costs and consequences of centralized government control over health care.
President Peter Pitts invited Canadian Shona Holmes to the reception to tell her story: She was diagnosed with a fast-growing brain tumor that was causing her to go blind; the expected survival time without treatment was less than the expected waiting time to begin treatment in Canada. So she decided to go to the Mayo Clinic for care. It was successful, and she credits Mayo with saving her vision and her life.
Her husband is working a second job to pay the bills -- as well as the taxes to pay for the Canadian universal health care system. But she is alive three years after the surgery. "Please don't do to your health care system what we have done to ours," she pleaded. "Otherwise, where would we go?"
The Chairman of CMPI, noted cardiologist Michael A. Weber, told the audience that he spent part of his childhood in England and, as a young boy, was told that he needed to have his tonsils removed. The physician said: "Go home, and you will receive a letter from the government telling you when and where to show up for your surgery," he recounted. "Every day, I look at my mail for that letter to arrive," he said. "I'm still waiting."
Physician payments: Meanwhile, the Congress has itself tied in knots trying to reverse an automatic 10% Medicare pay cut for physicians, scheduled to go into effect July 1. Members on both sides of the aisle overwhelmingly agree they want to stop the physician pay cut from kicking in, but a number of other issues are attached -- including cuts to the popular Medicare Advantage program and competitive bidding for durable medical equipment. Barring a last minute miracle, it now appears that Congress will leave town for the July 4 recess without passing a bill.
With the health sector now representing one-sixth of our economy and almost half of that run through government programs, politicians have enormous power over health care decisions. Do we really want to give them even more with health care reform proposals that give government a much bigger role in our health sector? Now how long would we wait for decisions?
That's a good question to ponder this Independence Day.
I did a radio interview this morning with the hosts of Money Matters Radio in Massachusetts. One was espousing the typical liberal line about health care systems in other countries being so much better at taking care of patients. I responded with actual facts about the growing difficulty of many Canadians to find a primary care doctor still accepting patients, long waiting times to see specialists and begin treatment, and lower survival rates in Canada and Europe for diseases like cancer.
The hosts didn't hang up quite quickly enough: After they said goodbye, one said I was knowledgeable and a great guest. The other said: "I thought she was annoying."
The facts are so difficult to swallow! Read the entire report at www.galen.org/component,8/action,show_content/id,14/blog_id,1057/category_id,0/type,33/
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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At the World Health Care Congress, an entrepreneur stated that his company was working on medical record systems that could be implemented before the government mandated 10-year point in 2014. They were able to integrate any system for optimal patient care. However, the government was less than enthusiastic about their progress for integrating health care as the Feds desired.
Several large systems already have very workable and efficient electronic medical records. In our community, UC Davis has their system that ties all their hospitals and doctors into a network. Kaiser Permanente has a super electronic medical records system that integrates the Kaiser hospitals, the Permanente physicians and all the ancillary services, which allows them to communicate freely with each other. There is appropriate patient access to much of this information. The other two large hospital systems in our community are continuing with the physicians on their staff to facilitate efficient care in an integrated electronic fashion.
Why doesn't the government like this medical efficiency? They would rather have each hospital and medical facility wired together into a comprehensive national network. That way Medicare and the insurance companies are always aware of all health care that occurs. But that wouldn't improve health care. The government isn't particularly interested in improving health care. They would rather keep the subterfuge going about how bad our doctors are delivering less than optimal care. They want to be the teachers looking over our work. How else could Big Brother invade our privacy - or rather the patient's privacy? And we thought it was the other side that George Orwell was writing about as being the Big Brother.
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Aeon J. Skoble is a professor of philosophy and chair of the philosophy department at Bridgewater State College in Massachusetts.
In his April 11 New York Times column, economist Paul Krugman discusses the minor trouble then- presidential candidate Hillary Clinton got into when an anecdote she told about a woman who died because she didn't have medical coverage was found to be inaccurate. Clinton had used the story in support of her proposal for mandatory medical insurance. Krugman argued that, true or not, the story makes "a valid point about the state of health care in this country."
On April 14 Krugman conceded that the woman did indeed have insurance, but he maintained that since many people do die from lack of insurance, his earlier column was worthwhile anyway.
I agree that the merits of Krugman's argument do not stand or fall with the veracity of the anecdote. But while Krugman's attitude seems to be, "Even if the woman was not uninsured, it's still true that we need universal care to avoid similar tragedies," mine would be, "Even if Clinton's anecdote were accurate, it wouldn't demonstrate that the only way for society to avoid such tragedies is through coercive national health insurance."
Part of the problem in discussing this issue is the tendency to conflate several distinct concepts: the ideas that 1) everyone should have access to health care, 2) everyone is entitled to equal levels of health care, and 3) a coercive federal mandate is the only way to accomplish either of those goals. The first is true, but does not imply the second. I doubt that the second is true, but even if it were, it wouldn't imply the third.
People sometimes mean different things when they speak of access. It would be strikingly immoral for there to be a class of citizens who were forbidden to seek medical attention. Happily, we do not live in such a society. But there are other senses of the word.
Do I have access to a Mercedes? Well, in one sense, yes—if I could afford to buy one, no one would be legally empowered to stop me from doing so.
But I can imagine someone arguing that since, in fact, I cannot afford one, I don't have "access." So the argument is not that some people are legally locked out of access to medical care, but that they cannot afford it and in that sense lack access. The very poor are already eligible for government-subsidized medical care, so this argument seems to be directed at uninsured people who make too much money to qualify for Medicaid. But how would mandatory national health insurance fix that problem? Mandating that people buy something won't suddenly make it affordable.
Why don't some people have insurance? They may work for employers who do not offer it as a fringe benefit. But they could still enroll in an HMO or in a Blue Cross-type insurance plan. Why don't they? One possible reason is that they cannot afford the premiums. This means they choose to spend their money in other ways. (Remember, we are not talking about the seriously poor, as they are already covered by government programs.) When I say, "I cannot afford a huge flat-screen TV," what I mean is that I choose not to afford it; I am saving my money for something else—a new lawnmower, my kids' college fund, retirement, or what have you. I have assigned a lower priority to a new TV than to several other things.
But wait, comes the rejoinder, flat-screen TVs are a luxury no one needs, but everyone needs health insurance. (Technically, that's not true, but let's assume it is.) Then the problem must be that people are arranging their financial priorities erroneously. Mandatory insurance would solve that problem. It would rescue them from their own folly.
This is the core premise of what Krugman calls Progressivism. People do not choose wisely; therefore, for their own good, they must have some choices mandated for them. This premise, of course, is profoundly antithetical to the classical-liberal tradition, in which people's autonomy and liberty are to be accorded the highest priority unless their actions infringe the equal rights of others. To assume that people cannot be trusted to make wise choices about their welfare is bad enough; it's worse to add the assumption that a policy wonk is better qualified.
Even if we grant that some people who choose to go uninsured are foolish and ought to be compelled, that wouldn't address the problem of those who make this choice not out of foolishness, but because they really are so strapped for money that they "cannot afford it" in the ordinary sense of that expression. The mandate then would have the effect of making those people even more impoverished. But at least they wouldn't die from lack of insurance. . . .
Imagine if Jiffy Lube had to employ factory-certified master mechanics at $80 an hour to do oil changes. You'd likely get fewer oil changes because they would cost a lot more. But without regular oil changes, your car would be at risk for more serious trouble. When a big problem occurred, people would lament that it could have been prevented with regular maintenance. Some would propose that the government should require people to get regular oil changes even if they can't afford them. But another approach would be to allow a free market in oil changes, which, as we know, keeps prices low, and enables everyone to get regular care.
Government has many other policies that restrict supply and make medical care artificially expensive. Let's get rid of them. Why resort to force? Freedom works.
If saving lives is as important a part of the government's responsibility as Krugman suggests, Progressives would do well to rethink their impulse to regulate behavior. Phrases such as "unregulated markets in health care" evoke the specter of either skyrocketing costs or substandard care. But ironically, that's the dilemma created by government regulation. Costs for simple preventive care are kept artificially high, so some don't get it. But unlike the inconvenience of a broken car, this can result in death. Coercion won't solve the problem.
To read the entire report, go to www.fee.org/publications/the-freeman/article.asp?aid=8303.
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Dr. Sam: I'm really getting fed up with the liberal politicians saying health care in this country is so bad that we have to have all kinds of programs to improve it.
Dr. Ruth: I think I provide top-notch care to my patients. As good as anybody I know.
Dr. Michelle: Sometimes I think if I had more time, I could improve somewhat. But then I read about the tragedies in socialized countries and I think we're doing very good.
Dr. Sam: We are not only doing very good, but super good. Does anybody go to Cuba or Columbia for severe disease or really major surgery on the heart or brain?
Dr. Edwards: I think the organizations that say care in Cuba or Columbia is better than the US do so because of their weird grading system. They give lots of points for National Health Insurance. They can't see how any other health care is worthwhile.
Dr. Rosen: I think Sam hit the nail. People don't go to those countries for good care. I remember a Mayo doctor told me they have two planeloads of patients that arrived from the Middle East every Monday. They return by the end of the week after a thorough evaluation and, frequently, diagnostic or therapeutic procedures. He said the initial doctor would have the history written down as he is taking it. He would then send the patient to various stations in the sequence determined by the computer. By Tuesday evening, the work up would come together, the finishing touches would be done on Wednesday or Thursday, and 90 percent of these foreigners who thought America had the best health care in the world would be able to return to their countries by Friday.
Dr. Milton: I think most of the large clinics can do the same, but they may not have the foreign reputation of Mayo.
Dr. Ruth: But Mayo has been at it longer because the current doctors' grandparents started it.
Dr. Edwards: I just hope they persist in doing this for another century. I was a graduate of Kansas University Medical Center and we had the world famous Menninger Clinic in Topeka, Kansas. It was the world's largest trainee of psychiatrists and because of financial problems was absorbed by Baylor Medical School. They lost a lot of their Kansas supporters with that move.
Dr. Rosen: It never makes sense to move downward and proceed on the path of less resistance. I never hear of Menninger from my psych colleagues any more. Do they even exist?
Dr. Edwards: The last time I did a Google search, there wasn't much going on. My name brought up more results than this formerly world famous clinic. How sad.
Dr. Milton: I think we all have to stand up for our profession, continue to do our best, let the politicians of doom and gloom say what they want. But I think most people can see through the populist demagoguery.
Dr. Ruth: Let's hope so. I think that's good advice on which to move forward.
Dr. Yancy: We should all strive to decrease our exposure to government programs, whether Medicare or Medicaid. We don't want to become slaves to a system that will dictate how we practice.
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BULLETIN, the Magazine of the San Mateo County Medical Association, Summer 2008
My Life and Times at Hoover By Philip R. Alper, M.D.
Internist and Endocrinologist, Burlingame, California; Clinical Professor of Medicine UCSF
Before my decade-long association with the Hoover Institution, I knew very little about the Stanford campus as a whole, let alone about the small cluster of buildings known worldwide as a conservative think-tank.
I applied to Hoover as an academic co-sponsor for a study of physicians' views on managed care locally. Our Medical Association had agreed to become the other participant in the town-gown joint effort I hoped to create. Personally, I had my doubts about the overall value of managed care in the form in which insurance carriers have presented it to us. My reservations were initially expressed in satire form in the New England Journal of Medicine (Alper, P.R., "Learning to Accentuate the Positive in Managed Care." NEJM 336 (1997): 508–09.) Now, I wanted data to either support or refute my hunch that most doctors believed that the implementation of managed care was seriously flawed and actually lowered the quality of care.
Things go slowly at Hoover, and by the time I was finally appointed as a Visiting Scholar some six months later, I had already accepted a similar position at the Stanford Medical School Bioethics Center. Naively, I asked my new Stanford partners in the project if they would agree to joint sponsorship of the study with Hoover. "Absolutely not!" I was told—the Hoover "taint" would decrease chances of acceptance in peer-reviewed medical journals… which apparently are not above being influenced by political considerations. This was quite an introduction into the realities of medical realpolitik.
Questionnaires were sent to more than one thousand members of the San Mateo County Medical Association. I was staggered by the complexity of designing and testing a proper questionnaire and the subsequent abstruse statistical manipulations that were necessary to make sense of the results. It would not have gotten done without the expertise provided by my Stanford colleagues, of whom two brilliant medical students did most of the detail work. Suffice it to say that nothing is as simple as it looks.
The results and analysis were published (Chehab, E.L., Panicker, N. and Alper, P.R.,et al., "The Impact of Practice Setting on Physician Perceptions of the Quality of Practice and Patient Care in the Managed Care Era." Arch Intern Med. 161 (2001): 202–11). Too few responses from community physicians limited what we could say with statistical significance about fragmentation and other quality of care issues. We did find, however, that in the five-year period studied, physician satisfaction decreased across the board, only somewhat less so among our Kaiser-Permanente colleagues.
That is when I got my second lesson in realpolitik. A Kaiser physician told me confidentially that the published results showing "greater satisfaction among Kaiser physicians" were used by management as a counter to requests for salary increases. It was more of the same when our study was misquoted in Alain Enthoven's "Toward a 21st Century Health System" to tout universal prepaid group-practice because that made doctors "happy" (rather than "less unhappy," as we had found).
I rearranged my practice schedule so I could make it down to Stanford one or two afternoons a week. As my connection with the Bioethics Center ramped down, my involvement at Hoover increased and eventually became a major influence in my life. Visiting Scholars are supposed to be appointed for a year or two unless they go on to become full-fledged Hoover Research Fellows. For a while, this looked like a possibility, and for two of my ten years, I was elected as the Robert Wesson Fellow in Scientific Philosophy and Public Policy and given a stipend. I also had an office in the Lou Henry Hoover Building.
It was very heady stuff. I began publishing in the Hoover Digest (www.hooverdigest.org) and Policy Review (www.policyreview.org). The articles are available online. I wrote on aspects of medicine, ranging from the Hippocratic Oath to the economics of primary care. Soon I started to audit courses in the Stanford business and engineering schools. Subjects that caught my attention were decision-support theory and practice, the psychology of consumer behavior, the interaction of new technology and social systems, and the economics underpinning drug development and other parts of the health system. To my pleasant surprise, I found that I had a lot to contribute to the class discussions. Much that I have learned in practice provided insights that were applicable in other fields. I was delighted at the positive response by both teachers and fellow-students. And, of course, I learned a lot.
Within the Hoover Institution, relations are very democratic. Everybody has access to everyone. For example, Pete Wilson explained at length to me why he chose not to run for governor again. Alvin Rabushka (one of the inventors and ardent proponents of the flat tax) became a frequent conversational companion. John Cogan and Daniel Kessler expressed views on the free market and medicine that showed up in the Wall Street Journal soon after we heard them over coffee. Economist John Taylor's thoughts on the Greenspan era (overall—but not total—approval) did the same.
These and many other conversations with brilliant people (let me not forget Victor Davis Hanson, eminent military historian and frequent editorialist on current world events and also international lawyer Abe Sofaer) have enriched my life immensely. I am grateful for my liberal arts education at Columbia that gave me a basis on which to build. But here too, what medicine has taught me turned out to be relevant in discussions far afield, e.g. the concept of homeostasis. Where overly rapid correction of the metabolic abnormalities in diabetic ketoacidosis can kill the patient, might not something similar be true with the economic dislocations caused by globalization? How fast may be just as important as how much when it comes to the ability to successfully adapt.
Sometimes the subject matter evokes thoughts about patients and practice. Joe Berger, the emeritus chair of the Stanford Sociology Department, has done pioneer research in how status considerations affect human social behavior. Katya Drozdova specializes in the interface between high tech and low tech. At the moment, this involves things like using hi-tech satellites to track terrorists while they employ very simple but effective low-tech methods like passing messages from hand to hand instead of using less safe but more efficient electronic communication. How catching terrorists can have anything to do with the place of primary care in an increasingly high-tech medical world may be hard to understand…until you talk about it. Both are examples of asymmetry and the need to deal with it.
I've met my share of Hoover's big names: George Schultz, Milton Friedman, Edward Teller, Gary Becker and others. They've all been friendly and accessible. It didn't take long to realize how long-lived and productive the Senior Fellows really are. Working into the 90s is not that unusual. I've told them that the real name of nearby Memorial Fountain is actually the Ponce de Leon Fountain—the Fountain of Youth—and that its mist must waft over the Hoover Institution, conferring longevity and productivity. The truth is more likely that the beautiful campus, stimulating company, economic security and freedom from teaching responsibilities come as close to heaven as any academician might wish. So why bother going elsewhere?
Hoover events—conferences, seminars and dinners—are among the best planned and executed that I've encountered anywhere. General John Abizaid happened to be the speaker one evening and on that occasion my wife got to chat with him afterwards. Learning she is French by birth, the General declared that he found the French to make very fine soldiers. Somewhat surprised, Bérénice asked, "Better than the Germans?" "Definitely!" Abizaid replied. It was a memorable moment. . .
My formal tenure as a Hoover Scholar has ended. Like the Man Who Came to Dinner, I stayed far longer than anticipated. But I intend to keep visiting as long as I'm welcome, and I still write for the Hoover Digest. ("Placebos in Medicine" will appear in the Spring 2008 issue; it should be online shortly.)
At the same time, I've confirmed to myself that the original choice I made many years ago was the correct one. Academia enriches my life and I love it, but practicing medicine is my true profession.
Read the entire report, at www.smcma.org/Bulletin/BulletinIssues/April08issue/April-2008-Bulletin.pdf.
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The Best-Laid Plans: How Government Planning Harms Your Quality of Life, Your Pocketbook, and Your Future by Randal O'Toole, Cato Institute • 2007 • 355 pages • $22.95
Reviewed by Gary M. Galles
In The Best-Laid Plans, policy analyst Randal O'Toole offers a well-documented case for why many government plans should be laid to rest. Its opening captures the central issue: "Somewhere in the United States today, government officials are writing a plan that will profoundly affect other people's lives, incomes, and property. . . . [T]he plan will go horribly wrong. The costs will be far higher than anticipated, the benefits will prove far smaller, and various unintended consequences will turn out to be worse than even the plan's critics predicted."
O'Toole locates planning's failures in the challenging gauntlet that stands between planning and success, and which "almost always leads to disaster because . . . the task is too big for anyone to understand and the planning process is too slow to keep up with the realities of modern life. . . . [M]ost of the professionals who call themselves planners are poorly trained to do the work they set out to do. Even if scientific planning were possible and the right people were doing it . . . politics inevitably distort the results into something totally irrational."
Further, he traces planning's problems to the "disparity . . . between how planners think people should live and how people really live." Consequently, "[b]y failing to ask the right questions, planners end up with a totally wrong-headed view of urban problems. . . . In too many cases, the plans become a source of oppression instead of a way for people to improve their lives and their regions.”
O'Toole relies heavily on two of F. A. Hayek's major themes. First, because central planning, unlike markets, cannot effectively use the valuable details of time and place that only some people know, its results will be inherently inefficient. Second, the problems caused by one government intervention lead to other interventions, resulting in an ever-growing encroachment on voluntary arrangements. These difficulties, plus those caused by the perverse incentives facing the political players involved, form the core of O'Toole's argument.
The author fills an important gap. Few people have thoroughly studied such a broad field as planning, largely because the number of different situations and the variety of interacting federal, state, and local programs are so overwhelming. Only someone who has devoted much of his life studying these areas could accumulate the knowledge for this book. We profit from O'Toole's investment.
The book must walk a fine line, however. He must get down to the details to see where the devil lurks—for example, because cities must repay federal funds on any abandoned rail project, even grotesquely inefficient projects are never admitted to be failures—without overwhelming the reader. The author does a good job in that regard, although the forest-planning section, which involves his greatest expertise, may be too complicated for many readers.
I found O'Toole's treatment of "smart growth" planning blunders particularly valuable. He offers useful discussions of how "smart growth" sharply increases housing prices, with regressive effects, and increases housing-price volatility; of planners' ill-considered assaults on cul-de-sacs; of how traffic-calming measures cost rather than save lives; of the bogus "we can't build our way out of congestion" attacks on freeway construction; of the misunderstanding behind pedestrian malls; of how urban renewal and mass transit were just special-interest politics, and much more.
O'Toole recognizes that so-called market failures are usually government failures, especially when the law makes it impossible for people to defend or sell their property. He also fleshes out why free markets can do nearly everything government planning does, but better and without resorting to coercion. . . . To read the entire review, go to www.fee.org/publications/the-freeman/article.asp?aid=8293.
Gary Galles is a professor of economics at Pepperdine University.
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Last week, I saw a patient who had 15 operations in 12 years. He had 6 carpal tunnel releases on his left hand and one ulnar nerve release on his left elbow, but none relieved his pain or returned his normal hand function. In fact, he no longer could use his left hand. It dangled by his side. He also had 4 operations on his right carpal tunnels, four arthroscopies on his left knee, two on his right, one on his left shoulder, and one on his back. He thought he needed a couple more on his knees because the procedures he had didn't help. Just one on his back? "Yes," he said, "I had a fight with that surgeon and I wouldn't let him operate again."
Sounds like he should have picked a fight with a few more surgeons, years earlier.
My attorney would charge me $300 and hour. But you have to do it free.
The daughter of a patient who had become very demented over the past two years called me to write a letter outlining her father's dementia. Her mother had a power of attorney, but his brokerage firm would not allow a substantial amount of money to be released on what they considered an inadequate Power-of-Attorney. I responded that it appeared they should get an attorney to write such a legal document. The daughter stated, "My mom is frugal. Her attorney would charge her $300 an hour for a couple of hours. And she knows you'll do it free. She says that you can't charge Medicare for this." I asked her, what if I charged you for this report? She said. "It's not covered by Medicare and, therefore, it would be illegal for you to charge us for a medical report."
Amazing how people with entitlements can finagle even more entitlements from our profession.
How to Obtain a Sperm Count
An 85-year-old man went to his doctor for a sperm count inasmuch as he'd been married for two years and no offspring in sight.
The doctor gave the man a jar and said, "Take this jar home and bring back a semen sample tomorrow."
The next day, the old man reappeared at the doctor's office and gave him the jar, which was as clean and empty as on the previous day.
The doctor asked what happened and the man explained, "Well, doc, it's like this - first I tried with my right hand, but nothing. Then I tried with my left hand, but still nothing."
"Then I asked my wife for help. She tried with her right hand, then with her left, still nothing. She tried with her mouth, first with the teeth in, then with her teeth out, still nothing."
"We even called up Arleen, the lady next door and she tried too, first with both hands, then an armpit, and she even tried squeezin' it between her knees, but still nothing."
The doctor was shocked! "You asked your neighbor?"
The old man replied, "Yep, and none of us could get that damn jar open."
And you thought this was going to be off color.
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• The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick wrote Lives at Risk issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at www.ncpa.org and register to receive one or more of these reports. This month, be sure to read that the uninsured are dropping. Further more, Devon Herrick reveals that 70 percent of the uninsured, could easily obtain coverage but have chosen to forgo insurance.
• Pacific Research Institute, (www.pacificresearch.org) Sally C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may signup to receive their newsletters via email by clicking on the email tab or directly access their health care blog. This month, be sure to read John Graham's on Nursing Home Evictions: Another Problem of Government Dependence.
• The Mercatus Center at George Mason University (www.mer.catus.org) is a strong advocate for accountability in government. Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, is now director of the Mercatus Center's Government Accountability Project. Join the Mercatus Center for Excellence in Government: This month, read Universal Service Reform: Start With Accountability.
• The National Association of Health Underwriters, www.NAHU.org. The NAHU's Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page. Be sure to scan their professional journal, Health Insurance Underwriters (HIU), for articles of importance in the Health Insurance MarketPlace. www.nahu.org/publications/hiu/index.htm. The HIU magazine, with Jim Hostetler as the executive editor, covers technology, legislation and product news - everything that affects how health insurance professionals do business. Be sure to review the current articles listed on their table of contents at hiu.nahu.org/paper.asp?paper=1. This month read Media Relations Tools: Find a Media Spokesperson. To see my recent column, go to http://hiu.nahu.org/article.asp?article=1660&paper=0&cat=137.
• The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging on at www.galen.org. This month, be sure to read some disturbing news: Of the 3.6 million who gained health insurance, nearly 3 million of them got coverage through a government program - taking America in the wrong direction. Unless we reverse this slide and modernize private insurance, more people will rely on their fellow taxpayers for coverage.
• Greg Scandlen, an expert in Health Savings Accounts (HSAs) has embarked on a new mission: Consumers for Health Care Choices (CHCC). Scroll down to read the initial series of his newsletter, Consumers Power Reports. There are two levels of membership to receive this newsletter by email and other benefits. Be sure to read this report: Health Affairs has published an important new study on Pay For Performance (P4P) that concludes it has had virtually no impact on physician practice. That is not to say physician practice isn't improving with time, but P4P programs have little to do with it…
• The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Richard M Ebeling, PhD, President, and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. This month, be sure to read Big Brother Is Watching as He's Never Watched Before.
• The Council for Affordable Health Insurance, www.cahi.org/index.asp, founded by Greg Scandlen in 1991, where he served as CEO for five years, is an association of insurance companies, actuarial firms, legislative consultants, physicians and insurance agents. Their mission is to develop and promote free-market solutions to America's health-care challenges by enabling a robust and competitive health insurance market that will achieve and maintain access to affordable, high-quality health care for all Americans. "The belief that more medical care means better medical care is deeply entrenched . . . Our study suggests that perhaps a third of medical spending is now devoted to services that don't appear to improve health or the quality of care–and may even make things worse." This being an election year, you must read OBAMA VS. MCCAIN Competing Health Care Visions.
• The Independence Institute, www.i2i.org, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter. Read her latest newsletter.
• Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at www.quebecoislibre.org/apmasse.htm to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis. This month, read this article: One problem with politicians is that when problems they create come to a head, they typically feel this irresistible urge to DO something, rather than to UN-do something, or to simply back off to avoid exacerbating the situation.
• The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at www.fraserinstitute.ca for an overview of the extensive research articles that are available. You may want to go directly to their health research section. The Institute is committed to "A free and prosperous world through choice, markets and responsibility."
• The Heritage Foundation, www.heritage.org/, founded in 1973, is a research and educational institute whose mission is to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. The Center for Health Policy Studies supports and does extensive research on health care policy that is readily available at their site. This month, be sure to read the truth: Certain recent proposals to ostensibly expand health care "choice" and "competition" [but] would have exactly the opposite effect…
• The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we've seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at www.mises.org to obtain the foundation's daily reports. This month, give yourself a treat and read a Farewell to Aleksandr Solzhenitsyn. You may also log on to Lew's premier free-market to read some of his lectures to medical groups. Learn how state medicine subsidizes illness or find out why anyone would want to be an MD today.
• CATO. The Cato Institute (www.cato.org) was founded in 1977 by Edward H. Crane, with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens' ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. This month, you may want to treat yourself to No Tax Increase Needed.
• The Ethan Allen Institute, www.ethanallen.org/index2.html, is one of some 41 similar but independent state organizations associated with the State Policy Network (SPN). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor.
• The Free State Project, with a goal of Liberty in Our Lifetime, http://freestateproject.org/, is an agreement among 20,000 pro-liberty activists to move to New Hampshire, where they will exert the fullest practical effort toward the creation of a society in which the maximum role of government is the protection of life, liberty, and property. The success of the Project would likely entail reductions in taxation and regulation, reforms at all levels of government to expand individual rights and free markets, and a restoration of constitutional federalism, demonstrating the benefits of liberty to the rest of the nation and the world. [It is indeed a tragedy that the burden of government in the U.S., a freedom society for its first 150 years, is so great that people want to escape to a state solely for the purpose of reducing that oppression. We hope this gives each of us an impetus to restore freedom from government intrusion in our own state.] To see if you'd like to move to New Hampshire, go to the New Hampshire Information Center and check out the info.
• The St. Croix Review, a bimonthly journal of ideas, recognizes that the world is very dangerous. Conservatives are staunch defenders of the homeland. But as Russell Kirk believed, war time allows the federal government grow at a frightful pace. We expect government to win the wars we engage, and we expect that our borders be guarded. But St Croix feels the impulses of the Administration and Congress are often misguided. The politicians of both parties in Washington overreach so that we see with disgust the explosion of earmarks and perpetually increasing spending on programs that have nothing to do with winning the war. There is too much power given to Washington. Even in war time we have to push for limited government - while giving the government the necessary tools to win the war. To read a variety of articles in this arena, please go to www.stcroixreview.com. This month, read excellent OpEds on the convention and the candidates by subscribing to "the most incisive, honest and informative little journal west of the Hudson."
• Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of "educating for liberty." It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. While schools throughout the nation are bowing to an unconstitutional federal mandate that schools must adopt a Constitution Day curriculum each September 17th or lose federal funds, Hillsdale students take a semester-long course on the Constitution restoring civics education and developing a civics textbook, a Constitution Reader. You may log on at www.hillsdale.edu to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. Congratulations to Hillsdale for its national rankings in the USNews College rankings. Changes in the Carnegie classifications, along with Hillsdale's continuing rise to national prominence, prompted the Foundation to move the College from the regional to the national liberal arts college classification. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, read Edward Erler on dual citizenship - dual allegiance. . . This is a sign of the decline of American citizenship and of America as a nation-state. The last ten years of Imprimis are archived.
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Del Meyer, MD, Editor & Founder
6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608
Words of Wisdom
"It is not what we get. But who we become, what we contribute ... that gives meaning to our lives." -Anthony Robbins: Authority on leadership psychology
Winners understand that life is a self-fulfilling prophecy. And they know that you usually get what you expect in the long run. So winners accept the belief that hope and a deep, unbreakable faith - forged into a fundamental attitude of positive self-expectancy - is the eternal spring from which all creative, motivating energy flows. -Denis Waitley
Whoever wishes peace among peoples must fight statism.. -Ludwig Heinrich Edler von Mises
Some Recent Postings
HEALTH CARE CO-OPS IN UGANDA - Effectively Launching Micro Health Groups in African Villages, by George C. Halvorson www.delmeyer.net/bkrev_HealthCareCo-OPInUganda.htm
A CALL TO ACTION - Taking Back Healthcare for Future Generations by Hank McKinnell www.delmeyer.net/bkrev_ACallToAction.htm
PUTTING OUR HOUSE IN ORDER - A Guide to Social Security & Health Care Reform by George P. Shultz and John B Shoven www.delmeyer.net/bkrev_PuttingOurHouseInOrder.htm
Beth Breuner Grebitus, member of prominent retailing families, dies July 30, 2008
Beth Breuner Grebitus, a member of prominent Sacramento retailing families and a longtime civic volunteer who was instrumental in the founding of Fairytale Town and the Children's Receiving Home, has died. She was 78. She died July 30, 2008 from complications of Alzheimer's disease, said her daughter, Kate.
Mrs. Grebitus, a Sacramento native, grew up working in her family's company, Breuner's Home Furnishing, founded by her great-grandfather in 1856. Her father was president of the Northern California furniture chain, which was sold in the 1970s and went out of business in 2004.
She married Ed A. Grebitus Jr. and made her own name in business running the gift and tabletop division at Grebitus & Sons Jewelers. She designed elegant table arrangements for customers, decorated homes for fund-raising tours and created popular Christmas wreaths with pinecones she handpicked from California trees.
As a store buyer and personal shopper, she had an eye for fine china, crystal and silverware. She experimented with colors and nontraditional elements in table settings and encouraged customers to mix and match items to stimulate conversation.
"She was Martha Stewart before Martha Stewart," Kate Grebitus said.
She championed the welfare of young people as president of the original board of the Children's Receiving Home of Sacramento. Mrs. Grebitus actively supported community programs for children as a longtime member and past president of the Junior League of Sacramento. She shepherded the league's effort to build a fantasy playground based on nursery rhymes and signed incorporation papers for Fairytale Town, which opened in William Land Park in 1959.
She was a champion swimmer at Del Paso Country Club and an active student at Sacramento High School. She married in 1950 and left her studies at the University of California, Berkeley, to rear a close-knit family of six children.
She patronized the arts as a board member of the Crocker Art Museum and the Sacramento Symphony League. She was active in the North Lake Tahoe Historical Society and enjoyed vacations and family gatherings at a house her father and brother built in the west shore community of Homewood.
Elizabeth Breuner was born July 21, 1930 to Clarence and Florence Bills Breuner. She graduated from Sacramento High School, attended UC Berkeley and married in 1950.
Mrs. Grebitus was a warm and gracious woman, her children and friends said. She supported local artists and collected California Impressionist paintings. She grew award-winning camellias for 40 years at her Sierra Oaks home.
She enjoyed hiking, skiing and sailing with friends in social circles from Sacramento to Lake Tahoe. She was an accomplished musician who played a grand piano and led sing-alongs with her husband and children at holiday gatherings.
"Beth had beautiful eyes and a beautiful smile, but she was never one to put on airs," longtime friend Shirley Plant said. "There was no artifice about her. She was a person of great integrity."
She is survived by her husband, Ed, of Carmichael; sons, Bill, of Incline Village, Nev., and Ted, Tom and Bo, all of Sacramento; daughters, Kate Grebitus of Sacramento, and Amy Goodheart of Lafayette; and 10 grandchildren.
Services were at 3 p.m. Aug. 17 at Trinity Cathedral Church, 2620 Capitol Ave., Sacramento. In lieu of flowers, donations may be made to the Children's Receiving Home of Sacramento, the Crocker Art Museum or Fairytale Town.
By Robert D. Davila | email@example.com. Call The Bee's Robert D. Davila, (916) 321-1077. Bee editorial researcher Jackie Betz contributed to this report, as did the editor of MedicalTuesday. www.sacbee.com/300/story/1135682.html
Beth Grebitus brough two dynasties together in Sacramento. Her father's died. Beth's continues.
On This Date in History - August 12
On this date in 1881, Cecil B. DeMille was born in Ashfield, Massachusetts. He made the first feature movie ever filmed in Hollywood. He produced such lavish Hollywood spectacles, many of them built around the Bible, that one captious critic remarked that when the Golden Age predicted in scripture came to pass, it would have to be known as De Millenium.
On this date in 1961, Communist East Germany created a literally captive audience. Overnight, they put up a wall sealing off East Berlin from West Berlin. Since very few people were trying to get into Communist East Berlin, the purpose was obviously to keep East Germans from getting out. The wall was not a temporary thing; over the course of years, it was reinforced and - if I may use such a word in this connotation - improved. And of course, it continually raised the question in the West of how long a wall of brick and mortar can stand against the abstract idea of freedom. Freedom, it has been said, jumps over walls. But sometimes one jumps through a window for freedom.
On this date in 1948, Mrs. Kasenkina jumped for freedom. More precisely, a freedom-lover, Mrs Olga Kasenkina, leaped through a window of the Soviet consulate in New York to escape being sent home. She was a schoolteacher, assigned to teach the children of the Russian Diplomats in New York. She was ordered home and was about to be sent back when she broke away and jumped through a consulate window to sanctuary on a free street. For a closed society, a window on the world can be a difficult thing. For an open society, there has to be windows, if only to keep us in touch with our freedom, so nobly won, that now may be threatened.
After Leonard and Thelma Spinrad
MOVIE EXPLAINING SOCIALIZED MEDICINE TO COUNTER MICHAEL MOORE's SiCKO
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
For more information visit www.sickandsickermovie.com or email firstname.lastname@example.org.