MEDICAL TUESDAY . NET
Community For Better Health Care
Vol VIII, No 10, Aug 25, 2009
In This Issue:
1. Featured Article: The End of Medical Miracles
2. In the News: Tasting the Light: Device Lets the Blind "See" with Their Tongues
3. International Medicine: Shooting for Targets in Healthcare can be Deadly
4. Medicare: Can Health Reform Save Money?
5. Medical Gluttony: Motorized Wheelchairs? And then it happened . . .
6. Medical Myths: Infant mortality is lower in countries with “universal medical care.”
7. Overheard in the CMA (Certified Medical Assistant) Meeting: Are offices getting hostile?
8. Voices of Medicine: Obama's Health Plan Will Succeed . . .
9. The Bookshelf: Code Blue: Reviving Canada's Health Care System
10. Hippocrates & His Kin: Human Rights In Health Care
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
For more information visit www.sickandsickermovie.com or email email@example.com.
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Americans have, at best, a love-hate relationship with the life-sciences industry—the term for the sector of the economy that produces pharmaceuticals, biologics (like vaccines), and medical devices. These days, the mere mention of a pharmaceutical manufacturer seems to elicit gut-level hostility. Journalists, operating from a bias against industry that goes as far back as the work of Upton Sinclair in the early years of the 20th century, treat companies from AstraZeneca to Wyeth as rapacious factories billowing forth nothing but profit. At the same time, Americans are adamant about the need for access to the newest cures and therapies and expect new cures and therapies to emerge for their every ailment—all of which result from work done primarily by these very same companies whose profits make possible the research that allows for such breakthroughs.
Liberals and conservatives appear to agree on the need to unleash the possibilities in medical discovery for the benefit of all. But it cannot be ordered up at will. It takes approximately ten years and $1 billion to get a new product approved for use in the United States. Furthermore, only one in every 10,000 newly discovered molecules will lead to a medication that will be viewed favorably by the Food and Drug Administration (FDA). Only three out of every ten new medications earn back their research-and-development costs. The approval success rates are low, and may even be getting lower—30.2 percent for biotech drugs and 21.5 percent for small-molecule pharmaceuticals.
It is the very nature of scientific discovery that makes this process so cumbersome. New developments do not appear as straight-line extrapolations. A dollar in research does not lead inexorably to a return of $1.50. Researchers will spend years in a specific area to no avail, while other areas will benefit from a happy concatenation of discoveries in a short period. It is impossible to tell which area will be fruitless; so many factors figure into the equation, including dumb luck. Alexander Fleming did not mean to leave his lab in such disarray that he would discover that an extract from moldy bread killed bacteria, yet that is how it happened. Conversely, if effort and resources were all it took, then we would have an HIV/AIDS vaccine by now; as it stands, the solution to that problem continues to elude the grasp of some of the most talented and heavily funded researchers.
Scientific discoveries are neither inevitable nor predictable. What is more, they are affected, especially in our time, by forces outside the laboratory—in particular, the actions of politicians and government bureaucracies. The past quarter-century has offered several meaningful object lessons in this regard. For example, in the 1980s, the Reagan administration undertook a number of actions, both general and specific, that had a positive effect on the pace of discovery. On the general front, low taxes and a preference for free trade helped generate a positive economic climate for private investment, including in the rapidly growing health-care sector. More specifically, the Reagan administration engaged in new technology transfer policies to promote joint ventures, encouraged and passed the Orphan Drug Act to encourage work on products with relatively small markets, and accelerated approval and use of certain data from clinical trials in order to hasten the approval of new products. All of these initiatives helped foster discovery.
That which the government gives, it can also take away. . .
A leading critic of Big Pharma, Greg Critser, wrote in his 2007 Generation Rx that President Clinton picked up on a public discomfort with drug prices and “began hinting at price controls” during his first term in office. These hints had a real impact. As former FDA official Scott Gottlieb has written, “Shortly after President Bill Clinton unveiled his proposal for nationalizing the health-insurance market in the 1990s (with similar limits on access to medical care as in the [current] Obama plan), biotech venture capital fell by more than a third in a single year, and the value of biotech stocks fell 40 percent. It took three years for the ‘Biocentury’ stock index to recover. Not surprisingly, many companies went out of business.”
The conduct of the businesses that had been responsible for almost every medical innovation from which Americans and the world had benefited for decades became intensely controversial in the 1990s. An odd inversion came into play. Since the work they did was life-saving or life-enhancing, it was not deemed by a certain liberal mindset to be of special value, worth the expense. Rather, medical treatment came to be considered a human right to which universal access was required without regard to cost. Because people needed these goods so much, it was unscrupulous or greedy to involve the profit principle in them. What mattered most was equity. Consumers of health care should not have to be subject to market forces.
And not only that. Since pharmaceuticals and biologics are powerful things that can do great harm if they are misused or misapplied, the companies that made them found themselves under assault for injuries they might have caused. It was little considered that the drugs had been approved for use by a federal agency that imposed the world’s most rigorous standards, and was often criticized for holding up promising treatments (especially for AIDS). Juries were convinced that companies had behaved with reckless disregard for the health of consumers, and hit them with enormous punitive damages claims. . .
. . . An oft-cited 1999 study by the National Institute for Health Care Management (NIHCM) claimed that the newest and costliest products were only offering “modest improvements on earlier therapies at considerably greater expense.”
The NIHCM study opened fresh lines of attack. The first came from the managed-care industry, which used it as a means of arguing that drugs had simply grown too expensive. Managed care is extremely price-sensitive, and its business model is built on cutting costs; executives of the industry were well represented on the board of the institute that put out the report. They were, in effect, fighting with the pharmaceutical companies over who should get more of the consumer’s health-care dollars.
The second came in response to the approval by the FDA in 1997 of direct consumer advertising of pharmaceuticals. The marketing explosion that followed it gave people the sense that these companies were not doing life-saving work but were rather engaged in the sale of relative trivialities, like Viagra and Rogaine, on which they had advertising dollars to burn that would be better spent on lowering the cost of drugs. And the third element of this mix was the rise of the Internet, which gave Americans a level of price transparency that they had not had before regarding cost differentials between drugs sold in the U.S. versus Canada and other Western countries. . .
A cultural shift had taken place. Pharmaceutical manufacturers, once the leading lights of American industry, had become a collective national villain.
The life sciences are among the most regulated areas of our economy, and are constantly subjected to significant policy upheaval from Washington. Because these products are so expensive to develop, the regulatory and policy whims of Washington tend to have a disproportionate impact on investment in the industry. Without investment, there is no research, and without research, there are no products. According to Ken Kaitin of the Center for the Study of Drug Development at Tufts, new drug approvals from the Food and Drug Administration are not keeping pace with rising research-and-development spending, which means that recent spending has not been leading to results. This raises the question of how long such investments will be sustainable if they do not provide sufficient return for investors.
FDA approval is not the only hurdle for products making their way to market. Manufacturers and investors need to deal with the Department of Health and Human Services at four levels in order to get a product to market and reimbursed. Basic research begins at the National Institutes of Health (NIH), a $30-billion agency that often partners with the private sector on promising new areas of research and that has just received a $10-billion boost from the stimulus package. The FDA then handles approvals of products. Once a product has been approved, someone must pay for it in order for the product to be used. The Centers for Medicare & Medicaid Services (CMS) determines which products will be paid for by Medicare. Because CMS is the largest single payer in the health-care system, its decisions often help to determine which products will eventually be covered by private insurance companies as well. Finally, the Agency for Healthcare Research and Quality is in the process of increasing its role in conducting post-market product evaluations. These bureaucratic and evaluative hurdles have injected far too much uncertainty into the process and have dried up investment capital for the industry as a whole. . .
At the same time, as Sally Pipes of the Pacific Research Institute has shown, the American system also lets its consumers obtain many products far more cheaply than consumers in other nations. This is because our competitive system allows for low-cost generic drugs that drive down prices. Brand-name products are more expensive here, but generics, which are available after patent protections expire, are cheaper and more widely available in the United States than elsewhere.
Another factor that reduces the availability of research-and-development investment is the growth of lawsuits. According to a Pacific Research Institute study, “American companies suffer over $367 billion per year in lost product sales because spending on litigation curtails investment in research and development.” A recent analysis by the Washington Post found that “courts have been flooded with product liability lawsuits in recent years, and statistics show about a third are against drug companies.”
. . . Most famously, perhaps, Dow Corning was forced to declare bankruptcy after being flooded with over 20,000 lawsuits and 400,000 claimants over its silicon breast implants, despite the fact that the evidence has finally demonstrated definitively that they are not harmful.
The results are unmistakable. Dow Corning was forced to remain in bankruptcy for nine years. . .
The situation as it stands now is bad enough. But it would be made worse by the proposed elimination of an FDA policy called preemption, which holds that when federal laws come into conflict with state or local laws on drug matters, federal laws prevail. This is particularly important for the FDA, which sets federal safety standards. Preemption makes the FDA standards supreme as long as the manufacturers adhere to FDA guidelines. This policy prohibits trial lawyers from suing manufacturers in circumstances where the manufacturer adhered to the federal guidelines but where state law differs. A recent Supreme Court case, Wyeth v. Levine, opened up this issue by ruling that the FDA’s approval of a medication does not protect the drug’s maker from state-level lawsuits, thereby limiting preemption’s scope. . .
Then there is the looming shadow of health reform. One of the great requirements of a systemic overhaul is controlling costs, which were $2.5 trillion last year and growing at a rate triple that of inflation. It is clear that Congress and the administration will have to cut costs in order to come close to paying for an ambitious plan. How they do so could have a devastating impact on medical innovation.
Attempts to universalize our system and pay for it with cost controls that could stifle innovation contradict their own goal, which is, presumably, better health. It also embraces the notion that you can get something for nothing—namely, that you can get innovative new discoveries and better health outcomes somehow without paying for these discoveries to come into being.
We forget the power of the single-celled organism. For most of man’s existence on earth, the power of a single-celled animal to snuff out life was an accepted—and tragic—way of the world. Human beings could be wiped out in vast communicable plagues or simple through ingesting food or water. In the last century, the advent of the antibiotic has changed all that. For millennia, the only cure for an infection in humans was hope. Today, antibiotic use is so common that public health officials struggle to get people not to overuse antibiotics and thereby diminish their effectiveness.
Just as there is potential danger from the way in which Americans take the power of the antibiotic for granted, so, too, one of the greatest threats to our health and continued welfare is that Americans in the present day, and particularly their leaders, are taking for granted the power, potency, and progress flowing from life-saving medical innovations. And in so doing, they may unknowingly prevent the kind of advance that could contribute as vitally to the welfare of the 21st century as the discovery altered the course of human history for the better in the century just concluded.
Read the entire treatise . . .
About the Author: Tevi Troy, deputy secretary of the United States Department of Health and Human Services from 2007 to 2009, is a visiting senior fellow at the Hudson Institute.
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Tasting the Light: Device Lets the Blind "See" with Their Tongues By Mandy Kendrick,
Neuroscientist Paul Bach-y-Rita
hypothesized in the 1960s that "we see with our brains not our eyes."
Now, a new device trades on that thinking and aims to partially restore the
experience of vision for the blind and visually impaired by relying on the
nerves on the tongue's surface to send light signals to the brain.
Legal blindness is defined by U.S. law as vision that is 20/200 or worse, or has a field of view that is less than 20 degrees in diameter. The condition afflicts more than one million Americans over the age of 40, according to the National Institutes of Health. Adult vision loss costs the country about $51.4 billion per year. . .
From the CPU, the signals are sent to the tongue via a "lollipop," an electrode array about nine square centimeters that sits directly on the tongue. Each electrode corresponds to a set of pixels. White pixels yield a strong electrical pulse, whereas black pixels translate into no signal. Densely packed nerves at the tongue surface receive the incoming electrical signals, which feel a little like Pop Rocks or champagne bubbles to the user. . .
Like learning to ride a bike
In any case, within 15 minutes of using the device, blind people can begin interpreting spatial information via the BrainPort, says William Seiple, research director at the nonprofit vision healthcare and research organization Lighthouse International. The electrodes spatially correlate with the pixels so that if the camera detects light fixtures in the middle of a dark hallway, electrical stimulations will occur along the center of the tongue.
"It becomes a task of learning, no different than learning to ride a bike," Arnoldussen says, adding that the "process is similar to how a baby learns to see. Things may be strange at first, but over time they become familiar."
Seiple works with four patients who train with the BrainPort once a week and notes that his patients have learned how to quickly find doorways and elevator buttons, read letters and numbers, and pick out cups and forks at the dinner table without having to fumble around. "At first, I was amazed at what the device could do," he said. "One guy started to cry when he saw his first letter."
Wicab will submit BrainPort to the U.S. Food and Drug Administration for approval at the end of the month, says Robert Beckman, president and chief executive officer of the company. He notes that the device could be approved for market by the end of 2009 at a cost of about $10,000 per machine. . .
2 b. In The News Continued: Gene Therapy for Blindness Scientific American, Sept 2009 Issue
Gene Therapy Treatment for Blindness Proves Safe--and
Effective--One Year In
By Katherine Harmon
therapy has been rhapsodized and vilified in its nearly two decades of
human testing, helping some and making others sicker. But a new 12-month
clinical trial has shown that, at least in one ocular disease, it appears safe
and—perhaps even more impressive—effective.
The research, part of a phase I clinical trial to test the safety of the treatment, was published as a letter to the editor in The New England Journal of Medicine earlier this week and will be in the September issue of Human Gene Therapy. (The paper was co-authored by about a dozen researchers, two of whom own equity in a company that could profit from a commercialized version of this procedure.)
The researchers report that three young adults with severe vision impairment from a hereditary disease maintained improved eyesight a year after gene therapy was administered—and didn't suffer any health side effects in the meantime. Gene therapy, which often employs viruses to deliver the good genes to a body's target cells, has been known to trigger severe immune responses and was blamed for the death of an 18-year-old in 1999, who was receiving gene therapy for a hereditary metabolic disorder.
The test subjects suffer from Leber congenital amaurosis (LCA), a form of hereditary retinal degeneration that occurs in infants and young children and is relatively rare. Most people who have lost vision due to hereditary retinal degeneration have either no photoreceptors with which to perceive light or photoreceptors that don't work. "This disease has a little bit of both," explains lead study author Artur Cideciyan, an associate research professor at the Scheie Eye Institute at the University of Pennsylvania. "It's a complex disease."
The participants, ages 22 to 25, all had a mutation on the RPE65 gene, the signature of LCA. Doctors administered normal RPE65 (delivered via an rAAV2 vector) into a site on one of the retinas that had the most photoreceptors left. And, Cideciyan says, "Within weeks of the procedure there was a substantial, very significant improvement in sensitivity to see dim lights. . .
Read the entire article at www.scientificamerican.com/article.cfm?id=ocular-gene-therapy-treatment
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NHS managers were . . . accused of putting targets and cost-cutting ahead of patients as a report into at Mid-Staffordshire Hospitals trust found up to 1,200 people may have died needlessly due to “appalling standards of care” at a single hospital by Rebecca Smith, Medical Editor, 18 Mar 2009
A litany of failings at the trust was uncovered by the Healthcare Commission in one of the most critical reports of NHS treatment ever published.
. . . patient groups voiced concern that managers who should have spotted failings at the trust but did not raise the alarm have been promoted to key jobs in the NHS and health care regulation.
The investigation into care between 2005 and 2008 found overstretched and poorly trained nurses who turned off equipment because they did not know how to work it, newly qualified doctors left to care for patients recovering from surgery at night, patients left for hours in soiled bedclothes and reception staff expected to judge the seriousness of the condition of patients arriving at Accident and Emergency.
Doctors were diverted from seriously ill patients to treat ones with minor problems to make the trust look better because it was in danger of breaching the Government’s four-hour waiting time target.
The trust – which was under pressure to save £10 million from its annual budget – was more concerned with hitting targets, gaining foundation trust status and PR marketing and had “lost sight” of its responsibilities for patient care, the report said. . .
It is not clear how many patients died as a direct result of the failures, but the commission found that mortality rates in emergency care were between 27 per cent and 45 per cent higher than would be expected, equating to between 400 and 1,200 “excess” deaths. . .
The trust is spread across two hospital sites, one in Stafford and one in Cannock. Most of the problems occurred at Stafford. Patients described one ward as a “war zone” and said people were often left in Stafford’s A&E for hours covered in blood and without pain relief, even though they had serious injuries. Others were left without food or drink, leading some to reportedly drink from vases when thirsty.
Some patients also received the wrong medication – or none at all.
Martin Yeates, the trust chief executive, and Toni Brisby, its chairman, stepped down two weeks ago. Mr Yeates, who is paid a salary of £160,000 a year, is suspended on full pay while an independent investigation is carried out.
But patient groups were angered that Cynthia Bower who, from July 2006, was chief executive of the West Midlands Strategic Health Authority — which had responsibility for checking standards at the hospital — is to become the head of the health super-regulator, the Care Quality Commission.
David Nicholson, her predecessor at the authority’s forerunner, the Shropshire and Staffordshire SHA, left in 2006 and is now the chief executive of the NHS. Sir Ian Kennedy, the chairman of the Healthcare Commission, said the report was a “shocking story” and that there were failures at almost every stage of care of emergency patients.
“There is no doubt that patients will have suffered and some of them will have died as a result,” he said. “Trusts must always put the safety of patients first. Targets or an application for foundation trust status do not lessen a board’s responsibility to its patients’ safety.”
The problems emerged after the hospital was reported in 2007 to have high mortality rates among patients. But the trust’s board of directors “fobbed off” NHS investigators by saying the rates were a result of statistical errors.
. . . the Healthcare Commission concluded this was not the case.
Its report stated that staff members claimed care of patients had become secondary to government-imposed targets. The report said there was a “reluctance to acknowledge or even consider that the care of patients was poor”.
Nurses were threatened with the sack because of the number of breaches of the target to treat A&E patients within four hours and felt they were “in the firing line”.
Patients in danger of breaching the target were put in a “clinical decision unit”, a “dumping ground” for patients in order to “stop the clock” on the waiting time.
Relatives reported nurses shouting at patients and a survey found two thirds of doctors would not be happy to have a family member treated at the hospital.
Eric Morton, the new chief executive of the Mid Staffordshire NHS Foundation Trust, said: “We would like to offer our very sincere apology. We would like to reassure the local community that our focus is, and will remain, on providing high quality, efficient and safe healthcare.”
The NHS does not give timely access to healthcare, it only gives access to targets.
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Health care spending per person varies widely across the country, but greater spending does not appear to produce better quality. A natural inference is that some areas of the country are less efficient in the use of health care resources.
Thus, it is argued that health spending could be cut substantially if the high-spending areas practiced medicine in the same way as the low-spending areas. Office of Management and Budget Director Peter Orszag, for example, argues that health care spending for the country as a whole could be reduced by $700 billion a year. But how can these savings be realized?
Medicare Spending Variation. A number of studies have found that Medicare spending varies substantially from one state, county or hospital region to another. For example:
· In 2004, average Medicare spending in Louisiana (the highest spending state) was $8,659 while spending in South Dakota (the lowest spending state) was $5,640, almost 35 percent less.
· Taken as a group, Louisiana, Maryland, New Jersey, Florida and Texas averaged more than $8,200 in 2004, or about $800 above the national average for Medicare spending.
· By contrast, South Dakota, Montana, New Mexico, Hawaii and Idaho all spent less than $5,800 - about 40 percent less than the states at the top of the distribution.
· Overall, if every state were as "efficient" as the fifth lowest spending state, Medicare spending could be reduced by about 25 percent.
These numbers appear to confirm Orszag's claim without answering the question of how we could dramatically change the practice of medicine in 45 states. However, before concluding that there are large potential savings, there are two important factors that need to be considered.
Spending on Other Patient Groups by State. News stories often imply that doctors in high-spending Medicare states are practicing medicine in a way different from doctors in low-spending states. One is left to infer that this must also be true for Medicaid patients and private patients as well. But this inference is not entirely true.
For example, although Louisiana is the highest spending Medicare state and South Dakota is the lowest, average per capita health care spending for the whole population is actually lower in Louisiana ($5,040) than it is in South Dakota ($5,327). This is not an isolated case:
· Although Texas is fifth highest in Medicare spending per capita, it is 43rd in per capita spending for the state's entire population.
· California is 11th in Medicare spending, but 42nd overall.
· North Dakota is 43rd for Medicare, but 11th overall.
It appears that high Medicare spending is often associated with lower spending on the non-Medicare/Medicaid population and vice-versa. This observation is consistent with cost shifting between public and private payers, although there may be other explanations as well.
Read the entire article at www.ncpa.org/pub/ba668.
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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When returning to my office on Fair Oaks Blvd last week, the traffic came to a halt. Ahead at the corner of FOB and Stanley, there had been an accident. Two motorized wheelchairs had collided in the intersection. As I started to get out of the car expecting to help two disabled persons, I noted that both were already up and laughing as they helped each other upright their MWC. They then proceeded to shake hands as they climbed aboard and took off again. The traffic resumed and I arrived at my office on time for my afternoon patients.
Requests for motorized wheelchairs are becoming almost a daily occurrence. The requests are seldom based on substantiation of disability, but rather that their neighbor or friend or someone else at the senior residence has one and they don’t seem to be as ill as my patient, or that it would be nice to tour the neighborhood in one.
I have a number of patients who live within a mile or two of my office that drive their wheelchairs to my office building and up the ramp. They park their motorized wheelchair in the hallway and stride into my office. Some use a cane. The patient last week said he would stop by the grocery store on his way home to buy his groceries for the week. Does he still own a car? He said he did but would probably convert that to cash since he now had an alternate form of transportation, with thanks to Medicare. He felt he was deserving since he paid for it with his Medicare premiums over the year.
Today, I had two requests for motorized wheelchairs from a 98-year-old woman and her 76-year-old daughter on a visit I made to their homes, which were in the same block. Both were rather weak. The younger one was suffering from fibromyalgia and could sit for no more than 30 minutes. How could she sit in a wheelchair and travel up the street to see her mother? She was too weak to even squeeze my hand. How could she manage the arm and lever to drive the wheelchair? What would she do if she overturned on the hilly area where she lived? I felt it was far too hazardous for her to have a motorized vehicle and that her grandson and great-grandson that lived with her should continue to help her about.
The older one was obviously too weak to even consider one and, furthermore, she was essentially blind. She put her hand to my face to help locate where I was at her bedside. I didn’t write a prescription for either.
When people get entitlements, they always feel they are entitled to even more. There is no limit.
With the proposed healthcare reforms, our medical costs will at least double until they are contained by denial of service and a waiting list, which worsen access to healthcare.
To keep up with health care reform, be sure to subscribe to HealthPlanUSA.net by entering your email address at www.healthplanusa.net/newsletter.asp.
Medical Gluttony thrives in Government and Health Insurance Programs.
Gluttony Disappears with Appropriate Deductibles and Co-payments on Every Service.
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July 3rd, 2009
A number of countries report lower infant mortality than the U.S., but it has nothing to do with the source of payment for medical care.
In Japan, which has the best statistics (3.3 die per 1,000 live births), the national system does not cover normal childbirth—or prenatal, postnatal, and postpartum care (Your Health Matters by Gregory Dattilo and David Racer, Alethos Press, 2006).
In the U.S., mortality is only 3.0 per 1,000 for full-term babies weighing at least 5.5 lbs (ibid.). Premature, low-birth-weight babies, who have a much higher risk of early death, have a better chance of survival in the U.S. than anywhere else, because of the excellent medical care they receive here.
The incidence of prematurity and low birth weight is relatively high in the U.S.; one reason is ethnic composition. Black American mothers give birth before 37 weeks twice as often as whites, and 3.8 times as often before 28 weeks (Future of Children, Spring 1995).
Predictors of premature birth include socioeconomic factors such as age under 20, single marital status, being on welfare, and not having graduated high school (Lieberman E, et al. N Engl J Med 1987;317:743-748); chronic health problems such as diabetes, hypertension, or clotting disorders; certain infections during pregnancy; use of cigarettes, alcohol, or illicit drugs (CDC); and prior abortions (Rooney B, Calhoun BC, J Am Phys Surg 2003;8:46-49). Increasing Medicaid coverage for pregnant women had no effect on birth outcomes (Ray WA, et al. JAMA 1998;279:314-316).
Many nations do not count very small babies as live births. Hence, they don’t count as deaths either. In France and Belgium, for example, babies born before 26 weeks are automatically considered stillborn, states Bernardine Healy.
In the U.S., all our babies count, even if they make our statistics look worse. The tiny ones we now save could be the first casualties of “reform.”
“[A question] that assumes even greater significance as we contemplate the finances of health care reform [is] how much capital are we willing to invest to save the lives of the most extremely preterm infants?” (Future of Children, op. cit.)
Additional information and references at www.aapsonline.org/newsoftheday/00307.
Medical Myths Originate When Statistics are Manipulated for Political Reasons.
Medical Myths Disappear With Honesty in Calling a Breathing Baby a Live Baby.
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Mabel: Have you noticed how impatient offices are getting with each other?
Ann: It seems like most of the consultant’s offices are rather short.
Nancy: Well, I have an angry doctor who’s upset because the referral and records aren’t here and the patient is here.
Ann: Don’t you check your fax inbox before you get angry with the referring physician who needs your doctor’s opinion? I’m sure your doctor is grateful for having his expert opinion sought.
Nancy: We get so many faxes every day. I don’t have time to go through all of them.
Mabel: Well, Good Grief. Is that any excuse to make a hostile phone call to the physician who is referring the patient whose fees pay your salary?
Ann: Don’t you think you should at least look through the fax “holding pen” or whatever you might call it before you cause further work for the referring physician’s office?
Jane: It shouldn’t be too much trouble to have them fax it again, should it?
Ann: When we fax the referral, we dismantle our chart to make sure the last complete exam is faxed along with recent and relevant x-rays and lab reports. We also include face sheets and insurance information so your doctor and office is efficient with time and can write a good report.
Jane: My doctor just dictates his consultation with the available information and then adds that additional reports will be sent when the information is complete.
Mabel: If your doctor has to give an additional report, because of your inefficiency, doesn’t that cause inefficiency through the whole chain?
Nancy: I don’t understand. Through the whole chain?
Mabel: If your doctor has to see the patient a second time to give a report, it no longer is timely.
Ann: Meanwhile, the referring office has to send the entire record again; the patient is inconvenienced and has to wait to benefit from the second opinion. Doesn’t that essentially double all costs?
Nancy: How so?
Mabel: If your doctor has to pay you twice to do the work that should have been done correctly the first time, doesn’t that double his cost of paying you?
Nancy: How does that affect my salary?
Mabel: If everything you do is doubled or takes twice as long, then you’re getting paid twice what you’re worth or what a more efficient CMA would cost.
Nancy: Just let my doctor try to cut my salary in half.
Ann: As his overhead goes up and he makes less and less, it won’t take him long to realize that it would be more cost efficient to pay a good CMA that does twice as much work as you do for about the same salary. Your job will be in jeopardy.
Susan: Mabel, listening to you and Ann has certainly put my job in perspective. I must confess that on several occasions, Ann has asked me to take another look for previously faxed records. And sure enough, they were already in our office two weeks prior, just as she had documented.
Ann: I think the key is getting everything taken care of, whether it’s messages or filing or acting on reports, before going home every night. The phone starts ringing within 30 seconds after I reach the office, so there is never any time the next day to catch up.
Mabel: You would be even further behind by the end of the next day.
Susan: I’m certainly sorry I’ve caused you extra work. I’ll make sure the faxes are filed immediately in the appropriate charts. If it’s a new referral, I’ll make up a temporary folder until the patient arrives for his or her appointment.
To keep up with what’s new, be sure to subscribe to HealthPlanUSA.net by entering your email address at www.healthplanusa.net/newsletter.asp.
The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.
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Obama's Health Plan Will Succeed . . . By: Mark Schiller, Front Page, Thursday, August 06, 2009
. . . At getting people to die faster.
critics are busy complaining that President Obama's healthcare reform plans are
doomed to failure. It would be nice if they would just quit their whining and
get back to caring for their polo ponies or something, because it's clear that
the plan will be successful. Think about it -- as severely
ill people die more quickly, costs will inevitably be cut.
It's really quite simple. Take cancer treatment. If we can just make sure to treat cancer patients with older, cheaper, more ineffective treatments, then treatment will actually be more effective -- at cutting costs as more cancer patients die. We not only save the cost of more expensive medication -- we also save by relying on less expensive stays in hospices instead of more extended active treatments.
More importantly, if we can help patients die quickly now, then we can save on the cost of any future major illnesses they would've had that would have cost society a whole boatload of money. Basically, one severe potentially terminal illness is cheaper than two. Some cancer patients may try to demand more up-to-date, effective treatments, but society must obviously ignore their selfish desires to live.
The Obama plan is going to accomplish this with its billion-dollar investment in "comparative-effectiveness research." This is a coup, because it sounds so rational and scientific. A sophisticated observer can see that it will be "comparatively effective" at reducing the rate at which new, more effective treatments are utilized. The kind of large, expensive studies required to prove that newer treatments are less effective at killing off patients will be so difficult to conduct that the newly created "Federal Coordinating Council for Comparative Effectiveness Research" (or FCCCER, pronounced faux care) will have cover for many years before it's compelled to approve any new treatment.
Such is the excellent model provided by Great Britain's National Institute for Clinical Excellence, known by the wonderful acronym NICE. Indeed it was "NICE" how the agency "regrettably" found last summer that four admittedly "clinically effective" lifesaving medications for kidney cancer were not "cost-effective uses of NHS resources." NICE has been wildly successful in shortening the overall amount of time that the British medical system is forced to treat cancer patients. In Great Britain, survival rates after a cancer diagnosis range from 40.2 to 48.1 percent for men and 48 to 54.1 percent for women. The United States currently boasts an inefficiently high rate of 66 percent for men and 63 percent for women.
Of necessity, part of Obama's plan is to get physicians focused on purchasing, integrating, and pulling their hair out over how to use fully computerized, government-approved medical records systems. Many physicians complain that these systems don't work well in their practices, that they're time consuming, and that they take time away from patient care. But these computer systems are absolutely essential in ensuring that physicians don't try to practice medicine themselves and instead comply with the FCCCER's dictates to use outdated treatments. Computer records will permit minute, constant scrutiny of physicians, who will be penalized for trying to use independent judgment in prescribing unapproved treatments.
An underappreciated part of the plan is the expected savings on Social Security benefit payments, if we can be more effective in not prolonging the suffering of those that could be terminally ill. It would be nice to see White House economists include such assumptions in their calculations to help bolster their argument for adoption of the President's plans. That is the type of forward thinking that we need to sell this bill of goods to an American public so unsophisticated that they are worried about having the government fully take over one-seventh of the national economy during this time of economic distress and multi-trillion-dollar federal debt.
Mark Schiller, M.D., is a Senior Fellow at the Pacific Research Institute and a board member of the Benjamin Rush Society, a medical society that is dedicated to serving patients, not the government.
VOM is Where Doctors' Thinking is Crystallized into Writing.
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Greg Scandlen reviewed Gratzer's Code Blue, the story of the Canadian Health Care System, for Medical Sentinel, the Official Journal of the Association of American Physicians and Surgeons. We think this message needs to be read by every American during the health care reform debate.
Long the shining beacon for the American Left, the grand example of successful socialism on North American soil, the Canadian health care system is falling apart, or so says David Gratzer in Code Blue: Revising Canada’s Health Care System. Gratzer was a medical student at the University of Manitoba when he wrote the book and now practices psychiatry in Toronto.
Canada’s system, known as “medicare,” is run by provincial governments and paid for by a combination of provincial and national funds. Copayments are not allowed, nor are people allowed to go outside the system and pay for services directly (unless one leaves the country). The system is plagued, Gratzer writes, by long waiting lists of sick patients, overcrowded hospitals, second-rate equipment, and a stream of doctors, nurses and patients fleeing to the United States. He documents these woes not only with a host of health care horror stories from Canadian newspapers, but with a long list of studies, both official and private.
Gratzer says, “Waiting lists are the biggest concern that Canadians have with their health care system. The lists are not a medical but an economic problem. Because patients have no incentive to think twice about using health care services, policy makers are forced to find ways to ration health care.”
Gratzer agrees that the Canadian system is less costly than the American one, but says the difference is overstated in a number of ways. Total American spending is inflated, and Canadian spending lowered, by the Canadians who cross the border to receive services in the States. He also points out that raw comparisons don't account for differences in spending on research, or differences in demographics or accounting procedures. He notes that, “Canada’s entire research budget is smaller than the R&D budget of the University of Texas’ M.D. Anderson Cancer Center.”
Even after adjusting for these differences, Canadian medicine may still be cheaper, but you fail to get what you fail to pay for – in this case, modern equipment, adequate facilities, and motivated physicians.
Gratzer’s most withering analysis is aimed at Canada’s “gutless” political establishment that relies on bromides and cliches in place of serious efforts to address the problems in Canadian medicine: “The badly needed national debate isn’t taking place. There is only the sound of silence as partisans of every political stripe advocate the intellectually vacant position of maintaining the status quo in an ideal system that doesn’t really exist.”
He maintains that the early success of medicare – back when the population was young and costs were low – became hard-wired in the Canadian psyche as a source of national pride. Now that the system is failing, no political leader wants to be the first to tell the truth. As with “The Emperor’s New Clothes,” denial reigns supreme.
Gratzer doesn’t stop at documenting the problems in Canadian medicine, nor at laying the responsibility at a political class that prefers to look the other way. He also examines possible solutions and their consequences, including simply spending more money, applying user fees, or creating a parallel privatized system to supplement the public program. Any of these reforms would be an improvement, he says, but “the most important step toward renewing health care in [Canada] is to accept that medicare is fundamentally flawed.” He notes that medicare currently “consumes 21 cents of every dollar earned by working Canadians,” and the Office of the Superintendent of Financial Services projects a tax rate of 94.5 percent will be needed to support the program in 2040 without fundamental reform.
Instead, Dr. Gratzer would like to see patients making their own decisions about how to best spend their health care resources, whether those resources come through the government or directly out-of-pocket. And the best way to do this, he proposes, is through a national system of medical savings accounts (MSAs), combined with high-deductible indemnity insurance plans. He examines several alternative MSA designs, including the possibility of government-provided high deductible insurance and tax-payer funded “allowances” for MSA deposits. He prefers self-funded MSAs using tax-free deposits. He argues that the poor and persons with “special needs” could be granted extra assistance.
He concludes that “Medical savings accounts aren’t a miracle solution. But an MSA system has the potential to address many of the problems with the present health care system in Canada.” They could fix the problems of waiting lists, second-rate equipment and fleeing physicians, while maintaining accessibility and timeliness of care.
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Hillary Rodham Clinton has been stomping through a number of South African Countries extolling human rights. William Jefferson Clinton has been meeting with the Dictators of the Most Unfree Country in the world, North Korea, for the human rights of two reporters in prison. Barack Hussein Obama has been stomping the United States to eliminate Human Rights in Health Care.
Can’t Politicians Ever Get Things Straight?
God Save Our Country
A noted psychiatrist was a guest Speaker at an academic function where Nancy Pelosi happened to appear. Ms Pelosi took the opportunity to schmooze the good doctor a bit and asked him a question with which he was most at ease.
“Would you mind telling me, Doctor,” she asked, “how you detect a mental deficiency in somebody who appears completely normal?” ”Nothing is easier,” he replied. “You ask a simple question which anyone should answer with no trouble. If the person hesitates, that puts you on the track.” ''What sort of question?” asked Pelosi. Well, you might ask, ”Captain Cook made three trips around the world and died during one of them. Which one?” Pelosi thought a moment, and then said with a nervous laugh, “You wouldn't happen to have another example would you? I must confess I don't know much about history.”
There has been no double-blind study on a treatment for “STUPID.”
The Father of Socialized Medicine
Always remember that Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, or any single-payer initiative, was born for the benefit of the state and of a contemptuous disregard for people’s welfare.
Will Barack Hussein Obama become as famous as Bismarck?
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• John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?," go to www.healthplanusa.net/AE-AreYouReallyInsured.htm.
• Medi-Share Medi-Share is based on the biblical principles of caring for and sharing in one another's burdens (as outlined in Galatians 6:2). And as such, adhering to biblical principles of health and lifestyle are important requirements for membership in Medi-Share. This is not insurance. Read more . . .
• PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist, practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.patmosemergiclinic.com/. To read more on Dr Berry, please click on the various topics at his website. Review How to Start a Third-Party Free Medical Practice . . .
• PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. (http://home.earthlink.net/~doctorlrhuntoon/) Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. I also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.
• FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder, www.westandfirm.org, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance. Read Lin Zinser’s view on today’s health care problem: In today’s proposals for sweeping changes in the field of medicine, the term “socialized medicine” is never used. Instead we hear demands for “universal,” “mandatory,” “single-payer,” and/or “comprehensive” systems. These demands aim to force one healthcare plan (sometimes with options) onto all Americans; it is a plan under which all medical services are paid for, and thus controlled, by government agencies. Sometimes, proponents call this “nationalized financing” or “nationalized health insurance.” In a more honest day, it was called socialized medicine.
• Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis."
• Dr Vern Cherewatenko concerning success in restoring private-based medical practice which has grown internationally through the SimpleCare model network. Dr Vern calls his practice PIFATOS – Pay In Full At Time Of Service, the "Cash-Based Revolution." The patient pays in full before leaving. Because doctor charges are anywhere from 25–50 percent inflated due to administrative costs caused by the health insurance industry, you'll be paying drastically reduced rates for your medical expenses. In conjunction with a regular catastrophic health insurance policy to cover extremely costly procedures, PIFATOS can save the average healthy adult and/or family up to $5000/year! To read the rest of the story, go to www.simplecare.com.
• Dr David MacDonald started Liberty Health Group. To compare the traditional health insurance model with the Liberty high-deductible model, go to www.libertyhealthgroup.com/Liberty_Solutions.htm. There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.
• Madeleine Pelner Cosman, JD, PhD, Esq, who has made important efforts in restoring accountability in health care, has died (1937-2006). Her obituary is at www.signonsandiego.com/news/obituaries/20060311-9999-1m11cosman.html. She will be remembered for her important work, Who Owns Your Body, which is reviewed at www.delmeyer.net/bkrev_WhoOwnsYourBody.htm. Please go to www.healthplanusa.net/MPCosman.htm to view some of her articles that highlight the government's efforts in criminalizing medicine. For other OpEd articles that are important to the practice of medicine and health care in general, click on her name at www.healthcarecom.net/OpEd.htm.
• David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at www.ssvms.org. To read his "Lessons from the Past," go to www.ssvms.org/articles/0403gibson.asp. For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm.
• Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, who would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at www.peerreview.org.
• Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848, no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment. Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as the California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD.
To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to www.semmelweissociety.net.
• Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), is making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals. For more information, go to www.sepp.net.
• Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, who wrote an informative Medicine Men column at NewsMax, have now retired. Please log on to review the archives. He now has a new column with Richard Dolinar, MD, worth reading at www.thenewstribune.com/opinion/othervoices/story/835508.html.
• The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to read News of the Day in Perspective: Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. This month, be sure to read . . . Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents.
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"Those who know what's best for us must rise and save us from ourselves." -Neil Peart
"The nine most terrifying words in the English language are 'I'm from the government, and I'm here to help.' "-Ronald Reagan
"Not everything that counts can be counted, and not everything that can be counted counts." -Albert Einstein
Some Recent Postings
Robert D. Novak, who died Tuesday at age 78, parlayed shoe-leather reporting and a dour worldview into a prime spot among the Washington commentariat.
He was universally known as "The Prince of Darkness" for his bleak take on human nature, and he wore the sobriquet proudly, using it as the title to his 2007 memoir of a half-century reporting from Washington. It helped nurture his gloomy persona on display on shows such as "Crossfire" and "The Capital Gang."
"I am a pessimist by nature, which is why I have spent my life as a journalist instead of trying to be a leader, which requires optimism," he wrote in his memoir.
But Mr. Novak's persona -- including his title as "The Prince of Darkness" -- was only a public one. Friends, who describe him as tough, are also quick to call him kind and generous.
"He was given that as a nickname as a very young reporter," says Geraldine Novak, his wife of nearly 50 years. "But everybody who knew him knew that it was nonsense. He was really very cheerful and fun to be with."
Al Hunt, Mr. Novak's longtime sparring pundit partner on television, spoke highly of him as a mentor during earlier years in the Washington press corps. "He was supportive and kind," says Mr. Hunt. "There was pessimism unless you cut the capital gains tax, and then he was an incredible optimist." . . .
A reporter from his student days at the University of Illinois, he later worked for The Wall Street Journal, where he was a Washington correspondent from 1958 to 1963. He left to team with Rowland Evans on "Inside Report," a column of Washington gossip and news that initially appeared six days a week for the New York Herald Tribune Syndicate. . .
Mr. Novak continued his column after Mr. Evans died in 2001, and in 2003 published perhaps his most incendiary column ever, identifying Valerie Plame as a Central Intelligence Agency operative. . .
Because naming a CIA agent can be a crime, questions soon arose as to whether Ms. Plame was in the CIA and who had told Mr. Novak. In the resulting imbroglio, Mr. Novak divulged his sources before a grand jury. A federal investigation ended with the 2007 conviction of a top vice-presidential aide, I. Lewis "Scooter" Libby for perjury and obstruction of justice.
Although a registered Democrat, Mr. Novak identified himself as a conservative. He wrote that his conservatism deepened as his TV persona grew. But his main role continued to be as an "obstreperous reporter looking for trouble." He wrote in his memoir about the heavy drinking that accompanied his hard reporting.
But in the early 1980s, partly because of a bout of spinal meningitis, Mr. Novak curtailed his drinking. That was one of several health setbacks that partly inspired his conversion to Catholicism late in life, at the age of 67. Mr. Novak said he also took part of his inspiration from Whittaker Chambers's book Witness, about Mr. Chambers's conversion from Communism to Christianity. The Judaism he was raised with, he said, was not inspiring at all.
With an all-star group of Washington politicians looking on and Ms. O'Beirne as his godmother, Mr. Novak converted to Catholicism in a 1998 ceremony at St. Patick's Church in Washington.
Presiding at the ceremony was Monsignor Peter Vaghi, who had been a staffer for Sen. Pete Domenici and a source for Evans & Novak before entering the priesthood. Just before Mr. Novak bowed his head to receive the sacramental waters of baptism, Msgr. Vaghi told the onlookers they were about to witness the transformation of a "prince of darkness" into a "child of light."
His friend Sen. Daniel Patrick Moynihan joked, "Well, we've now made Bob a Catholic. The question is, can we make him a Christian."
Years later, Mr. Novak told the Washingtonian magazine that "it was an exhilarating experience, one of the great moments of my life."
In 2008, he seemed in a daze after leaving the scene of an accident after his Corvette hit a Washington pedestrian. Days later, he was diagnosed with the brain tumor that would eventually kill him.
Robert Novak at a taping of 'Meet the Press' in 2007
On This Date in History - August 25
On this date in 1930, Sean Connery was born in Edinburgh, Scotland, the son of a truck driver. He worked the morning milk route before heading off to school. He introduced the role of British superspy James Bond to the silver screen in the 1962 film Dr. No. He recreated the James Bond role five more times before he moved on to other projects after 1971.
On this date in 1918, Leonard Bernstein was born in Lawrence, Massachusetts. He was a famous conductor by the age of 25, and composer of the symphony, “Jeremiah.” He moved with ease from the classical to the popular side of composing, meanwhile bringing the New York Philharmonic new glory as its conductor.
On this date in 1836, Bret Harte, the writer, was born in Albany New York. It was Bret Harte who gave the public its first exciting and grubbily humorous accounts of Western life, including such classics as “The Luck of Roaring Camp” and “The Outcasts of Poker Flat.” Within ten years he had burned himself out as an author, while friends and colleagues like Mark Twain not only kept on going, but kept on getting better all the time. Some people rise like meteors and fall the same way, while others seem to keep on going, shining brighter all the time. Sometimes it’s difficult to know when you’re at the brightest and it’s time to stop. If you don’t, tragedy may happen on your descent.
After Leonard and Thelma Spinrad
The 7th Annual World Health Care Congress
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. The 7th Annual World Health Care Congress will be held April 12-14, 2010
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