MEDICAL TUESDAY . NET
Community For Better Health Care
Vol VI, No 18, Dec 25, 2007
In This Issue:
MERRY CHRISTMAS & A HAPPY NEW YEAR
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Diabetes has reached virtually epidemic levels in the modern world. In 2005 the U.S. Centers for Disease Control and Prevention estimated that about 7 percent of the American population (20.9 million people) had diabetes - and 6.2 million of them were unaware of it. More than 1.5 million people over the age of 20 will be diagnosed with it in the U.S. this year. About 21 percent of those older than 60 have the disease.
Small wonder, then, given the severe complications associated with diabetes, that it continues to be the sixth leading cause of death in the U.S. And although diabetes was often called a "disease of affluence" in the past, it is now one of the fastest-rising health concerns in developing nations as well: the World Health Organization pegs the global total at more than 171 million cases.
An unfortunate catch-22 of diabetes is
that although the right diet and exercise can help with its prevention and
management, diabetes itself can complicate both eating and physical activity.
Patients may need to pay extra attention to taking meals on a regular schedule
and to monitoring how exercise dehydrates them or lowers their blood glucose.
Some may fail to comply consistently with prescribed regimens that seem
inconvenient or unpleasant, thereby raising their risk of complications. But
thanks to leaps in science's understanding of the disease, doctors now wield a
diverse and growing arsenal of drugs and management technologies to fight the
progression - and even onset - of illness. People with diabetes have more and
better options than ever before for enjoying healthy, active, long lives.
To read more, please go to www.medicaltuesday.net/index.asp .
Diabetes is a disease in which too much of a sugar called glucose accumulates in the blood because of a breakdown in how the body makes or reacts to the hormone insulin. Insulin enables muscle, fat and other types of cells to take up and process glucose. If cells can't burn or store glucose normally and the blood levels rise chronically, damage accumulates throughout the body - in the worst cases leading to blindness, amputation, kidney failure or death.
Most cases fall into one of two
Type 1 diabetes (formerly known as juvenile diabetes) occurs when the body sabotages its own ability to produce insulin. A disorder of the patient's immune system causes it to attack the insulin-making beta cells in the pancreas. Consequently, patients with type 1 diabetes need an artificial source of insulin. Although it is the most common form of diabetes in children, only 5 to 10 percent of all cases of diabetes in the U.S. are of this variety.
Type 2 diabetes, which has become increasingly prevalent during the past few decades, arises from "insulin resistance," which causes cells, for poorly understood reasons, to stop responding properly to the hormone. At first, the pancreas can compensate by producing greater amounts of insulin. But over time, the pancreas reduces its production, making matters worse. Initially this type of diabetes may respond to diet, exercise and weight control, but later medications, and perhaps insulin, may be necessary depending on the severity of the case.
In addition, about 4 percent of all pregnant women develop gestational diabetes, a form that usually resolves itself after delivery. Diabetes can also be a rare consequence of certain genetic conditions or chemical exposures.
Symptoms, Risk Factors and Diagnosis
More than six million Americans have type 2 diabetes and don't know it because its early symptoms can seem so harmless and vague:
· Frequent urination
· Extreme thirst and hunger
· Blurred vision
In contrast, type 1 diabetes comes on more quickly and with more prominent symptoms, such as unexplained rapid weight loss, dehydration or a severe illness called ketoacidosis. Medical science has still not yet determined precisely why some people develop diabetes and others do not - the genetic and environmental triggers for the disease are surprisingly complex.
For example, type 1 diabetes is not simply genetic in origin, because even the identical twin of someone with diabetes, who shares the same genes, will develop the condition no more than 50 percent of the time. Some as yet unidentified factor in the environment - perhaps a virus - must therefore trigger the immune systems of genetically susceptible people to attack the beta cells in their pancreas. Other environmental factors also seem to be involved: research finds that type 1 diabetes is less common among those who were breast-fed.
For type 2 diabetes, the genetic component is greater: it tends to run more obviously in families, and the identical twin of a person with diabetes will manifest the disease up to 75 percent of the time. Yet it is also very strongly linked to weight gain and insufficient exercise. As the American Diabetes Association (ADA) notes, "[A] family history of type 2 diabetes is one of the strongest risk factors for getting the disease, but it only seems to matter in people living a Western lifestyle." In the U.S., type 2 diabetes is also more common among African-Americans, Latinos, Asians and Native Americans.
Two ways to diagnose diabetes definitively are testing a patient's blood with either a fasting plasma glucose (FPG) test or an oral glucose tolerance test (OGTT). The FPG measures the concentration of glucose in the blood of a person who has been fasting for 12 hours; if it is above 125 milligrams per deciliter, the patient is diabetic. The OGTT measures the subject's blood glucose level both after a fast and two hours after consuming a glucose-rich drink; diabetes is the diagnosis if the latter reading is above 200 milligrams per deciliter. (The ADA favors the FPG because it is less expensive, faster and easier for patients.)
Prevention and Prediabetes
People do not become diabetic overnight. Almost all of those who eventually acquire type 2 diabetes move first through a "prediabetes" state in which their blood glucose levels are elevated but not quite high enough to qualify as diabetes. (Prediabetes is also called impaired glucose tolerance and impaired fasting glucose, depending on the tests used to diagnose it.) Research suggests even those slightly less than diabetic blood glucose levels may do long-term damage to the body, and patients with prediabetes are at a 50 percent higher risk for heart disease and stroke. In a major clinical trial from 2002 called the Diabetes Prevention Program (DPP), roughly 11 percent of those with prediabetes became type 2 diabetics during the three years of the study.
The good news for the estimated 54 million Americans who have prediabetes is that many can prevent their conditions from progressing through moderate exercise and changes to diet. In fact, many of them might even be able to return their blood glucose levels to normal. The DPP found that patients who lowered their body weight by a mere 5 to 10 percent - typically just 10 to 15 pounds - through diet and moderate exercise reduced their risk of developing diabetes by 58 percent. These interventions were even more effective among patients older than 60: their risk fell by 71 percent. And it should go without saying that regular exercise and a healthy diet can help keep people from acquiring prediabetes, too.
To read about management and treatment and review the entire article, please go to www.sciam.com/article.cfm?id=managing-diabetes&print=true.
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Accepting The Laws Of Science Takes A Leap Of Faith. By Paul Davies, Tempe, Ariz.
SCIENCE, we are repeatedly told, is the most reliable form of knowledge about the world because it is based on testable hypotheses. Religion, by contrast, is based on faith. The term "doubting Thomas" well illustrates the difference. In science, a healthy skepticism is a professional necessity, whereas in religion, having belief without evidence is regarded as a virtue.
The problem with this neat separation into
"non-overlapping magisteria," as Stephen Jay Gould described science
and religion, is that science has its own faith-based belief system. All
science proceeds on the assumption that nature is ordered in a rational and
intelligible way. You couldn't be a scientist if you thought the universe was a
meaningless jumble of odds and ends haphazardly juxtaposed. When physicists
probe to a deeper level of subatomic structure, or astronomers extend the reach
of their instruments, they expect to encounter additional elegant mathematical
order. And so far this faith has been justified.
more, please go www.medicaltuesday.net/index.asp .
The most refined expression of the rational intelligibility of the cosmos is found in the laws of physics, the fundamental rules on which nature runs. The laws of gravitation and electromagnetism, the laws that regulate the world within the atom, the laws of motion - all are expressed as tidy mathematical relationships. But where do these laws come from? And why do they have the form that they do?
When I was a student, the laws of physics were regarded as completely off limits. The job of the scientist, we were told, is to discover the laws and apply them, not inquire into their provenance. The laws were treated as "given" - imprinted on the universe like a maker's mark at the moment of cosmic birth - and fixed forevermore. Therefore, to be a scientist, you had to have faith that the universe is governed by dependable, immutable, absolute, universal, mathematical laws of an unspecified origin. You've got to believe that these laws won't fail, that we won't wake up tomorrow to find heat flowing from cold to hot, or the speed of light changing by the hour. . .
To read the entire article, go to www.nytimes.com/2007/11/24/opinion/24davies.html?_r=1&oref=slogin.
Paul Davies is the director of Beyond, a research center at Arizona State University, and the author of "Cosmic Jackpot: Why Our Universe Is Just Right for Life."
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Health Care: The officials who run Great Britain's National Health Service apparently don't believe patients need the benefits of medical innovations. Advanced medicine costs too much, so they can just go without.
Medical treatment will always be rationed. Care may be abundant in many parts of the world, but it's not unlimited. The question, then, is who does the rationing? The patient? Or the government?
For years we've warned readers that the universal
health care model those on the left have been trying to force on the country
will establish a system in which the state takes over medical treatment and
makes decisions for the sick.
To read more,
please go to www.medicaltuesday.net/intlnews.asp .
The ugly reality of this is evident in Britain, where the NHS is denying cardiac patients access to a vital device.
"The Health Service's rationing watchdog says drug-coated stents used to treat around 30,000 patients a year are not cost-effective and should no longer be provided," Britain's Daily Mail reported last week.
Surgeons say that holding back drug-coated stents will actually increase NHS' costs because many patients who don't get the stents will eventually need expensive heart bypass surgery. No matter. The bureaucracy has spoken, and decisions have been made in the ivory towers that affect others.
Briton Edward Crane didn't need a stent earlier this year, but he did need hip surgery. So what does the NHS do? It cancels four scheduled consultations with Crane. Fed up, the 75-year-old retiree, who had paid into the NHS for decades, spent his life's savings to have a hip replacement performed by a private practice.
Many Britons swear by their system, but they are not the ones who have been denied care, put on long waiting lists or rudely neglected, as Crane was, because bureaucrats are doling out the care.
No comment on universal care would be complete without mentioning Canada, home of the Great White Waiting List. For an industrialized nation, Canada's shortage of modern medical equipment is alarming. Among Organization for Economic Cooperation and Development countries, the Fraser Institute notes in a recent study, Canada ranks No. 13 out of 24 in access to MRIs, No. 18 in CT scans and No. 7 out of 17 in access to mammograms.
Clearly, Britain and Canada are not the ideal places to get sick.
Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.
--Canada's Supreme Court
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Medicare Administrative Costs vs. Private Insurance Administrative Costs
We hear estimates of Medicare administrative costs ranging from 1.5% to 12%. We also hear bloviations of private insurance companies' administration costs ranging from 10% to 50%. Definitions of what constitutes administration, and what does not, vary widely. Some activities are considered administration for private insurers but not for government programs.
So what exactly is administration? More importantly, where can we find true numbers to make an intelligent comparison? With more and more people screaming for Government medicine, wouldn't accuracy in comparing systems lead to a much more sound decision?
At the end of the day, isn't the purest measure of
administrative costs the dollars allocated to the program less what is spent on
patient care, less any taxes?
To read more,
please go to www.medicaltuesday.net/medicare.asp
The Medicare and Medicaid (CMS) website contains an analysis of costs between private insurers, Medicare, and Medicaid. According to their tables, private insurers have one line item entitled "Government Administration and Net Cost of Private Health Insurance". This is the line item so often quoted in isolation when proponents of government medicine are trying to understate the costs of administration. For private insurers, this one line item includes administrative costs, marketing, research, premium taxes, facilities, equipment, insurance and reinsurance losses, as well as profit. Perhaps the reason that these charges were all lumped into one line item is because different private companies report differently or maybe private carriers did not want their competitors to know who much they spend on any particular line item?
The 2 main government programs; Medicare and Medicaid, have additional line items which fall below the administration line. These are: Government Public Health Activities, Research, and Structures and equipment. Information on taxpayer funded public programs is more readily available, non-patient care costs are easy to break down into 4 separate categories. Medicare administration is also very different in that they actually don't pay any claims themselves. These activities are delegated to private insurers.
Statistics, unfortunately are like a lamp post for a drunk; they are used more for support than illumination. What is illuminating, however is the actual per capita cost in absolute dollars of administering government programs versus the per capita cost of administering private programs. If we compare administrative cost of 4.02% for Medicare to 14,07% for private insurance, we may mistakenly believe that Medicare has lower administration costs. However, when we look at the percentage of costs for activities not related to patient care (in other words the reciprocal of the medical loss ratio ), we see that Private insurers non-patient care costs are 14.07% vs. 11.68% for Medicare and 31.12% for Medicaid. When we look at costs in dollars per capita in Table 3 however, we come to a much different conclusion ---the truth, which has been purposely hidden from us by the proponents of government medicine. Even if we look at the one line item entitled Government Administration and Net Cost of Private Health Insurance in isolation, we quickly see that the NET costs of administering Medicare are 33% higher than private insurers. When we include ALL non-patient care costs Medicare is 386% the cost of private administration and Medicaid is 435% the cost. Combined government administrative costs are more than 4 times the cost of private insurers.
Anyone who has been inside the government will not be surprised by this honest assessment of government efficiency. It is due to these inefficiencies, that government projections are always low. They use the percentages in Table 2 to project then they spend closer to the actual figures n Table 3 and end up having to ration care to compensate.
Copyright © 2007 Ralph Weber CFP® REBC, All rights reserved. Used with permission.
To review the tables, go to www.stopgovernmentmedicine.com/ and click on the title.
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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Rep. John Shadegg, an Arizona Republican, thinks they should -- and today will reintroduce legislation to make that possible.
The Health Care Choice Act would allow residents in
one state to buy health insurance that is available in and regulated by another
state. If enacted, the law would create a competitive, 50-state market for
health insurance, likely making it cheaper. It would do this without imposing a
large cost on taxpayers and without creating a new government bureaucracy.
To read more, please go to www.medicaltuesday.net/gluttony.asp .
This should be a no-brainer for Congress. But a few years ago, Mr. Shadegg went looking for a Democratic cosponsor for his bill. He found one who initially signed on, then withdrew under pressure from Democratic House leaders who wanted to dismiss the Shadegg bill with the excuse that it lacked bipartisan support.
The health-insurance market can be divided into three segments. The first consists of mostly large employers, with self-funded plans, and are regulated by the federal Employee Retirement Income Security Act (ERISA) and thus not subject to state regulation. The two remaining segments of the health-insurance market are heavily regulated by states: those that serve small-group plans (typically covering two to 50 people), and individuals who pay for their own insurance. Mr. Shadegg's bill only applies to the individual market. . .
One of the most expensive state-level regulations is "guaranteed issue," which requires insurers to sell insurance to anyone willing to buy it, regardless of their health, or other factors that may make it much more expensive to cover them. New Jersey, for example, enacted guaranteed issue in 1994. At the time, a family policy could be purchased in the state for as little as $463 a month or as much as $1,076, depending on which of the 14 participating insurers a family chose. Now there are just 10 insurance companies offering plans in the state and the cost has soared to $1,726 per month on the low end and $14,062 on the high end.
In New Jersey then, residents who buy their own insurance have to pay at least $20,000 a year for the cheapest family policy. Meanwhile, in neighboring Pennsylvania similar health-insurance policies cost a third of what they cost in New Jersey. What Mr. Shadegg wants to do is to let New Jersey residents buy what's now for sale in Pennsylvania.
Mandates are another reason the cost of health insurance varies from state to state. States impose those mandates on what an insurance plan must cover -- such as chiropractic care or mental-health services. The Council for Affordable Health Insurance, which tracks mandates, estimates that there are more than 1,900 state mandates nationwide. These mandates can increase the cost of health insurance by as much as 50%, which can then force residents in many states to decide between "Cadillac coverage" -- insurance that covers nearly everything and costs a mini fortune -- or no coverage at all.
Typically, state mandates are justified by the belief that they make health insurance more comprehensive. But consider this: Idaho has just 14 state mandates, the fewest in the nation, while Minnesota, with 63, has the most. Yet, the people of Idaho aren't dying in the streets for lack of mandates.
Critics of the Health Care Choice Act claim that it would limit the ability of states to protect their residents. The assertion is that cross-state health-insurance purchases are a risky experiment. In truth, millions of people already have access to health insurance across state lines. Employees of large companies with plans covered by ERISA are one example.
But there are others. Some small businesses cover employees working across state lines. And, because people are mobile, some people buy individual insurance in one state and then end up moving to another. In many cases, they can take their health-insurance policies with them. A person living in Pennsylvania with an individual policy now could retain that policy even if he moved to New Jersey. Premiums would likely increase, but they would be cheaper than if he had started out with a New Jersey policy.
If states are worried about losing regulatory control over health insurance, they might try making their regulations competitive with other states. Health insurers would likely respond by returning and offering a wide range of affordable policies. As it stands, many states are "protecting" their residents right into the uninsured camp.
The Health Care Choice Act won't solve every problem. But it would increase competition and consumer choices currently denied to residents in many states.
Mr. Matthews is executive director of the Council for Affordable Health Insurance and a resident scholar with the Institute for Policy Innovation.
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Health Alert: Diabetics and Bagels by John Goodman, PhD
What do diabetics and bagels have in common? Almost nothing. However, the market for bagels might be useful for testing ideas about health care reform. I imagine that the market for diabetic care is about a thousand times more complicated than the market for bagels. So why not use the bagel market to experiment with hair-brained payment schemes think tanks propose to inflict on unsuspecting patients? Here's the argument: a) if a payment scheme doesn't work for bagels, it probably has no chance of working for diabetics either; b) the social cost from being wrong is far less if we are experimenting with bagels; and
c) just as the FDA requires drug companies to experiment first with rats, we should require policy wonks to try their ideas out on some relatively simple, inanimate product - and a bagel is just as good as any. To read more, please go to www.medicaltuesday.net/myths.asp . All this is brought to mind by a recent missive from Karen Davis, president of the Commonwealth Fund. Karen says we pay doctors in the wrong way. That is true, but Karen is not suggesting that third parties butt out. She wants them to butt in - becoming even more meddlesome than they already are. Since she's not sure what the right answer is, she calls for third parties to experiment with many ideas. With hope that we do not cause unnecessary harm to either bagels or patients, I propose some mental experiments in form of the following challenges. The Bagel Challenge for the Commonwealth Fund: Take some part of the market, and have a third-party payer set delicatessen prices and pay at least 90 percent of the customer cost for fresh bagels (no more than 24 hours old). Show how the payment scheme would work, with no greater excess supply or excess demand from day to day and week to week than we have today. Feel free to make liberal use of pay for performance, best bagel practices, computerized bagel records, bagel utilization review, etc. Note: You don't have to actually implement the scheme. Just make a plausible case for how it would work. The Diabetes Challenge for Other Readers: Here is a far more productive challenge for everyone else. Start with a common insurance pool for diabetics in which all payments and all decisions are made by the insurer. Ignore catastrophic expenses and consider only routine care. Now begin to individualize the pool - giving patients more control over the dollars they are spending along with the power to individually negotiate prices and switch providers. Continue doing this as long as there are quality improvements and cost reductions. When no more improvements are possible, stop. Here's the question: At the stopping point, does the market for diabetic health care look like the market for bagels? Or, does the insurer retain control over some of the money and reserve the power to restrict some patient behavior? And if there is a residual role for the insurer, why is this good? (That is, why do all the original members of the pool benefit?) I don't expect to hear from Commonwealth any time soon. I hope I hear from others, however. If you want to submit a mathematical model, that's fine. In fact, it is preferable. If your response is verbal, keep it short and pithy. Cheers. John Goodman, President, National Center for Policy Analysis
1 2770 Coit Rd., Suite 800, Dallas, Texas 75251
For Karen Davis' letter, go to www.commonwealthfund.org/aboutus/aboutus_show.htm?doc_id=559687 .
For the NCPA's vision of how real markets would produce diabetic care, see the final chapter of Handbook on State Health Care Reform: www.ncpa.org/email/State_HC_Reform_Book_conclusion.pdf .
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Dr. Kaleb: Remember the doctors who moved out of St. George, their complaint about a change of address triggering six to nine months of harassment by Medicare is striking home.
Dr. Rosen: Sooner or later everyone will feel the strong arm of Government Medicine even without Single Government Payer.
Dr. Sam: Why are there any doctors for Single Payer Government Medicine? Are their heads in the Sand?
Doctors are so brow beaten, they don't know what to believe. So what's new with
To read more, please go to www.medicaltuesday.net/lounge.asp .
Dr. Kaleb: I've been listening to your complaints since last spring and am now experiencing what has been said. My wife has a general practice and moved last July. She has just completed the Medicare application for the third time. They found a small typo on the first two and she was not allowed to simply correct it, she had to fill out a new 17-page and a 7-page additional application. It's been more than six months since her last Medicare check. She's in solo practice and that really is devastating except I'm getting paid. In fact, our group was going to move, but because of all the discussion in the lounge over lunch, we decided to stay put in our inadequate office and build up our hospital practice instead.
Dr. Rosen: We delayed our initial application last May because they needed a voided check with our new address. We had planned to use our old supply but Medicare wouldn't accept that. They have the same bank routing number and the same account number.
Dr. Yancy: Simple harassment by Medicare.
Dr. Kaleb: When I called Medicare to try to expedite my wife's application, I felt like I was talking to a blank wall. The answers didn't speak to my question at all.
Dr. Michelle: OK guys, I didn't move but I think you are grossly overplaying it. They are treating me nice.
Dr. Sam: How much of your fee are they paying you?
Dr. Michelle: About half. Isn't that what you get?
Dr. Rosen: When we got our first check last week after six months, we could plainly see that the global return was now down to 40% of our billable charges and we haven't raised our fees significantly in years.
Dr. Kaleb: Can you imagine what medical practice would be like if Medicare was the only game in town?
Dr. Michelle: Don't you think if they were the only game in town, they would treat you better?
Dr. Yancy: I don't understand your logic at all, Michelle. Do leopards change their spots when they eat their prey?
Dr. Sam: Maybe the logic is that zebra's lose their stripes when they're eaten.
Dr. Milton: We have to remember that doctors are a small minority of less than one-quarter of one percent of the population. And the patients are totally defenseless in protecting themselves from the government.
Dr. Rosen: This means that unless we explain our position in a more unified voice to the public-at-large, our minority will never become the majority.
Dr. Milton: But
we don't have a forum.
Our Medical Societies
have gotten pro-government single-payer, and most doctors will not go against
the establishment and thus we remain fragmented.
Dr. Rosen: Maybe
we need to start our own forum outside of our societies. The MedicalTuesday
newsletter is now reaching more physicians
than the California
Societies' newsletters. Maybe we need get-togethers on MedicalTuesday evenings
on a monthly basis.
Dr. Edwards: Didn't FirstTuesday reach a 100,000 business folks that way? I went to one in Chicago and there was standing room only.
Dr. Rosen: Does anyone have any remaining energy after working twice as hard for half the money to spearhead that?
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SONOMA MEDICINE , the Magazine of the Sonoma
County Medical Association I remember the afternoon vividly. It was during the
summer, when gentle coastal fog brushes Sonoma County, giving us a brief
reprieve from the insufferable heat. I had paced the office hallways all
morning, thinking about how to present the details of the 24-hour ambulatory
EKG monitor data to John. He was an 85-year-old veteran with recent episodes of
extreme exhaustion, generalized fatigue, dizziness, and exertional shortness of
The monitor data revealed that John had occasional
very slow heartbeats, with heart rates sometimes dipping into the mid-20s. His
diagnosis was quite obvious, and implanting a pacemaker would not have been
difficult, except for his frail body habitus. John walked with a limp, used a
thick cane, and had only one arm. His body was contorted because of severe
kyphoscoliosis from previous trauma and subsequent surgeries.
All these features, along with extensive scar
tissue on his lower neck and chest, made implant surgery difficult. To read more, please go to www.medicaltuesday.net/voicesofmedicine.asp .
Now I stood in the exam room with John and his
wife, detailing every possible complication known for pacemaker implantation
and subsequent management. John listened to me quietly with a smile on his
face. Halfway through my presentation, he suddenly blurted out, "Have you
ever killed anyone while putting in a pacemaker?"
I was a little stunned. After regaining my
composure, I gravely said, "Sir, we are discussing serious matters
John stood up, limped toward me, and whispered in
my ear, "Doc, you take your job too seriously. Nothing can happen to me,
especially with what I have gone through in the past. I suffer from
post-traumatic pleasure syndrome, not post-traumatic stress disorder."
This was a strange statement, especially in an era
when many of us blame our current inadequacies on some traumatic event we
suffered in the past.
John then gave me a detailed account of his own
traumatic event. . . To read the whole tragic heartwarming story, go to www.scma.org/magazine/scp/Fall07/dhar.html . Dr. Dhar is a cardiologist in
private practice in Santa Rosa. To read other VOM, go to www.healthcarecom.net/vom2000.htm .
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9. Book Review From our Archives: THE AMERICAN WAY OF HEALTH - How Medicine is Changing and What it Means to You by Janice Castro, Back Bay Books, (Little, Brown, & Company), Boston, 1994, x & 282 pages, including glossary, notes, & index, $9.95, Paperback.
Janice Castro, senior health-care correspondent at
TIME who interviews professionals, patients, and others, opens with "Ask most
people what they think about the state of American medicine, and they will tell
you about their own doctors, or about something that happened to them during an
illness. Chances are, if they see a need for health-care change, it will be
very specific, based on personal experience. On the other hand, listen to
American leaders discussing health-care reform. They speak of providers.
Access. Alliances. Competition. Mandates... The concepts seem impossibly
complicated and remote from the experience of one sick person needing
help." To read more,
please go to www.medicaltuesday.net/bookreviews.asp . She continues, "This book will help the
general reader understand how the American health system works, why it costs so
much... Medicine is too important, too personal, to be left to economists and
politicians... After all, the health-care debate is really about life and
death. It is about those times when people need help and about whether it will
be there, about one sick patient at a time and the doctor or nurse who provides
care... It is fundamentally a moral problem. Viewed in that light, the
challenge... begins to come more clearly into focus. It is not really that
complicated. We know what we need to do. We need to take care of old people...
Children should see doctors and dentists. A pregnant woman should be able to
check in with a doctor as the baby grows. People should not be dying in the
street... Families shouldn't lose their home over the cost of coping with
medical disasters. Breadwinners should not quit good jobs in order to qualify
for poor people's insurance... People should take responsibility for their own
health and for their family's. Children should not be having children..." And, "If we are going to ensure that every
American has access to decent health care, while also controlling the
burgeoning costs, all of us must curb our medical greed. All of us must stop
pretending that someone else is paying the bills. 'What do you think most people
would say if one of their parents called up and said they needed a hundred and
twenty-five thousand dollars for an operation?' asks one economist. 'Do you
think that son or daughter would think twice and wonder whether that operation
was really necessary? Of course they would. But none of us think we pay for
medical care. And of course we all do.' All of us must pay our share..."
To read the entire review, please go to www.delmeyer.net/bkrev_AmericanWayOfHealth.htm . To read other book reviews by topic, go to www.healthcarecom.net/bookrevs.htm . To read other book reviews alphabetically, go to www.delmeyer.net/PhysicianPatientBookshelf.htm .
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Looking back, 2007 may well be remembered as the year green went mainstream: Al Gore got an Oscar, Wal-Mart flogged organic jammies, and bottled water went from being a symbol of purity to the beverage equivalent of a pack of Luckies.
To read more
medical vignettes, go to www.medicaltuesday.net/hhk.asp .
What kind of an opinion do you need?
Three and a half years ago, the Lewin Group wrote a report for California state Senator Sheila Kuehl which basically came to the conclusion that single-payer government medicine with rationing was the best solution for California. On December 12, 2007, the same Lewin Group, when hired to help the NFIB to prepare healthcare reform policy came to the conclusion that "To the greatest extent possible, Americans should receive their health insurance and health care through the private sector." www.stopgovernmentmedicine.com/
It appears that you can buy any kind of data you wish. But how can you tell if it's valid?
Why pregnant women don't tip over.
Researchers from Harvard University and the University of Texas at Austin examined 19 pregnant women and discovered a number of reinforcements in their backs that men lack, including a lumbar (lower back) curve that spans three instead of two vertebrae and spinal joints that are 14 percent larger and positioned differently. These enhancements allow expectant mothers to lean back by as much as 28 degrees more than normal to offset the added heft of a baby bump - up to 30 pounds on average, or the weight of two bowling balls - without destroying their backs, the investigators report in Nature.
To read more HHK, go to www.healthcarecom.net/hhk1998.htm#September%201998.
To read more HMC, go to www.delmeyer.net/hmc2004.htm.
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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.
• PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.emergiclinic.com. To read more on Dr Berry, please click on the various topics at his website.
• PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. http://home.earthlink.net/~doctorlrhuntoon/. Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. I also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.
• Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis" at www.northernurology.com/articles/healthcarereform/administrativectomy.html.
To read the rest of this section, please go to www.medicaltuesday.net/org.asp .
• 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.
• 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. To read Physicians Make Lousy Advocates, go to www.healthplanusa.net/DGPhysicianAdvocate.htm. Or click on his name at www.ssvms.org/magazine/sep_oct_07.asp, where you can also read the original pro and con debate. To read why politicians can't manage a health care system, go to www.healthplanusa.net/DGPoliticiansCannotManager.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. Read an article concerning Dr. Willner at www.orlandomedicalnews.com/news.php?viewStory=525.
• Semmelweis Society International, http://www.semmelweis.org/, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848 no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as the California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD.
To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to www.semmelweissociety.net.
• Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), is making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals. For more information, go to www.sepp.net.
• Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column at NewsMax. Please log on to review the last five weeks' topics or click on archives to see the last two years' topics at www.newsmax.com/pundits/Medicine_Men.shtml. This week's column is on Mandatory Insurance Mandates New Problems.
• The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943, represents physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to scroll down on the left to departments and click on News of the Day in Perspective: CMS will no longer be paying extra for certain complications deemed to be "preventable or go to it directly at www.aapsonline.org/nod/newsofday484.php. 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 HILLARYCARE, TAKE TWO Better to do things entirely behind closed doors, writes Paul Starr, who chaired three cluster groups on the Clinton Task Force at www.aapsonline.org/newsletters/nov07.php. Scroll further to the official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. www.jpands.org/. There are a number of important articles that can be accessed from the Table of Contents of the current issue. Read breaking news such as Nation's Worst Medical Board Met Its Match at Extraordinary Hearing by Andrew L. Schlafly, Esq. or Our "Broken Healthcare System?" by President Tamzin A. Rosenwasser, M.D or the Editorial on Sham Peer Review.
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Del Meyer, MD, Editor & Founder
6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608
Words of Wisdom
"What this country needs are more unemployed politicians." -Edward Langley, Artist 1928-1995
Your secrets are safe with your friends because they cannot remember them either. CSA Bulletin
"The more corrupt the state, the more numerous the laws." -Tacitus
"The broad mass of a nation . . . will more easily fall victim to a big lie than to a small one. -Adolf Hitler
Some Recent Postings
ASHLEY AND THE DOLLMAKER - by Jared James Grantham, MD, Professor of Medicine, www.delmeyer.net/bkrev_Ashley&Dollmaker.htm
ASHLEY AND THE MOONCORN PEOPLE by Jared James Grantham, MD, Professor of Medicine, www.delmeyer.net/bkrev_AshleyMooncorn.htm
Politicians Cannot Manage a Health Care System By David J. Gibson, MD, www.healthplanusa.net/DGPoliticiansCannotManager.htm
The CMA has become part of the problem, By David J. Gibson, MD, www.healthplanusa.net/DGReformingCMA.htm
Karlheinz Stockhausen, seeker of new sounds, died on December 5th, aged 79
OTHER children had teddy bears
and dolls; but Karlheinz Stockhausen had a little wooden hammer. As he toddled
round the run-down family farm in the hills near Cologne, he would hit things
with it to see what sound they made. Each note, he established young, sent him
a different message. No plink or plunk was quite the same as any other.
To read more, please go to www.medicaltuesday.net/org.asp .
Most folk at his premières in the 1950s and 1960s might have wished he had never discovered that. Each Stockhausen piece was a shock to the system. It was not just that he had decided tonality was dead; Schoenberg's 12-note serialism had already made dissonance routine. It was not just that he thought "intensive measuring and counting" the key to music's future; Stravinsky had got there long before him. It was that Stockhausen kept on looking for, and finding, sounds never heard before. He made a formula out of the individuality of notes - their particular pitch, timbre and duration, and whether they were soft as a leaf or knocked your hat off - and revelled in it in the most alarming way. . .
After the 1970s, Stockhausen seemed to disappear up his own cul-de-sac of experimental noise. But this was his mission. He often dreamt that he had been born and trained on Sirius, and was on Earth "to bring celestial music to humans, and human music to the celestial beings". To ensure that contact, some of his pieces had to be performed under the stars. By making new sounds, he was preparing the way for a higher kind of life.
To read the entire obit, go to www.economist.com/obituary/displaystory.cfm?story_id=10281353.
On This Date in History
On this date in about the year zero (some say 6 BC) Jesus of Nazareth was born. The Angels told the Shepherds that it was the Christ and his birthday is commemorated every year by more than double His nearly two billion followers as Christmas.
On Christ night, back in 1776, George Washington led his troops across the Delaware to attack the British the next day in New Jersey. In some respects, we are all Crossing the Delaware in our lives.
On this date in 1642, Sir Isaac Newton, the man who discovered the law of gravity, was born in Woolsthorpe, England. We have escaped our own gravity and are experiencing the gravity of other moons and planets.
After Leonard and Thelma Spinrad