1.
Featured Article:
The Race to Ban What's Bad for Us, Reason Magazine
Trans
fat, smoking, foie gras--what's next? By Nick
Gillespie December 11,
2006
Is there any doubt that the infantilization of adults
is one of the defining characteristics of contemporary politics?
Last week alone, New York City banned the use of trans fats in restaurant meals, and an Ohio law passed in
November that bans smoking in
virtually all business establishments (even in company-owned vehicles such as
trailer-truck cabs) went into effect. However different the actions may seem on
the surface, they share something all too common in today's America: They rob
us of the right to make decisions--however stupid, unwise or repugnant to
refined sensibilities--about how we want to live, work and eat.
Although "give me partially hydrogenated
vegetable oil or give me death!" is not likely to become a rallying cry
anytime soon, it's worth pausing a minute to consider the country's headlong
rush to prohibit just about anything that bureaucrats--or simple majorities of
voters--find offensive.
New York used to pride itself on being the toughest
city in the world. After passing the first municipal ban on trans fat in the
Trans fats, which are made by adding hydrogen to
vegetable oils, are the flavor-enhancing substances that make many commercially
prepared baked goods and fast foods so predictably yummy--and, alas, so
predictably artery clogging. They are reviled by physicians, nutritionists and
exercise gurus--everyone, in short, except for cooks and their customers.
So now New York City restaurants face a fine of at
least $200 per infraction come next July. For good measure, the Board of Health
also dictated that restaurants already posting nutritional information must
post calorie counts for their meals.
"We are just trying to make food safer,"
said Mayor Michael Bloomberg, who in 2002 pushed through one of the toughest
smoking bans in the country.
It's not as tough, though, as the statewide ban that
58 percent of Ohio voters approved and that now is in effect . . .
When Ohio--a bellwether state that once billed itself
as "The Heart of It All" on its license plates--mimics policies found
in New York and California (which passed the first statewide smoking ban in
1995), it's a given that no unwise, unhealthy or just unseemly choice is safe
from regulation.
Indeed, how else to explain, say, Chicago's decision
in April to ban the sale of foie gras out of concern for the geese who give their
lives--and their livers--for diners' pleasure? Observers say it's likely that
Illinois and Minnesota will be the 19th and 20th states to ban smoking in bars
and restaurants, even as cities in California and elsewhere mull the idea of
banning all smoking outside of private, single-family dwellings.
Similarly,
Such bans often are, by turns, mendacious, redundant
and likely to be ineffective. The trans fat ban, averred Bloomberg, is
"not going to take away anybody's ability to go out and have the kind of
food they want," even as it limits what ingredients can be used.
Fast food chains such as Wendy's and KFC had already
committed to ridding their menus of trans fats, as had various high-end
eateries in
It's probable that smoking bans in the workplace
encourage employees to quit or cut back. The CDC, for instance, notes that "a
2002 review of 26 studies concluded that a complete smoking ban in the
workplace reduces smoking prevalence among employees by 3.8 percent and daily
cigarette consumption by 3.1 cigarettes among employees who continue to
smoke." And there's no doubt that not smoking clears the air.
But even when bans do have an impact that most of us
would agree is positive, one-size-fits-all actions leave no place for
individuals to make some intensely personal choices.
They ignore the evolving social arrangements--such as
non-smoking sections, not to mention smoke-free businesses--that give people,
especially the 20 percent of adults who still light up regularly, more options
rather than fewer. By the time
Most important, these bans reduce all of us to the
status of children, incapable of making informed choices. Is it quaint to
suggest that there's something wrong with that in a country founded on the idea
of the individual's rights to life, liberty and the pursuit of happiness?
To read the entire article, go to www.reason.com/news/show/117171.html.
Nick Gillespie is editor-in-chief of Reason. This article originally
appeared in the Chicago Tribune.
[Nick Gillespie, PhD,
strikes a responsive chord we can relate to in medicine also being swept into the
same category as children. Doctors who spend their life taking care of people
in pain, where the sine qua non is to relieve pain, have Assembly women
in our legislature spear-heading requirements for how many hours of pain CME
(continuing medical education) each doctor should be forced to take and how
frequently. Doctors have for millennia helped people navigate their end-of-life
care, and these legislators dictate the hours of terminal care we should be
forced to take. Similar efforts are being waged for CME in HIV, geriatric, and
who knows what else.
[It would seem more
appropriate that these novices in the legislatures be required to take courses
in pain, geriatrics, end-of-life and HIV problems to give them some minimalist
understanding of the issues involved. Their action confirms that they are the
children in need of parenting since they have so little comprehension and
understanding of the issues involved. Because they also have little
understanding of the basic principles of liberty on which our country was
founded, they cannot conceivably be the parents of physicians telling them what
they must learn.]
* * * * *
2. In the News: States Struggle to Cover Retirees, By
Dennis Cauchon, USA TODAY
Medical liabilities exceed $1 trillion
Medicare unfunded liabilities rose to $32.3 trillion in 2006
State and local governments are starting
to take aggressive steps to reduce the enormous cost of providing health care
benefits to retired teachers, police officers, firefighters and other public
workers.
As 43 state legislatures prepare to
convene next month, governments are cutting benefits, setting aside money to
cover future costs and shifting expenses to the federal Medicare program. The
efforts are the first to address a liability of more than $1 trillion for
providing medical care promised to about 25 million current and future retired
state and local civil servants.
The changes are being driven by a new
accounting rule, which took effect Friday and forces states and large local
governments to report how much they owe for medical benefits promised to
retirees.
"The numbers make your jaw
drop," says
The retirement of baby boomers - 79
million born from 1946 to 1964 - will make it hard for state and local
governments to keep up with the cost of medical benefits for retirees. What
governments are doing now:
West Virginia. The state pension
board is to vote Wednesday on shifting prescription-drug coverage for retirees
to Medicare, a federal program. The change, along with making retirees pay
more, would slash the state's $8 billion unfunded liability to $5 billion.
North Carolina. Civil servants
hired after Oct. 1 will have to work 20 years before qualifying for 100%
state-paid medical coverage. Previously, workers had to wait only five years.
San Diego. The City Council this
month eliminated retiree health coverage for some workers who got big pension
hikes in 2002.
South Carolina. Republican Gov.
Mark Sanford's next budget will propose putting $245 million in a new trust
fund dedicated to retiree medical benefits. Georgia, Vermont, Virginia and New
York City also have started trust funds or plan to create them. . .
Because of soaring revenue, states haven't
had to cut other spending or raise taxes to cover retiree medical care. State
and local government attempts to shed retiree medical costs could be bad news
for Medicare because many now pay retiree health care costs that would
otherwise be paid by the federal government.
Medicare's financial situation already is
deteriorating. The government's audited financial statement, released Friday,
reported that Medicare's unfunded liability rose $2.4 trillion in 2006 to $32.3
trillion.
Unlike pension benefits, medical benefits
usually are not protected by law and can be discontinued by state legislatures.
"These benefits are affordable as long as we do something now," says
Charles Agerstrand, a retirement consultant for the Michigan Education
Association, which represents teachers. "If not, we're heading for a major
collision."
To read the original, go to www.usatoday.com/printedition/news/20061218/1a_lede18.art.htm.
* * * * *
3. International Medicine: The Treasure
of Mumbai, (Bombay) WIRED Magazine, December 2006
To Big Pharma, Indian drug maker Cipla is a pirate operation.
To the developing world, it's a vital medicine chest. And now its cheap pills
are coming to a pharmacy near you. By Erika Check
FORTY
YEARS AGO, A BRITISH COMPANY called ICI Pharmaceuticals developed a
potent high blood pressure medication called propranolol. It was the first beta
blocker, a class of drugs that inhibits fight-or-flight hormones like
adrenaline. But it was expensive. So Yusuf Hamied, a 34-year-old chemist at an
Indian drugmaker, got his company to start manufacturing a cheaper version. ICI
protested to the Indian government, and Hamied found himself face to face with
prime minister Indira Gandhi. "Should millions of Indians be denied the
use of a lifesaving drug just because the originator doesn't like the color of
our skin?" he asked her.
It was a specious argument ICI was worried about
profits, not skin color but Gandhi was persuaded. She urged parliament to
change the laws governing drug patents, making them apply not to the chemical
compounds themselves but to the processes used to manufacture them. If a
company like Hamied's could come up with a different way to make the same beta
blocker (or whatever), it could sell its own version in India free and clear.
That one law transformed India's pharmaceutical
industry. Today, Hamied's company, Cipla, is the third-largest in India, with
sales of $651 million in 2005. That's not much compared to multibillion-dollar
concerns like GlaxoSmithKline, but Cipla is still the medicine cabinet to the
developing world. As much as 40 percent of the AIDS patients in poor countries
who take medications take Cipla drugs.
What Hamied does is legal in India and the countries where
Cipla sells drugs. But the company is still making copies largely without
permission of the people who hold the patents on the compounds. So to most of
the international pharmaceutical industry, Hamied is a pirate.
He is 70, portly, with white hair and wire-frame
glasses. But his rhetoric is still inflammatory. Pacing around the Cipla
boardroom, he tells the story behind every drug the company makes, punctuating
each anecdote by pulling a box of samples from the floor-to-ceiling cabinets
and throwing it on the table. These are the copied drugs that earned Cipla its
outlaw reputation: anti-cholesterol pills, antibiotics, AIDS treatments. He
tosses in an asthma inhaler and a box of ciprofloxacin, the powerful antibiotic
popular with bioweapon-fearing Americans.
Hamied made the greatest waves last year, when global
fears of a bird flu pandemic inflated demand for oseltamivir, the only drug
thought to be effective against the disease. Its maker, Switzerland-based Roche
Pharmaceuticals, said it couldn't produce enough. Hamied stepped in, without a
license from Roche, and started manufacturing the drug with the intention of
selling it in countries where Roche didn't hold the patent and, though he
won't acknowledge it overtly, anywhere else. As is his style, Hamied made a lot
of noise about his planned defiance. He has built his business on challenging
the companies and patent structures that dominate the global drug market,
because it's a worthy cause and because it's good for his bottom line. Now the
Indian laws that let Hamied get away with all that are changing. In 2005, the
Indian government brought its patent laws in line with those of the developed
world. Indian companies can keep making certain knockoffs, but they can't copy
drugs patented after 1995 without a license. So Cipla needs a new business
model: It's going to sell legal generics to rich Americans. . .
HAMIED'S FATHER, A CHEMIST and an Indian nationalist, founded Cipla in 1935,
when there wasn't a single pharmaceutical company in the country. It was a
nation-building project; Hamied the elder wanted to do everything he could to
make India self-sufficient. His timing was perfect. Embroiled in World War II,
Great Britain asked its colonies for help, and Cipla gladly began churning out
medicines for the war effort. . .
And it's as a businessman that Hamied feels the
lopsidedness of the way drug patents work around the world. In the US and many
other countries, new drugs are patent-protected for 20 years. When a company
wants intellectual property protection in a new country, it needs a patent
there, too. After 20 years, any company can start making its own version,
called a generic.
In practice, makers like Cipla often manufacture and
sell drugs owned by other companies in countries where the patents aren't
enforced. Pharmaceutical giants like Roche or GlaxoSmithKline see that as
pirate behavior, arguing that if you start messing around with the patent
system, you take away their profit incentive to invent new medicines. According
to a 2003 study in the Journal of Health Economics, it can take 12
years and $800 million to discover one novel drug. . .
Hamied doesn't consider himself a pirate. "Cipla
never breaks the law," he says. "It lives by the law of the land it
is working with." But he doesn't deny that he feels the system favors the
rich and the Western. "The third world cannot afford the prices of
medications that are prevailing in the first world," Hamied says. "So
don't talk about patents in isolation. Talk about access to medicine at
affordable prices."
. . . Rich nations the ones responsible for propping
up the current patent system came to see the risks of the legal monopolies.
In May, the member states of the World Health Organization passed a resolution
expressing concern about the "impact of high prices of medicines on access
to treatment." The resolution also declared that patents aren't helping
poor patients get new medicines. . .
Hamied's competitors in India have vowed to expand
their R&D to compete with Big Pharma. But Hamied doesn't think it'll work.
Western drug companies feed off massive federal research grants that the Indian
government couldn't possibly match. The future, Hamied says, is legal, licensed
drugs.
Well, mostly legal. At Hamied's factory, a full ton of
powdered oseltamivir is stashed in plastic drums. A Cipla manager proudly
brandishes the tangible proof behind his boss's bluster: a plastic baggie heavy
with the stuff. He says he watches the news daily for updates. If a pandemic
hits, what does he think the Americans will do? "We are waiting," the
manager says with a smile.
To read the entire article, go to www.wired.com/wired/archive/14.12/indiadrug_pr.html.
Erika Check (erika.check@gmail.com) is a reporter for Nature in San Francisco.
Canadian Medicare does not
give timely access to healthcare, it only gives access to a waiting list.
--Canada's Supreme Court
* * * * *
4. Medicare: Probing D.C. Medicaid costs, Editorial, The
Washington Times, November 29, 2006I
In an editorial a month ago, we warned that
"Blinding Medicaid waste and abuse" had created a $22.3 million hole
in D.C. coffers. Now comes word that the failure to file the proper
reimbursement paperwork for Medicaid and Medicare services has already caused
overruns in the current budget. With the fiscal year having only started on
Oct. 1, this is a red flag neither Mayor Tony Williams nor his successor can
ignore.
D.C. Chief Financial Officer Nat Gandhi has warned
Mayor-elect Adrian Fenty that the city already has overspent by $87 million,
The Washington Post reported yesterday. That figure could rise to $300 million
next year if spending reins aren't gripped immediately. Most of the potential
shortfall is attributed to rising costs for health care, and The Post cited
higher-than-expected health-care enrollments as creating part of pressure. But
much of the fault lies with an inefficient bureaucracy.
As The Washington Times reported and editorialized
last month, an audit by the D.C. Inspector General found the city's Medicaid
program is in "serious breach of basic internal controls," with D.C.
officials spending $22.3 million on non emergency transportation for Medicaid
recipients. Problem is, they cannot determine whether the money should have
been paid or not because transportation firms filed dozens of claims for
Medicaid patients who were actually dead.
A health-insurance program for the poor, Medicaid
transportation costs have been pushing skyward for some years now. The costs
are of such concern to the 109th Congress, that as part of the Deficit
Reduction Act, it also created the Medicaid Integrity Program, granting
open-ended authority to the federal Department of Health and Human Services to
tackle Medicaid waste, fraud and abuse -- authority that was relegated
previously to the states. The District, amid its spending frenzy on
nonemergency transportation, didn't catch on. As we said in our Oct. 27
editorial, "We could point fingers at City Hall... This time, though, we
are just grateful that the feds are looking in the right direction."
Indeed, while federal and local auditors scrutinize
the District's Medicaid spending habits, Congress has put City Hall on notice,
too. Sens. Charles Grassley and Max Baucus, the chairman and ranking member of
the Senate Finance Committee, said in a Nov. 17 letter to the D.C. inspector
general that they want details on "all ongoing audits, evaluations and
investigations that examine the Medicaid program in the District of
Columbia." And well they should: National nonemergency Medicaid transportation
costs have reached $1.5 billion -- a 48 percent increase since the 1999-2003
period.
This isn't the first time the District has been warned
about its egregious Medicaid offenses. As the senators say in their letter,
previous probes have cited "unnecessary trips and excessive claims as well
as billing Medicaid for trips never provided."
The D.C. lawmaker chiefly responsible for Medicaid
oversight, David Catania, told reporter Jim McElhatton that he was
"delighted" with the steps City Hall has taken to reform the
Medicaid. We do not share Mr. Catania's enthusiasm. Neither the District nor
the several states that are wasting tax dollars should be let off the hook. We
thank the senators for their ongoing inquiry, and hope they continue with the
knowledge that bureaucracies like the District's don't quickly reform
themselves.
www.washingtontimes.com/functions/print.php?StoryID=20061128-085041-7870r
Government
is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
5.
Medical
Gluttony: Hospitals Need Professional
Homicide to Eliminate Unwanted Doctors
PEER REVIEW, the protected legal milieu that
allowed doctors to review each other to improve their practice without fear of
retribution, was corrupted some twenty years ago. Doctors were supposed to be
the most objective in their judgments of any profession. But it turned out that
doctors are some of the most opinionated people of any profession.
Hospitals began having their doctors on
payroll review charts of the doctors they wished to remove from their staff for
various economic reasons. Essentially all medical records are at variance with
what other doctor's think is the best of care. We have all experienced national
medical conferences where professors from one institution may be 180 degrees in
opposition to a specific mode of diagnosis or treatment. By having their own
selected physicians be on the reviewing committee, the hospitals were able to
remove physicians they felt undesirable for a variety of reasons. The courts
were reticent to interfere with hospital internal matters. So, this destruction
of physicians has been able to proceed relatively unchallenged for decades.
For an excellent overview of Peer Review
and how it has been abused, read Dr. Larry Huntoon's review of the subject by
clicking on his article at www.jpands.org/jpands1102.htm.
Recently Dr. Huntoon spoke at a town hall
meeting explaining the process of Peer Review and Abusive Peer Review. He was
shocked when a member of the hospital board tried to justify Abusive Peer
Review as being an appropriate way to remove undesirable physicians.
Anna Marie
Silvas, a member of the Christus Spohn Hospital Beeville advisory board, tells
those gathered at Thursday night's town hall meeting on hospital-physician
relations that sham peer review is a useful tool for hospitals to remove
troublesome physicians.
Local physicians replied that there is no
place in the medical industry for sham peer reviews. www.bee-picayune.com/story65.shtml
The very concept that physicians who have probably
spent a quarter million dollars of their parent's resources obtaining a medical
education, with the institution probably investing an equal amount in providing
the structure of this education, can have this investment terminated for
non-medical reason without due process is a travesty of our American Judicial
System. To toss a half million-dollar investment in healthcare out of the
window is an extreme form of not only Medical Gluttony, but of the destruction
of a human being (professional homicide) and his family. That hospitals are
able to do this is a serious blight on American health care. No wonder doctors
are afraid to speak out and be an effective force in shaping America's health
care. Who wants to volunteer for the guillotine?
To read a series of insightful articles by attorneys
and others that we published while I served as editor of Sacramento Medicine,
please go to www.delmeyer.net/HMCPeerRev.htm.
* * * * *
When cardiac surgeons stop the heart while working on them,
the patient is under anesthesia. There is obviously no pain and it really
doesn't matter how many minutes it takes to stop the heart and later to restart
it. The period in between is really a cardiac arrest, which is what is trying
to be obtained in the execution chambers. Of course, there are no physicians
present for ethical reasons.
That a judge would think that a killer being executed
and the technician after giving the anesthesia takes a bit longer to get his
heart stopped and then to think the killer is suffering while unconscious, is a
total disconnect with reality.
Cal Thomas reports: In California, U.S. District Judge
Jeremy D. Fogel declared California's execution procedure unconstitutional and
lethal injections -- the preferred execution method in 37 states -- an offense
to the ban on cruel and unusual punishment.
One wishes such considerations were available to
relatives of the deceased, and to the deceased themselves. Diaz spent more than
two decades in prison before he was executed. That probably inflicted cruel and
unusual punishment on the relatives of his victim.
According to court records, Diaz was convicted of
second-degree murder in his native Puerto Rico. He escaped from prison there
and also from Connecticut's Hartford Correctional Center in 1981. In Hartford,
he held one guard at knifepoint while another was beaten. Diaz was responsible
for three other inmates escaping with him.
As to the constitutional issue regarding cruel and
unusual punishment, here too some history may be helpful. This is why
"original intent" of the founders is important to consider, because
what they meant by the phrase and what we think we believe about it differs
considerably.
At the time the Bill of Rights was written, the
authors specifically sought to ban such execution methods as burning at the
stake, crucifixion and breaking on the wheel.
To understand this in perspective, read the entire
OpEd by Cal Thomas: The cruel and unusual in punishment at www.sacbee.com/110/v-print/story/94627.html.
Looks like Federal Judges are more in need of End of
Life and Pain Education than Physicians.
It would be appropriate if judgments were based on
facts.
* * * * *
7.
Overheard in the
Medical Staff Lounge: Physicians are Back in Kindergarten
Dr. Sam: I
can't believe the loops we have to go through in our office in order to get
paid. We sent our end-of-the-month statements and the patients were irate. They
said these are bills from 2005? Why are you billing me now?
Dr. Dave: What
did they say after you told them?
Dr. Sam: I asked my billing clerk, "Did you tell
them we've been working on their insurance for more than a year. Isn't that
enough? Don't you think it's about time we got paid?"
Dr Dave: What
kind of response did she get?
Dr Sam: She
said she didn't confront them. That would have gotten us into trouble with the
insurance carrier. Can you believe after a year of insults, we can't be frank
about reality and instead have to bend over and just take a spanking like we
did in kindergarten?
Dr. Yancy: I
don't bend over for anyone. When I get done with an operation, I enter the
details into my Palm Pilot, and download it into my computer as soon as I get
to the office and send the patient the first statement with a warning that if
their insurance company doesn't respond within 30 days, I expect payment.
Dr. Dave: You
surgeons can get their attention with a $1,500 bill. If I did that with every
$150 office call, my CPA says I would lose 10 percent of the fee with each
statement.
Dr. Rosen: The insurance
company can play games with the $150 charges. They know you can't take any
significant legal action, paying an attorney $300 an hour to collect a few $150
bills.
Dr. Patricia: I see
you guys are getting close to agreeing with me. Let the government take over
and get rid of the insurance companies. Then we'll get a check every two weeks.
Dr. Sam: Or
every month or three? Have you forgotten the September "No Check-Write for
two weeks" already? And no make-up checks that I could determine with a
slight blip in income. I'm beginning to understand that wasn't really a loan
from doctors for fiscal reasons. It was pure harassment, causing confusion in
doctors' billing offices, and elimination of income.
Dr. Patricia: But if we were dependent on the government for our
entire income, they would be our friends and would treat us better. We would
all get government salaries. Like the VA or the Military doctors. They get paid
on time, every two weeks or every month.
Dr. Rosen: But
if there were no private practice competition, the government doctors' salaries
would slowly edge downward to make room for the administrators' salaries to
migrate upwards. The government will never be the doctor's friend. And we must
make sure that we are never the government's patsies. We should sever our
Medicare and Medicaid ties and sink or swim. I know we will swim quite well
after the third time we come up for air.
To read more staff room talk, go to www.medicaltuesday.net/archives/july1106.htm#OVERHEARD.
* * * * *
8. Voices of Medicine: A Review of What Doctors Say in
the Regional Medical Journals
Hippocrates Upended: A Cause for Revaluation of the
American Physician By Donald J. Prolo, M.D.
What the earthquake of 1906 did to the Bay Area, World
War II in 1941 and the advent of Medicare in 1965 did to the American
physician. Let us look at the parallels. Before Hippocrates, physicians could
be hired as assassins to do in an enemy or facilitate the premature demise of a
parent for early inheritance. Now physicians are paid to perform according to
the bureaucratic formulas and edicts of the federal government, business
groups, insurance companies, HMOs and IPAs. Lost in this third-party deluge of
financial forces is the primacy, prestige and freedom of a properly educated
and licensed physician to act and advocate entirely for the patient, as well as
the patient's freedom to choose a physician and to expect that physician to
honor a sacred bond of trust. American medicine has been reduced to
considerations of what percent of gross domestic product can be spent on
healthcare, how many forms can reasonably be completed before a third party
will pay, whether an insurer will allow an assistant at surgery, and how fast a
patient can be rushed through an examination or discharged from the hospital.
The impact of these exactions on the value of both the
patient and the physician is enormous. Our contemporary ethos is to devalue
patients, their physicians, and their bond of trust in order to legitimize
payer coercion. The patient becomes a pawn, the doctor becomes a wage slave,
and both lose their freedom to aspire to and achieve their highest hopes and
calling.
If the dignity and stature of physicians are not
universally idealized societal values, then patients cannot be healed. A sick,
fragile human, ravaged by physical and/or emotional illness, surrenders himself
or herself to the mercy and unmitigated loyalty of a physician. This experience
is not analogous to standing in line awaiting service from a bank teller
or a grocery clerk. This profound act of self-exposure and trust by a patient
to the skills and mercy of a physician is a difference in kind from all other
human interactions, not a difference in degree.
Societies do not grant this privilege casually:
Consider the rigorous and prolonged educational process, national board examinations,
licensure, specialty training, specialty board certification, and maintenance
of certification and recertification. Paradoxically, the federal government and
its echoing chorus of commercial business and payers now expect the physicians
to behave as drones, groveling annually to the Congress for their share of a
diminishing handout. The fact is that it is only collectively through our
professional associations that we can respond in an effective manner. It has been stated, "Medicine is, at its
center, a moral enterprise grounded in a covenant of trust. This covenant
obliges physicians to be competent and to use their competence in the patient's
interests. Today, this covenant of trust is significantly threatened. By its
traditions and very nature, medicine is a special kind of human activity - one
that cannot be pursued effectively without the virtues of humility, honesty,
intellectual integrity, compassion and effacement of excessive self-interest.
Our first obligation must be to serve the good of those persons who seek our
help and trust us to provide it." "Ask not what organized medicine
can do for you; ask what we can do for our patients." The strangulating
grip of third-party influence destroying health care over financing issues must
be broken.
Let us insist on revaluation of the American
physician as the cornerstone critical to the healing power of physicians.
Let us pledge eternal warfare against
influences and health systems that violate our calling.
Let us renew our commitment to the 2,400-year-old Oath
of Hippocrates, immortalizing the patient-physician covenant.
To read the original along with the references, please
click on Hippocrates at
www.csahq.org/pageserver.cgi?tpl=internal.tpl§ion=publications&name=bulletin_view&idx=14.
Donald Prolo, M.D., is a neurosurgeon practicing in
San Jose, California. He is the past president of the California Association of
Neurologic Surgeons and the president of the Santa Clara County Medical
Association. He also serves on the Executive Committee of the Specialty
Delegation to the California Medical Association.
To
read the Voices of Medicine Archives, please go to www.healthcarecom.net/voicemed.htm.
* * * * *
9.
Book Review:
Books From The Physician/Patient Bookshelf Archives
THE BEST OF MEDICAL HUMOR - A Collection of Articles,
Essays, Poetry, and Letters Published in the Medical Literature, 2nd Edition, By Howard J Bennett, MD
Just as medical texts required second and further
revisions on a regular basis, Dr Howard Bennett revised his book on Medical
Humor because humor changes. Over 50% of this edition is new. On the faculty of
George Washington University School of Medicine in Washington, DC, Bennett did
extensive library research to collect witty, humorous aphorisms and items as
the subtitle states. This is not a joke book. It won't make an audience belly
laugh or fall out of their seats. But it will make you smile and feel good.
Just seeing the informed consent for a hernia with
signature lines of the patient, his lawyer, the doctor's lawyer, the hospital's
lawyer, the anesthesiologist's lawyer, the mother-in-law, and the notary public
will allow you to see today's realities, reflect on them, and decide that we've
gone too far and pull back to the real realities.
He found a pulmonary fellow who sent his wife a
valentine when he thought that the cardiac system was receiving far too much
attention: Roses are red, Violets are blue, Without your lungs, Your blood
would be too.
There are short witty essays "On the Professional
Patient," "Dial a Lawyer," "PostMortem Medicine--A New
Specialty," "Managed Care: The Fast-Food-for-Thought Therapy
Approach," all with references for further reading! His Medical Horoscopes
is rather ingenious. This is just a wonderful volume to have within reach when
inspiration fails or the mood simply needs elevating.
To read more reviews, please go to www.delmeyer.net/PhysicianPatientBookshelf.htm.
* * * * *
10. Hippocrates & His Kin: From Our Archives:
Government Logic
The
government ran out of funds and Newt Gingrich was in charge. He did what
any respectful business does. Cut spending and layoff excessive staff. Actually
the government ran out of funds decades ago but there is a renegade crowd in
D.C. that is calling a spade a shovel, or rather a spoon. When the government
shut down by calling off 800,000 nonessential workers, David Lettermen
commented that maybe we have found the cause of our national problem . . .
Jackie Mason, on CNN, stated that it was obvious that the 40% put on furlough
should not be rehired. Since the other 60% didn't seem to be exerting
themselves to get additional work done, he suggested that another 10% or half
of the 2 million federal workers should be furloughed . . . Debra Saunders in
the SFChronicle, commenting on this showdown, stated that the $66 per year
Medicare premium increase is reasonable since retirees are getting $126,700
more in lifetime benefits than they paid into the system. . . The national debt
monitor near
Newt, where are you now when we need you?
Doctors'
incomes continue to fall. The current estimate is that after paying over
$180,000 in expenses, we make about $150,000 for our 3000-hour year which is
about $50 an hour. About the same as the "handy man" that fixed the
skylight and ceiling in my office. Except we had to have an extra 12 years of
higher, professional and post doctoral education to allow us to make this
humongous hourly wage.
Another prediction missed the mark: The SF-based Pew Health Professions Commission, a
private foundation of 21 experts from universities, the health care and health
insurance industries, and other private and public organizations, predicts that
in 2007 there will be a surplus of at least 100,000 doctors, 200,000 nurses and
40,000 pharmacists. They recommend closing one-fifth of the medical schools and
dramatically reducing the FMG's in US residencies. They attribute the surplus
in medical professionals to the government subsidies in the 1960s and 1970s,
which encouraged the excessive construction of medical schools, and to managed
care... But without the government push to increase medical school enrollment
and residency programs, neither the mass importing of FMGs or managed care
would have occurred. Nearly all our current ills are caused by government
planning. Unfortunately, much of government planning is done by physicians in
the bureaucracy. The challenge is how can we keep from hurting ourselves.
Von Gordon Sauter, Former CEO of KVIE Channel 6
(Public/Government TV) spoke at a meeting of the Comstock Club. As you know,
some people inside of public radio and TV are bemoaning shrinking government money.
Sauter replied, "Once the government gives you money, you accept the
government concept on how you will proceed. Government money does not help . .
."
And with that, we wish everyone a Merry Christmas and
a professionally satisfying Happy New Year.
And may you have less trouble than Santa, courtesy of
Dr Ron Virmani.
SANTA'S TROUBLES.
"Twas the night before
Christmas and Santa's a wreck!
How to live in a world that
is politically correct?
Four reindeers just vanished
without much propriety,
Released to the wild by the
Humane society.
His workers would no longer
answer to "elves"
"Vertically
challenged" they were now calling themselves.
Both the hours and
conditions at the North Pole
Were alleged by their union
to stifle the soul.
Equal employment had made it
quite clear
He had better not employ
only reindeer.
So Dancer & Donner,
Commet & Cupid
Were replaced with four
pigs, which really looked stupid.
All the runners were removed
from Santa's sleigh;
The ruts were deemed
dangerous by the E.P.A.!
Besides, people had started
to call the cops,
When they heard noises on
their rooftops.
To demonstrate the
strangeness of life's ebbs & flows,
Rudolph was suing for
unauthorized use of his nose.
He went on Geraldo, & in
front of the nation,
He demanded several million
in compensation.
Half the reindeers were
gone, along with his wife,
Who suddenly decided she'd
had enough of this life.
She joined a self-help
group, & left in a whiz,
Demanding forevermore he
addressed her as Ms.
As for the gifts, why he had
ne'er a notion
That making choice would
cause such commotion.
Nothing of leather, nothing
of fur,
This meant nothing for him,
& nothing for her.
Nothing that might be
construed to pollute,
Nothing to aim and nothing
to shoot.
Nothing that clamored or
made lots of noise;
Nothing for just girls, or
just for the boys.
Nothing that hinted of being
gender specific,
And nothing that's warlike
or non-pacifistic.
No candy or sweets
they're
bad for the tooth,
And nothing that seems to
embellish the truth.
So Santa just stood there,
disheveled, perplexed,
He simply couldn't figure
out what to do next.
He tried to be merry, he
tried to be gay,
But one has to be careful
with that word today
His sack was quite empty,
flung to the ground.
Could anything acceptable
ever be found?
Something special was
needed, a gift that he might
Give to all without angering
the left or the right.
An offering that would
satisfy, with no indecision,
Each group of people, every
religion.
So here is his gift, its
price beyond worth ---
"May you & your
loved ones enjoy Peace on Earth!"
Thanks Ron.
* * * * *
11. Physicians Restoring Accountability in Medical
Practice, Government and Society: