MedicalTuesday

1. Featured Article: Rethinking the Social Responsibility of Business: A Reason Debate featuring Milton Friedman, Whole Foods’ John Mackey, and Cypress Semiconductor’s T.J. Rodgers

[The current issue of Fast Company, www.fastcompany.com/homepage/index.html, discusses the top 25 socially responsive corporations in the world. This week we feature a Reason Magazine debate by three world-renowned experts discussing the social responsibility of business. To participate in this debate, please enter your response in our BLOG at www.medicaltuesday.blogs.com/.]

Thirty-five years ago, Milton Friedman wrote a famous article for The New York Times Magazine whose title aptly summed up its main point: “The Social Responsibility of Business Is to Increase Its Profits.” The future Nobel laureate in economics had no patience for capitalists who claimed that “business is not concerned ‘merely’ with profit but also with promoting desirable ‘social’ ends; that business has a ‘social conscience’ and takes seriously its responsibilities for providing employment, eliminating discrimination, avoiding pollution and whatever else may be the catchwords of the contemporary crop of reformers.”

Friedman, now a senior research fellow at the Hoover Institution and the Paul Snowden Russell Distinguished Service Professor Emeritus of Economics at the University of Chicago, wrote that such people are “preaching pure and unadulterated socialism. Businessmen who talk this way are unwitting puppets of the intellectual forces that have been undermining the basis of a free society these past decades.”

John Mackey, the founder and CEO of Whole Foods, is one businessman who disagrees with Friedman. A self-described ardent libertarian whose conversation is peppered with references to Ludwig von Mises and Abraham Maslow, Austrian economics and astrology, Mackey believes Friedman’s view is too narrow a description of his and many other businesses’ activities. As important, he argues that Friedman’s take woefully undersells the humanitarian dimension of capitalism.

In the debate that follows, Mackey lays out his personal vision of the social responsibility of business. Friedman responds, as does T.J. Rodgers, the founder and CEO of Cypress Semiconductor and the chief spokesman of what might be called the tough love school of laissez faire. Dubbed “one of America’s toughest bosses” by Fortune, Rodgers argues that corporations add far more to society by maximizing “long-term shareholder value” than they do by donating time and money to charity.

Reason offers this exchange as the starting point of a discussion that should be intensely important to all devotees of free minds and free markets. www.reason.com/0510/fe.mf.rethinking.shtml
Comments should be sent to letters@reason.com.

Putting Customers Ahead of Investors by John Mackey

In 1970 Milton Friedman wrote that “there is one and only one social responsibility of business—to use its resources and engage in activities designed to increase its profits so long as it stays within the rules of the game, which is to say, engages in open and free competition without deception or fraud.” That’s the orthodox view among free market economists: that the only social responsibility a law-abiding business has is to maximize profits for the shareholders.

I strongly disagree. I’m a businessman and a free market libertarian, but I believe that the enlightened corporation should try to create value for all of its constituencies. From an investor’s perspective, the purpose of the business is to maximize profits. But that’s not the purpose for other stakeholders—for customers, employees, suppliers, and the community. Each of those groups will define the purpose of the business in terms of its own needs and desires, and each perspective is valid and legitimate.

My argument should not be mistaken for a hostility to profit. I believe I know something about creating shareholder value. When I co-founded Whole Foods Market 27 years ago, we began with $45,000 in capital; we only had $250,000 in sales our first year. During the last 12 months we had sales of more than $4.6 billion, net profits of more than $160 million, and a market capitalization over $8 billion.

But we have not achieved our tremendous increase in shareholder value by making shareholder value the primary purpose of our business. In my marriage, my wife’s happiness is an end in itself, not merely a means to my own happiness; love leads me to put my wife’s happiness first, but in doing so I also make myself happier. Similarly, the most successful businesses put the customer first, ahead of the investors. In the profit-centered business, customer happiness is merely a means to an end: maximizing profits. In the customer-centered business, customer happiness is an end in itself, and will be pursued with greater interest, passion, and empathy than the profit-centered business is capable of.

Not that we’re only concerned with customers. At Whole Foods, we measure our success by how much value we can create for all six of our most important stakeholders: customers, team members (employees), investors, vendors, communities, and the environment . . .

[T]here can be little doubt that a certain amount of corporate philanthropy is simply good business and works for the long-term benefit of the investors. For example: In addition to the many thousands of small donations each Whole Foods store makes each year, we also hold five 5% Days throughout the year. On those days, we donate 5 percent of a store’s total sales to a nonprofit organization. While our stores select worthwhile organizations to support, they also tend to focus on groups that have large membership lists, which are contacted and encouraged to shop our store that day to support the organization. This usually brings hundreds of new or lapsed customers into our stores, many of whom then become regular shoppers. So a 5% Day not only allows us to support worthwhile causes, but is an excellent marketing strategy that has benefited Whole Foods investors immensely . . .

Read the remainder of Mackey’s presentation at www.reason.com/0510/fe.mf.rethinking.shtml.

Making Philanthropy Out of Obscenity by Milton Friedman

By pursuing his own interest [an individual] frequently promotes that of the society more effectually than when he really intends to promote it. I have never known much good done by those who affected to trade for the public good. —Adam Smith, The Wealth of Nations

The differences between John Mackey and me regarding the social responsibility of business are for the most part rhetorical. Strip off the camouflage, and it turns out we are in essential agreement. Moreover, his company, Whole Foods Market, behaves in accordance with the principles I spelled out in my 1970 New York Times Magazine article.

With respect to his company, it could hardly be otherwise. It has done well in a highly competitive industry. Had it devoted any significant fraction of its resources to exercising a social responsibility unrelated to the bottom line, it would be out of business by now or would have been taken over.

Here is how Mackey himself describes his firm’s activities:

1) “The most successful businesses put the customer first, instead of the investors” (which clearly means that this is the way to put the investors first).

2) “There can be little doubt that a certain amount of corporate philanthropy is simply good business and works for the long-term benefit of the investors.”

Compare this to what I wrote in 1970:

“Of course, in practice the doctrine of social responsibility is frequently a cloak for actions that are justified on other grounds rather than a reason for those actions.

“To illustrate, it may well be in the long run interest of a corporation that is a major employer in a small community to devote resources to providing amenities to that community or to improving its government .…

“In each of these…cases, there is a strong temptation to rationalize these actions as an exercise of ‘social responsibility.’ In the present climate of opinion, with its widespread aversion to ‘capitalism,’ ‘profits,’ the ‘soulless corporation’ and so on, this is one way for a corporation to generate goodwill as a by-product of expenditures that are entirely justified in its own self-interest. . . .

Finally, I shall try to explain why my statement that “the social responsibility of business [is] to increase its profits” and Mackey’s statement that “the enlightened corporation should try to create value for all of its constituencies” are equivalent. To read the remainder of Milton Friedman’s response, please go to www.reason.com/0510/fe.mf.rethinking.shtml.

Put Profits First by T.J. Rodgers

John Mackey’s article attacking corporate profit maximization could not have been written by “a free market libertarian,” as claimed. Indeed, if the examples he cites had not identified him as the author, one could easily assume the piece was written by Ralph Nader. A more accurate title for his article is “How Business and Profit Making Fit Into My Overarching Philosophy of Altruism.”

Mackey spouts nonsense about how his company hired his original investors, not vice versa. If Whole Foods ever falls on persistent hard times—perhaps when the Luddites are no longer able to hold back the genetic food revolution using junk science and fear—he will quickly find out who has hired whom, as his investors fire him . . .

My company, Cypress Semiconductor, has won the trophy for the Second Harvest Food Bank competition for the most food donated per employee in Silicon Valley for the last 13 consecutive years (1 million pounds of food in 2004). The contest creates competition among our divisions, leading to employee involvement, company food drives, internal social events with admissions “paid for” by food donations, and so forth. It is a big employee morale builder, a way to attract new employees, good P.R. for the company, and a significant benefit to the community—all of which makes Cypress a better place to work and invest in. Indeed, Mackey’s own proud example of Whole Foods’ community involvement programs also made a profit. . . .

If one goes beyond the sensationalistic journalism surrounding the Enron-like debacles, one discovers that only about 10 to 20 public corporations have been justifiably accused of serious wrongdoing. That’s about 0.1 percent of America’s 17,500 public companies. What’s the failure rate of the publications that demean business? (Consider the New York Times scandal involving manufactured stories.) What’s the percentage of U.S. presidents who have been forced or almost forced from office? (It’s 10 times higher than the failure rate of corporations.) What percentage of our congressmen have spent time in jail? The fact is that despite some well-publicized failures, most corporations are run with the highest ethical standards—and the public knows it. Public opinion polls demonstrate that fact by routinely ranking businessmen above journalists and politicians in esteem.

I am proud of what the semiconductor industry does—relentlessly cutting the cost of a transistor from $3 in 1960 to three-millionths of a dollar today. Mackey would be keeping his business records with hordes of accountants on paper ledgers if our industry didn’t exist. He would have to charge his poorest customers more for their food, pay his valued employees less, and cut his philanthropy programs if the semiconductor industry had not focused so relentlessly on increasing its profits, cutting his costs in the process. Of course, if the U.S. semiconductor industry had been less cost-competitive due to its own philanthropy, the food industry simply would have bought cheaper computers made from Japanese and Korean silicon chips (which happened anyway). Layoffs in the nonunion semiconductor industry were actually good news to Whole Foods’ unionized grocery store clerks. Where was Mackey’s sense of altruism when unemployed semiconductor workers needed it? Of course, that rhetorical question is foolish, since he did exactly the right thing by ruthlessly reducing his recordkeeping costs so as to maximize his profits. To read the remainder of Mr Rodgers’ report as well as the rebuttals, please go to the original article at www.reason.com/0510/fe.mf.rethinking.shtml.

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2. In the News: A Tribute to Peter Drucker By STEVE FORBES WSJ, November 15, 2005; Page A22 What made Peter Drucker, who died last Friday [November 11, 2005] just shy of his 96th birthday, the most influential management guru of the modern era?

Mr. Drucker's genius for extraordinarily farsighted insights came from a combination of intense curiosity, right principles and deep understanding of the perfections and imperfections of human nature. He never went stale intellectually, which is why business journalists, executives, entrepreneurs, leaders of nonprofit institutions, students and the occasionally wise politician eagerly sought to pick his brains right up to the time he died.

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What helped make Mr. Drucker so insightful was a profound understanding of economics, an understanding that still eludes most economists today. Not for him was the notion of "macroeconomics," of seeing the economy as something of a machine that can achieve steady, stable growth. To him, traditional economic notions of "equilibrium" or Keynesian ideas of "aggregate demand" were nonsense. Innovation, constant change, and turmoil were the true constants of a progressing economy.

No surprise that the economist fellow-Austrian (at least by birth) Joseph Schumpeter was Mr. Drucker's hero. In 1983, at the centennial of both Schumpeter and the then-legendary John Maynard Keynes, Mr. Drucker wrote in Forbes that Schumpeter's centenary birthday would hardly be noticed. Yet "Schumpeter it is who will shape the thinking and inform the questions on economic theory and economy policy for the rest of this century, if not for the next 30 or 50 years." Today Schumpeter's emphasis on the crucial importance of entrepreneurship and "creative destruction" are now commonplaces . . .

B.C. Forbes, our company's founder, who came to this country 100 years ago with little education and even less money, liked to say that you learn more about a company's prospects from observing its "head knocker" (what he called CEOs) than you will from its balance sheet. Mr. Drucker spent a lifetime hammering home the point that people are key. For instance, a leader who looks at workers as a cost instead of a resource is fatally flawed.

No surprise he long recognized the importance of entrepreneurs: "All great change in business has come from outside the firm, not from inside."

Mr. Drucker's ability to prophesy -- almost always correctly -- was uncanny. All of this is why he could come up with innovations that now seem commonplace, such as management by objective. He continued to admonish executives to carve out time to think and make careful decisions, to focus on one or two tasks, to delegate to others what you can't do well yourself. That's why, for example, Mr. Drucker remained a one-man shop, a soloist; he could easily have founded a large consulting firm and gotten immensely rich. But that would have gone against his profoundest instincts. He was at his best as a teacher -- gathering information, gaining insights and then getting others to gain understanding. Schumpeter believed asking the right questions was more important than the answers. Mr. Drucker agreed -- to a point, anyway.

Decades ago, Mr. Drucker foresaw the rise of "knowledge workers." After World War II, he realized the far-reaching consequences of the GI Bill of Rights, which enabled millions of veterans to go to college, thus leading him to predict long before computer chips and the Internet that "knowledge workers" would replace manual workers. Mr. Drucker also prophesied the breakdown of the traditional, thoroughly integrated, hierarchal industrial corporation. In the 1950s, he predicted the rise of Japan as a major economy, an astonishing insight when many experts thought the country would forever be a nation of small farmers and manufacturers of cheap, shoddy goods. He also saw Japan's subsequent troubles -- an aging population and lack of vigorous entrepreneurship and worker flexibility.

Mr. Drucker long ago warned of the consequences of the rise of corporate and government pension funds, and the impact these vast accumulations of money -- and thus power -- would have on corporate governance, years before anyone had heard of Calpers. He also warned of a backlash from the extraordinary rise in CEO pay. "In the next economic downturn," he told Forbes readers nearly a decade ago, "there will be an outbreak of bitterness and contempt for these super corporate chieftains who pay themselves millions. In every major economic downturn in U.S. history, the villains have been the heroes during the preceding book."

Mr. Drucker also told us to expect enormous changes that will come in higher education, thanks to the rise of satellites and the Internet. "Thirty years from now big universities will be relics. Universities won't survive. It is as large a change as when we first got the printed book." He believed "High school graduates should work for at least five years before going on to college." It will be news to most college presidents and a lot of alumni that "higher education is in deep crisis. Colleges won't survive as residential institutions. Today's buildings are hopelessly unsuited and totally unneeded." All this from a life-long academic. . . .

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How higher education is managed did not impress Mr. Drucker; but what did is our continuing education system, whether in community colleges or by computers. Also: "Our most important education system is in the employees' own organization." That is where most Americans learn the most. Mr. Drucker also came up with the admonition of pursuing your opportunities and cutting your losses: "A critical question for leaders is 'When do you stop pouring resources into things that have achieved their purpose?'" As he repeatedly told Pastor Rick Warren, founder of the 15,000 member Saddleback Community Church in Lake Forest, Calif., and who has helped start another 60 churches around the world, "Don't tell me what you are doing, Rick, tell me what you stopped doing."

Until his last breath, Mr. Drucker himself never stopped doing and doing.

Mr. Forbes is president & CEO of Forbes, Inc. and editor-in-chief of Forbes magazine.

http://online.wsj.com/article_print/SB113202508406497251.html (Subscription required)

Refusing to play the academic game By Simon London in the Financial Times

If a young Peter Drucker turned up today at a top-flight business school he would not be considered for an assistant professorship, let alone tenure. The most influential management thinker of the modern era, who died last week aged 95, refused to play the academic game. He declined to publish in obscure journals, to fill his papers with redundant algebra, to narrow his field of vision when an understanding of management demanded breadth.

To academics, this meant Drucker’s work lacked rigour. Yes, he was learned and perceptive. But where were the sampling methodologies and statistical regressions? How could you take seriously a man who preferred to write for newspapers than for the International Journal of Operations and Production Management? The decades-long stand-off meant that Drucker never held a faculty position at Harvard, Stanford, Wharton, Kellogg or the other powerhouses of US management research. http://news.ft.com/cms/s/b0f14194-5600-11da-b04f-00000e25118c.html

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3. International Medicine: British Doctors Are Europe’s Richest by Sarah-Kate Templeton and Jon Ungoed-Thomas, The Sunday Times – Britain - December 11, 2005

BRITISH doctors now earn more than their counterparts on the Continent, according to a new study. It has revealed that hospital consultants’ salaries increased by more than 30% between 2000 and 2004.

British consultants and GPs are now better off than medical specialists in France, Germany and Denmark.

Despite the increases, consultants are asking for a pay rise of 4.5% — almost twice the rate of inflation. Their average annual earnings exceeded £94,000 in 2004. These pay increases were accelerated after consultants agreed changes to their National Health Service contracts two years ago in return for pay rises . . .

A separate report reveals that 43% of GPs were paid more than £100,000 a year in 2004, compared with 23% the previous year, making them the best paid in Europe. . . .

Half the extra £5.9 billion invested in the NHS in the past financial year has gone on extra pay and pensions, according to official figures.

While health experts say pay increases were required to reward nurses and recruit lower-paid staff, the rises for consultants and GPs have been criticised for being too generous. The contracts for consultants limited their basic working week to 40 hours.

GPs have also enjoyed large pay rises from new contracts, in which they are paid more for treating vulnerable groups and meeting new health targets. The contracts also allow GPs to stop providing out-of-hours cover. If they provide such cover they are paid more.

Dr Des Spence, a Glasgow GP, said the extra money was counterproductive. “My wage has doubled in the past 10 years,” he said. “Giving GPs this amount of money may even make staffing resources worse, because GPs have no need to do extra work out of hours.

“This increase in money has not been translated into improvements in patient care.”

NHS expenditure on doctors has doubled in the past five years. In 1999 the NHS spent £3 billion on their pay, increasing to £6 billion in 2004. The pay rise has not been matched by any significant increases in productivity.

The Office for National Statistics (ONS) has calculated that between 1997 and 2003 doctors’ productivity fell by an average of about 0.75%.

The government argues the ONS figures do not take into account the quality of care. Sir Nigel Crisp, the NHS chief executive, said deaths from heart disease and cancer were continuing to fall as hospital services improved.

The BMA said the 4.5% pay claim for next year is necessary to ensure consultants are retained in the NHS. Dr Paul Miller, chairman of the BMA’s consultants’ committee, said: “Almost eight out of 10 consultants say they plan to retire early. This would be disastrous for the health service. The NHS should be doing all it can to retain consultants.” . . .

Dentists have also enjoyed generous salary rises and are among the best paid in Europe. An independent report, the EU Manual of Dental Practice, reveals dentists in general practice are paid more than counterparts in France and Germany.

Patricia Hewitt, the health secretary, has warned that the large increases for doctors should stop. She is backed by hospital managers who say any further pay rises above inflation for consultants would result in cuts to hospital services, including equipment, medicines and staff.

A survey by the NHS Confederation, which represents hospital managers, showed the vast majority of chief executives do not believe higher pay for nurses and doctors is affordable.

Alastair Henderson, deputy director of NHS Employers, the part of the confederation dealing with pay, said: “If you take more money for one area, such as staff salaries, there is less for other patient services, such as equipment, medicines and employing more staff.”

Additional reporting: Tom Baird

www.timesonline.co.uk/article/0,,2087-1920107,00.html

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4. Medicare: Doctors Tell Congress: Keep Your Medicare Money!

Oppose Pay Raise, Support More Autonomy Instead

Washington – We don’t want your pay raise, says a leading physician group, responding to the American Medical Association’s effort to stop payment cuts scheduled to go into effect beginning in January 2006, and replace them with a pay raise.

In a memo sent to Members of Congress today, the Association of American Physicians and Surgeons writes: “Some other medical groups have been telling you that proposed cuts in physician payments will harm seniors by creating a crisis in access to physicians. But we disagree. There’s already a problem, and it has nothing to do with the new rates.”

In ads and on their website, the AMA says that its survey shows that 38% of its members will cut the number of new Medicare patients they accept if the first round of cuts goes into effect in 2006. They not only call for a halt to the cuts, but a change in the Sustainable Growth Rate (SGR) that would provide for pay raises in 2006 and subsequent years.

In its memo, AAPS refutes the AMA conclusions and tells the government they don’t [want] a pay raise, but instead lays out the case for less government interference.

“But those numbers are extremely misleading because it’s not all about the money.

“Our surveys show many physicians ALREADY refuse new Medicare patients. In fact, about 33%. But even more alarming is that 40% already restrict services the services they’ll perform to current Medicare patients. (See Disheartened Doctors, Patient Problems: AAPS Biannual Survey of Physicians on Medicare and Patients’ Access to Care, Journal of American Physicians & Surgeons, Winter 2004.)

“But here’s what you need to know: the reason they do so is NOT because of money. When asked, it’s the government ‘hassle factor.’ The two leading reasons given were ‘billing and regulatory requirements, and hassles and/or threats from Medicare carriers/government.’ Payment rates were down the list

“So it’s really about FREEDOM, not the money. And what the AMA survey doesn’t show is that those trends have been in play for about a decade. We’ve conducted our survey every two years since 1995 – not just to show a trumped-up “crisis” about current rate schedules. In fact, our survey shows that doctors would rather treat uninsured patients for FREE than to treat Medicare patients.

“So it’s clear that tweaking the reimbursement rates by a few percentage points by taking money away from hospitals or putting more financial pressure on an already collapsing system won’t alleviate the other serious problems that are leading to physician discouragement with Medicare that are directly impacting patients access to care.

“FREEDOM FOR PATIENT AND DOCTORS WILL MAKE A DIFFERENCE.
H.R. 580 Seniors' Health Care Freedom Act of 2005, and Say 'NO' to Government Cookbook Medicine

“We oppose the various bills playing with the Sustainable Growth Rates (SGR), such as HR 3617, HR 2356, HR 1162 and S. 1574. Instead of changing the SGR, we support H.R. 580, the Seniors’ Health Care Freedom Act of 2005” that would allow the use of private contracts under the Medicare program. This is a win for patients, doctors and taxpayers as well.

“Our survey shows that 63% of doctors would be more willing to treat Medicare patients if unrestricted private contracts were allowed.

“Also, we oppose any mandatory 'Pay for Performance' provisions that would tie Medicare payment to physician compliance with government practice guidelines. This would be a radical break from Section 1801 of the Social Security Act that prohibits federal officials from interfering in the practice of medicine.

“In conclusion, it’s not always 'about the money' for doctors, and it’s too bad other groups are perpetuating that stereotyped image of 'rich, greedy' doctors. What doctors really need is freedom to practice medicine in the best interests of their patients. That will truly serve our seniors and help preserve access to the best care.

“Otherwise, the best and the brightest will continue to leave the program.”

NOTE: AAPS survey posted at www.AAPSonline.org.

Government is not the solution to our problems, government is the problem.

Ronald Reagan

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5. Medical Gluttony: Patient’s Want Lists Bear No Relationship to Medical Needs

Although this section has drawn some of the greatest responses from MedicalTuesday members, sometimes it may sound like a broken record. I believe the large response is due to the lay reader’s difficulty in understanding the frequency of the avarice of so many patients. The legislators, Congress and medical bureaucrats simply don’t believe it. Almost weekly we see comments by these well-meaning people who just can’t imagine anyone wanting more health care than necessary. A California legislator recently said that she felt most people are very frugal in their health-care needs. Well, for practicing physicians, patient over utilization is a daily occurrence, but only for those patients who have no financial liability in their health care.

Mrs. Francis came in for an initial visit. She had to change insurance because of her husband’s job. This time, she thought she would get her “medical needs” right. She came in with a list of tests, procedures and consultants she wanted and stated that the one she had prepared for her husband when he came in was much longer. She wasn’t very interested in spending the thirty minutes reviewing her medical history or the time necessary for me to examine her. She had no major medical problems, no significant current symptoms, and couldn’t recall any abnormal tests. Review of her family history failed to reveal any familial pattern of diabetes, carcinoma or significant cardiovascular problems. Review of her personal history failed to reveal any smoking or drug problems or significant drinking. She wasn’t on any medications.

However, she had done her homework. In addition to complete extensive chemistry, lipid, rheumatic and thyroid panels, she wanted a complete body CT scan of all her organs. She also wanted genetic screening, an MRI for Alzheimer’s, and to see a neurologist. There was no one with Alzheimer’s in her family. She wanted to see a cardiologist and have an echocardiogram. She wanted to see a gastroenterologist and have her stomach and colon checked. As she continued the list, I began looking at her insurance card and noted that she had a For Profit HMO. To divert her attention, I reminded her this was bare bones health care. She responded that she had insurance and a right to everything she needed. When I outlined several things I agreed that she needed, she became indignant. Who did I think I was to interfere with her insurance options?

Her basic wants were at least ten fold (1000 percent) greater than the average new patient. While those uninformed legislators, Congress persons, and health-care bureaucrats want to control a system they don’t understand and speak about how to reduce health-care costs by five or ten percent, people like Mrs. Francis continue to try to exceed health-care costs by 1000 percent. It is difficult for a physician to control such costs when there is no patient responsibility. If Mrs. Francis had to pay even 10 to 20 percent co-payment on at least $10,000 worth of testing, she would have been a participant in helping to determine just what testing was necessary. In her case, she might even have opted for no testing since she was healthy.

This demonstrates how Medicare or any bureaucratic medicine is under constant pressure to exceed budgets and all reasonable costs. If only half of Medicare and third-party insurance patients (100 million) were successful in convincing their doctors of such excessive testing ($10,000), that would be an extra one trillion dollars of health-care costs in this country.

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6. Medical Myths: Does the Catholic Church Affect Health? By Brent Rooney

On my other account, I received my first copy of Medical Tuesday.  I thought the following unpublished item on the effect of the Catholic Church on health might be of interest.

An open letter to Charles Radin <radin@globe.com> (Boston Globe), Wed, 14 Dec 2005

Thank you for your recent article in the Boston Globe. (Conservatives gain visibility on charity (Boston Globe, 9 Dec. 2005)) Perhaps some of your readers fear too much political influence by Catholics.  As someone who has never been a Catholic & has zero intent on becoming one, I (a medical researcher with special interest in premature birth risk factors) can be objective about Catholics.

Before the fall of communism in Poland in 1989 the Catholic influence was strong but not dominant.  With the victory of Solidarity, Catholic influence became very strong.  How would this affect women’s health, in particular, reproductive health?  Those supporting ‘reproductive health’ claimed that strong restrictions on abortion access starting in 1989 would be a disaster.  But what actually happened?  Between 1989 and 1993 the abortion rate dropped sharply (97%).  Of course, the premature birth rate (preterm newborn per 100 newborn) must have skyrocketed upward, correct?

‘To the amazement of all’, the UN Demographic Yearbook reveals that the sharpest ever drop in  premature birth rate in post World War II Europe occurred in Poland between 1995 and 1997.  The

premature birth rate crashed by 41% over a 3 year period. This means that literally thousands of Polish newborn were spared from death or disability over the last dozen years due to the severe restrictions on abortion access.  Was the 41% drop all due to the lower IA (Induced Abortion) rate?  Certainly, improved diet likely helped, but that IAs boost premature birth rate has overwhelming support behind it; for those interested in that evidence, visit:  www.jpands.org/vol8no2/rooney.pdf.

That published article was key to Texas warning women about the APB (Abortion Premature Birth) risk, starting in December 2003. Michigan with a ‘pro-choice’ governor informs women that IAs increase their risk of having ‘ICE’ (Incompetent CErvix), a known premature birth risk factor.  In fact, ‘ICE’ is an

accepted risk factor for CERBRAL PALSY. . . .

Brent Rooney, Reduce Preterm Birth Risk

Vancouver, Canada

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7. Overheard in the Medical Staff Lounge: DOCTORS & LAWYERS FORM ‘DREAM TEAM’ TO ASK SUPREME COURT TO PROTECT MEDICAL WHISTLEBLOWERS
Dershowitz Authors Brief for Review of Secret Hospital Abuse of Power

In an extraordinary collaboration of parties more likely to be adversaries in a courtroom, doctors and trial lawyers have teamed with famed attorney Alan Dershowitz to urge the Supreme Court to consider a case that would protect physician whistleblowers and expose secret hospital abuses of power.

The Association of American Physicians and Surgeons (AAPS) has been joined by the Association of Trial Lawyers in America (ATLA) in filing a “friend of the court” brief asking that the Supreme Court hear the case of Gil Mileikowsky, M.D. of California, who was ousted from a hospital after agreeing to testify on behalf of a patient against the facility, owned by industry giant Tenet Healthsystem. (See www.aapsonline.org/mileikowsky.)

Also adding to the “odd couple” element of the case is that the attorney who filed the original petition for review for Dr. Mileikowsky is Andrew Schlafly. “I’m thrilled that Mr. Dershowitz is bringing his immense legal skills to shed some light on this abuse of power by hospitals,” said Mr. Schlafly. “I’m also glad that my fellow attorneys in ATLA are willing to expose these secret proceedings that rob patients of their most effective advocates through ‘sham’ peer review.”

Other parties joining AAPS in the amicus brief authored by Professor Alan M. Dershowitz, Amy Adelson and Nathan Z. Dershowitz are: the Union of American Physicians and Dentists (UAPD), the Semmelweis Society, the Consumer Attorneys of California (COAC), and the Government Accountability Project (GAP).

Mr. Dershowitz’s office released the following statement: “…Physicians who are entrusted with the care of their patients can see their professional careers destroyed if they dare to challenge a hospital’s practices. When a ‘whistleblowing’ physician is retaliated against, it threatens not only the physician’s livelihood, but the care of all patients. This is a case, therefore, that affects every patient and potential patient in America.”

“This case epitomizes why doctors are afraid to report medical errors and problems,” said Larry Huntoon, M.D., chairman of the AAPS Committee to Combat Sham Peer Review. “To bury their own mistakes, hospitals label doctors as ‘disruptive’ and file trumped-up charges of wrongdoing. Then they count on the ‘where there’s smoke, there’s fire’ perception to make the doctor the scapegoat.”

And it’s usually the most vocal critics and patient advocates who are thrown on the fire. “[Dr. Mileikowsky] was an outspoken member of the staff and was disliked by some administrators for that reason, as he did not shirk his responsibility to publicize administrative shortcomings at the Hospital that undermined patient care,” states the doctor’s petition to the Supreme Court.

Writing in the brief filed late Monday, Mr. Dershowitz et al. point out that an accused felon would have had more right to due process than do doctors: “Doctors, like the petitioner in this case, are required to defend themselves without counsel against charges that, as in this case, have been brought in retaliation for the doctor’s support of a patient claiming inadequate care.”

The brief explains the implications on patient safety:

"The American public, as medical patients, will be the biggest loser if physicians are compelled to choose between their own livelihoods and speaking out when they witness dangerous or inadequate medical care. Few physicians will risk the dire consequences of a bad faith peer review to speak up on behalf of a single patient, and a critical prong in the checks and balances integral to a successful health care program will be silenced.”

Concluded Dr. Huntoon: “The game is over for these hospitals and their secret star-chamber hearings. Standing up for patients should not mean the end of a career.”

To read the background of the case, go to www.aapsonline.org/press/nr-12-20-2005.php.

To read the Brief, go to www.aapsonline.org/mileikowsky/.

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8. Voices of Medicine: A Physician Forum: If I Moved to Sacramento, Would You Help Me Die?

A friend of ours on the West Coast developed increasing weakness and pallor. She was living with her mother, a practicing Christian Scientist. Her mother covered all the mirrors so she could not see how awful she looked. She was going to cure her daughter with her Scientist practice. Another member of her family came by to visit and saw how ghastly she looked and immediately took her to the hospital where she spent six weeks having diagnostic surgery, radiation and chemotherapy. On a visit to our home some months later she brought in her path report for me to see and it read: Lymphosarcoma. She also announced that she was cured.

About two years later, she came for a visit and obtained living accommodations near us. On moving day, as she was driving to Sacramento, she was called on her cellular phone and instructed to return immediately to the hospital that had diagnosed her sarcoma. She was found to have no platelets or red blood cells. She was transfused in the emergency department and then resumed her drive to Sacramento. We helped her obtain the services of a good internist and she was promptly admitted to the hospital in our area. After multiple blood transfusions, she seemed to improve and she informed us that they were looking for a bone marrow donor. However, she continued to deteriorate and died of multiple organ failure on life support. She was cremated and her mother requested that my wife keep the ashes. She obviously had moved to be near my wife to die. Two of her three brothers who lived nearby never visited her during her six-week hospital stay.

The next week, my wife received a call from a longtime friend in Washington, DC, asking her if she moved back to Sacramento, would my wife help her die? She had breast cancer that was resected some five years earlier. She had just found out that the cancer was now widely metastatic throughout her body. She was a high-ranking U.S. Army officer working in the Pentagon and was given a medical discharge. She told my wife that she was the only friend she had and wanted to die near her.

With all the medical resources of Walter Reed U.S. Army Medical Center (euphemistically called Walter Wonderful when I was in the military service), it’s the personal non-medical care that on occasion still exceeds all the high quality care that bureaucrats frequently speak about and don’t understand. It reminds me of the time I was attending a meeting in Boston and Jackie Kennedy was in the final stages of her malignancy. The Boston Globe reported that Jackie had wished all her physicians and super specialists farewell, and was going home to die with only her nurse and family in attendance.

It is gratifying to note, which may be disconcerting to medical bureaucrats, that sometimes a caring family, friend and nurse are far more important than doctors and hospitals with the highest level of care.

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9. Book Review: Saturday, by Ian McEwan, 304 pages, Nan A. Talese, $26.

Current Books: A Moment in History by Colleen Foy-Sterling, MD in Sonoma Medicine

The novel Saturday, by Ian McEwan, depicts 24 hours in the life of a delightfully non-intellectual English neurosurgeon named Henry Perowne. The content is restricted to the thoughts, actions, and sensations of poor Henry as he goes through his day in London, beginning “some hours before dawn” on a Saturday when he happens to be off-duty.

I dislike the word mindfulness, but that is what this book calls for. The best way to experience the novel is to mind-meld with Henry as McEwan describes his every moment, beginning in the early hours, when Henry is just becoming conscious of being conscious. Normally Henry is working, so this is not usual behavior for him. Being off-duty, however, allows him to be fully aware of his life, his home, his family. Without the distraction of his all-consuming medical work, and the obvious intensity of the neurosurgery operating theatre, Henry is finally present in his daily existence.

Henry stands by his bedroom window, overlooking a city square in London:

It’s as if, standing there in the darkness, he’s materialized out of nothing, fully formed, unencumbered … He doesn’t feel tired … nor is his conscience troubled by any recent case. In fact, he is alert and empty-headed and inexplicably elated. … Henry thinks the city is a success, a brilliant invention, a biological masterpiece—millions teeming around the accumulated and layered achievements of the centuries, as though around a coral reef, sleeping, working, entertaining themselves, harmonious for the most part, nearly everyone wanting it to work.

In this predawn moment of the year 2002, in the metaphoric early hours of the 21st century, Henry sees the silhouette of a jet against the horizon and contemplates that “everyone agrees, airliners look different in the sky these days, predatory or doomed.” He soon realizes that the plane is on fire, and as he watches its surreal descent toward Heathrow, he wonders what might happen if he were aboard, “plastic fork in hand … screaming in the cabin partly muffled by that deadening acoustic, the fumbling in bags for phones and last words, the airline staff in their terror clinging to remembered fragments of procedure, the leveling smell of shit.”

McEwan (who previously authored The Cement Garden, an eerie story of a disturbed family) is a haunting writer, and his prose keeps you on edge, with a continuously intriguing darkness coloring his characters’ lives. We are slowly brought into Henry’s life and thought via precise descriptions of his bedroom, his sleeping wife, his view of the London skyline, his sensations, and his brief contemplations about the world in which he lives. The action begins just before England’s official decision to go to war in Iraq:

And now, what days are these? Baffled and fearful, he mostly thinks, when he takes time from his weekly round to consider. But he doesn’t feel that now. He leans forwards, pressing his weight onto his palms against the sill, exulting in the emptiness and clarity of the scene. His vision—always good—seems to have sharpened. He sees the paving stone mica glistening in the pedestrianised square, pigeon excrement hardened by distance and cold into something almost beautiful, like a scattering of snow.

Henry winds his way through Saturday morning, his mind expectant of that evening’s family dinner in honor of his daughter’s return from college. He battles a traffic jam brought on by an antiwar demonstration and is involved in a minor accident that challenges his perceived entitlement to “the good things in life,” including the obligatory Nice Car. Unfortunately, the drivers in the other vehicle are thugs, but Henry quickly diagnoses an early case of Huntington’s chorea in the gang’s leader, turning this information to his favor to convert a physical confrontation (which he is doomed to lose) into a battle of wits in which he comes out the winner.

After narrowly escaping with a painful contusion to his chest and a minimal scratch to his vehicle, Henry is filled with doubt as to whether he has abused his medical knowledge to take advantage of his aggressors, who are his inferiors in both intellect and class. Is this confrontation a metaphor for the Western world’s conflict with Iraq? With his ego and self-assuredness bruised, Henry continues on to a squash game with an American physician colleague and feels driven to use physical aggression as well as mental gaming strategies in an effort, ultimately failed, to outsmart his challenger.

The cerebral theme continues later, as Henry drives through the newly littered streets, post-antiwar rally, in order to make an obligatory visit to his demented mother. In the hands of McEwan, the prose of her mind’s connections and disconnections is poetry of nonsense and worth stopping to read aloud. To read the entire book review, please go to www.scma.org/magazine/scp/Fall05/foy_bkrvw.html.

Dr. Foy-Sterling, a family physician, serves on the SCMA editorial board.

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10. Hippocrates & His Kin: Great Moments in Socialized Medicine

London's Daily Telegraph reminds us why the idea of government-controlled health care is a terrifying one: People who are grossly overweight, who smoke heavily or drink excessively could be denied surgery or drugs following a decision by a Government agency . . . The National Institute for Health and Clinical Excellence (Nice) which advises on the clinical and cost effectiveness of treatments for the NHS, said that in some cases the "self-inflicted" nature of an illness should be taken into account. www.telegraph.co.uk/news/main.jhtml?xml=/news/2005/12/09/nice09.xml

If the government would assess all risky behavior, could they also eliminate the treatment of AIDS?

Doctor (to patient in the consultation room): Have you had any tests done lately? Patient: Just the wallet biopsy when I came in. (After Batiuk & Ayers)

Must be a relic from the history of medicine when patients paid their doctors!

Working at University of California, a government institution, has a number of perks as recent headlines indicated. When discharged from your $300K position, make some noise about the state breaking their own law and you can keep your salary plus an extra $20,000 and don’t have to report to work.

When you spend taxpayers or other people’s money, there is no limit to your spending.

Mrs. Francis (in section 5 above) thought nothing of having her Medicare HMO pay for $10,000 worth of medical testing that didn’t cost her anything. Why shouldn’t she have the highest level of care? It’s free, isn’t it?

When you spend taxpayers or other people’s money, there is no limit to your spending.

P. J. O'Rourke: If you think health care is expensive now, wait until you see what it costs when it's free.

It is total insanity to take the second most expensive item in any family’s budget and hand it out free for a health care smorgasbord feast and call it a humane and decent thing to do when it does nothing but make us all pigs at the trough. It not only destroys a civil society but destroys quality health care as is seen in any socialized country with increasing restrictions and drag on appropriate health care.

The Supreme Court of Canada has ruled that Canadian Medicare does not give universal access to health care. It only gives access to a waiting queue.

The US Treasury must be some bank account with unlimited overdraft capabilities.

Of course. It reaches into every citizen’s personal bank account.

Couldn’t we at least pass out some Risperdal in Congress to stabilize this insane thinking?

To read more Hippocrates Vignettes, please go to www.healthcarecom.net/hhkintro.htm.

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• PATMOS EmergiClinic - www.emergiclinic.com - where Robert Berry, MD, an emergency physician and internist practices in Greeneville, TN. Here is his story: Three years ago, I left ER medicine to establish a primary care clinic in a town of about 15,000 in northeast Tennessee - primarily for the uninsured, but also for anyone willing to pay me for my care at the time of service. I named the clinic PATMOS EmergiClinic - for the island where John was exiled and an acronym for "payment at time of service." I have no third party contracts...not commercial, not Medicare, TennCare or worker's compensation. My practice today has over 4,000 patient charts. My patients are typically between 5-50 years old, but I do have a significant number of Medicare patients. A year ago, over 95 percent of the patients I saw had no insurance. Today, that figure may be 75 percent. But even those with insurance learn a simple lesson when they come to me: health insurance does not equal healthcare, at least not at my clinic. I clearly tell my patients how much a visit will cost. Everything is up front and honest. I will prepare a billing claim for my patients with insurance, for a small fee, but I expect them to pay me when I see them. Because I need only one employee in my office, my costs are low. For the same services, I charge about 60 percent of charges made by other local clinics, 40 percent of what the local urgent care clinic charges and less than 20 percent of what the local ER charges. I am the best bargain in town. My income last year was about average of an ER doc - not great - but I'm free and having fun. If I can do it, caring for the uninsured in a small rural town, any doctor can.

• This month we welcome Dr Lawrence Huntoon to our list of physicians Restoring Accountability in Medical Practice and Society. 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. http://home.earthlink.net/~doctorlrhuntoon/id1.html. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.

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

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

• Dr David MacDonald started Liberty Health Group. To compare the traditional health insurance model with the Liberty high-deductible model, go to www.libertyhealthgroup.com. 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, has made important efforts in restoring accountability in health care. She has now published her important work, Who Owns Your Body. To read a review, go to www.delmeyer.net/bkrev_WhoOwnsYourBody.htm. Please go to www.healthplanusa.net/MPCosman.htm to view some of her articles that highlight the government’s efforts in criminalizing medicine. For other OpEd articles that are important to the practice of medicine and health care in general, click on her name at www.healthcarecom.net/OpEd.htm.

• David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at www.ssvms.org. To read his "Lessons from the Past," go to www.ssvms.org/articles/0403gibson.asp. For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm.

• Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, who would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at www.peerreview.org.

• Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848 no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime’s response, as well as the California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD.

To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to www.semmelweissociety.net.

• Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), is making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals. For more information, go to www.sepp.net.

• Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column at NewsMax. Please log on to review the last five weeks’ topics or click on archives to see the last two years’ topics at www.newsmax.com/pundits/Medicine_Men.shtml. This week’s column is on AARP Grinch Foiled by Congress and can be read at www.newsmax.com/archives/articles/2005/12/20/203632.shtml.

• The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to scroll down on the left to departments and click on News of the Day: How to avoid Medicare Part D at www.aapsonline.org/nod/newsofday243.php. How to have a Medicare and Insurance free practice at www.aapsonline.org/freemarket/. The “AAPS News,” written by Jane Orient, MD, and archived on this site, provides valuable information on a monthly basis. This month read Payment for Value at www.aapsonline.org/newsletters/dec05.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. There are a number of important articles that can be accessed from the Table of Contents page of the current issue with something for everyone at www.aapsonline.org/jpands/jpands1004.htm. Choose from an article by Lawrence Huntoon, MD, PhD, on Modern Bioethics; on Sham Peer Review (It can be no sufficient compensation to a corpse to know that the dynamite that laid him out was not of as good a quality as it had been supposed to be.) by William K Summers, MD, “A Psychiatrist’s Experience and Analysis,” or just some good reviews of books by Mona Charen, Edward Klein, Robin Cook, or Tom Wolfe.

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Recent or Relevant Postings

The Tipping Point - How Little Things Can Make a Big Difference by Malcolm Gladwell. www.delmeyer.net/bkrev_TheTippingPoint.htm

In Memoriam: Alexander Yakovlev