1.
Featured
Article: Comparative Analysis:
Medicine, Business, and Nations: Think Strategically
Thinking Strategically, by Andy Grove, WSJ, January
22, 2007
As a connoisseur of strategy
-- student, practitioner (in business) and teacher -- I have long been
intrigued with the relationship between strategic principles applied to nations
and strategies pursued by businesses. Strategy had its origin in military use,
but over time it migrated into the business setting. The linkage is still
there: Most contemporary business students, for example, will have read Sun
Tzu's "Art of War" in their Business Strategy course. But it is a
different relationship that preoccupies me.
Just as medical research
tests biological processes in large populations of fruit flies or rodents
before human application, I am intrigued by the prospect of applying -- to
nations -- the strategic practices that have been formulated and evaluated in
the "laboratory" of the world's businesses. As in medical
applications, we must be careful in extrapolating from one to the other.
Nevertheless, I believe there are benefits to such comparative analysis.
The first question that
needs to be examined is this: If business's task is to generate revenue and
profits for its owners, what is the equivalent task for a nation and its
government? The principal measure is the Gross Domestic Product of the
country. Changes in this number are commonly used yardsticks of economic
health. Moreover, when one compares two national economies, say the economies
of the U.S. and China, the first measure we use in this comparison is GDP. But
when we talk of GDP, we must consider not just the GDP of today, but the
long-term stability of the productive capacity of our economy. This is how
factors like national security enter into the objectives of a government.
What about governance?
Corporations are run by senior management, with power concentrated in the hands
of the chief executive. The equivalent to this in our country is the
institution of the executive branch headed by the president. It is
important to stress that even as individual presidents come and go, we expect
the institution to be durable, with a view and a constancy of purpose that is
appropriately long-range.
A successful business
strategist must understand cognitively and instinctively the structure of the
industry in which the business operates, and must know that as the structure
changes, so must the winning strategy. By way of historical example, IBM, a
huge, vertically integrated company, dominated the computer industry before the
advent of the personal computer. All computer companies had to be cognizant of
IBM's influence on the entire industry, and had to construct strategies which
allowed them to prosper in coexistence with this monolith. The arrival of the
personal computer changed all this. New rules replaced old ones governing
vertical integration, development of standards, and many other factors.
After the Cold War, a
similar change took place in the world of nations. Monolithic and vertically
integrated military powers gave way to numerous sources of power, each
following independent strategies, sometimes in partnership, sometimes embroiled
in friction. That changed the rules governing international relations. If
national strategy in the days of the Cold War was dominated by the presence and
size of nuclear weapons capabilities, what are the critical dominant factors
today, when these weapons are increasingly widespread? What takes their place?
Religious beliefs? Historical relationships or enmities? How does one set
strategies when these factors are unknown? As in the case of the computer
industry, it takes many years to figure out how the new rules work. . .
In a well-publicized study
of a large number of corporations, Jim Collins has found that longevity of
success in the marketplace is associated with a certain leadership style. I was
particularly impressed by the finding that successful leaders are able to face
what Mr. Collins calls the "brutal facts" of the competitive
positions of their companies. As I observe our political leaders today, I have
a hard time finding many examples of a willingness to do this. In fact, I find
an alarming tendency to skirt the critical issues by not even pronouncing the
words that describe them, rendering them "non-words." Examples: Who
among our national leaders spells out that the likely consequence of the
heightened global competition is to suppress domestic wage rates? Or addresses
the need to allocate the increasingly complex and expensive medical procedures
being developed today? Or admits that our emergency medical system is heading
toward catastrophe as it becomes the last-resort access to medical care for the
growing millions of uninsured? Non-words lead to non-solutions, in energy
dependence and in other key issues.
Our nation's corporations
have been under severe criticism for a variety of shortcomings. Even so, the
capitalist/free-market system of corporations consistently produces results.
When corporations do not produce, they become irrelevant and often perish. In
other words, if the brutal facts are not faced by the leaders, the brutal
reality sets in. By contrast, our national strategy-setting and -execution machinery
often seem broken. Consider this: Could we pull off the Manhattan Project
today? With its complexities of planning and execution, under extreme time
pressure? I doubt it.
Fruit flies can teach us how
to cure diseases in human beings. Why not study how businesses set strategies
and execute them, and adopt the best methods to address the overwhelmingly
important issues facing our society?
Mr. Grove is retired
chairman of Intel Corp.
To read the entire article,
please go to (subscription required) http://online.wsj.com/article_print/SB116942729333183265.html.
* * * * *
2.
In the News: Do
Brain Exercises Help the Mind Like Body Exercises Help the Body?
Putting
Brain Exercises to the Test by Kelly Green, WSJ, February 3, 2007
A host of new products are
arriving in stores and online to help people "exercise" their brains.
But what are you getting for your time and money?
At least a dozen companies
are promoting software, Web sites and gizmos that promise a daily dose of
mental stimulation. The products are the vanguard of what scientists expect
will be a flood of tools for a ready market: baby boomers who are anxious to
stave off Alzheimer's disease and related ills.
The thinking -- and
advertising -- behind most of the products is simple: If 30 minutes on the
treadmill each day is good for your body, 30 minutes (or so) of playing
computer games and similar activities must be good for your noodle.
Scientists don't universally
accept the use-it-or-lose-it mantra. Some say there's little evidence that
engaging in mentally stimulating activities actually slows mental aging. Other
researchers argue that training can improve mental performance -- meaning
mental exercise can help your brain function at a higher level than it would
otherwise.
For the moment, definitive
answers to the question -- Will brain exercise help me? -- will have to wait
for additional testing. That said, if you wish to hedge your bets, as many
consumers are doing, what follows is a look at a half-dozen of the most widely
available "workouts."
We asked a panel of nine
experts, who deal with brain-aging issues in different ways as part of their
day jobs, to try these tools at home and in the office. How do they work? What
science, if any, is involved? And are these products more about "fun"
than about health?
The answers indicate that no
one has cornered the market on a tool that's scientifically proven, easy to use
-- and entertaining. What is clear, the panel notes, is that the 50-plus crowd
is already thinking about mental health and how best to maintain it.
"Boomers are looking at
this remarkably increased longevity and, for the first time, are very seriously
wondering: Are their minds going to keep up with their bodies?" says Gene
Cohen, director of George Washington University's Center on Aging, Health and
Humanities in Washington, D.C.
To read about these
products, please go to
http://online.wsj.com/article_print/SB117010794633391594.html.
* * * * *
3.
International
Medicine: UK's
Continuing Struggles with the NHS
Sir Gerry
Robinson: How I would fix the NHS,
The Telegraph, Jan 9,
2007
If 2006 was the "best year ever" for the
NHS, according to Patricia Hewitt a statement that made millions of us wonder
if we inhabited the same universe, let alone planet, as the Health Secretary
then the start of 2007 hints at this being one of the grimmest.
A week into the new year
and hospitals are being told to delay surgery for as long as possible to ease
budget problems; a leaked government report is predicting 37,000 health service
jobs will be lost as hospitals battle to manage deficits, while also warning of
a drastic shortage of doctors and nurses by 2010.
Health unions are
already muttering about industrial action. And another report, from the
Right-wing think tank Reform, claims that despite record levels of investment
since 1997, quality of service is poorer than it was two years ago.
There is a growing sense
that the NHS is beyond help, that no political party is prepared to introduce
the reforms necessary to make it work, yet neither politicians nor civil
servants can manage it in its existing state. Well, one of Britain's leading
businessmen, Gerry Robinson, disagrees.
Sir Gerry, the former
chairman of Granada, Allied Domecq, and the Arts Council, management guru and
New Labour donor, conducted his own six-month investigation into the problems
involved in running the NHS. He set himself the task of reducing waiting lists
at a Yorkshire hospital and the results are revealed in Can Gerry Robinson Fix
the NHS?, which begins on Monday on BBC2.
It was, says Sir Gerry,
a fascinating, frustrating and ultimately fulfilling exercise that Ms Hewitt
and her team should take note of.
He discovered the NHS to
be riddled with practices that, in his words, "defied belief", and
his solutions which range from finding a "million-dollar" man or
woman to run it, to banning hospital car-parking charges are rooted in the
common sense and good business practice that seem to have escaped the thousands
of management consultants employed at great cost by the Department of Health to
advise it.
Sir Gerry, 59, who lives
with wife, Heather, and two children in a beautiful Georgian house in County
Donegal, exudes warmth and good humour, [sic] but there is no doubt that this
is allied to a fierce sense of discipline and resolve that forms the core of
his management technique.
Yet one of the first
lessons Sir Gerry learnt when he began his experiment at Rotherham General
Hospital early last year was that a combination of charm and his reputation as
a manager par excellence had absolutely no impact on surgeons, who, frankly,
weren't that keen to work on a Friday afternoon.
"Without a
doubt," he says now, leaning back in a plump leather chair in his study
and smiling incredulously at the memory, "the biggest single surprise for
me was seeing how under-utilised [sic] the operating theatres were. Theatres
are the engine rooms of a hospital most procedures have some connection to
them. Orthopaedic work, ophthalmic, routine stuff, elective stuff it all goes
through theatre.
I thought they'd be
packed and that this was the reason there was a problem with waiting lists.
But it really wasn't like that. The theatres simply weren't being managed in
any way that I would recognise as being appropriate for an important and
expensive resource.
"There was a
schedule worked out, and kept to, by and large. But if somebody cancelled an
operation, no one used that slot for something else. And then there were
Fridays the operating theatres were empty on a Friday afternoon."
Sir Gerry was assured by
Rotheram's chief executive, Brian James, that this was acceptable, that the doctors
worked their full complement of hours, but that they preferred not to operate
when only weekend cover would be available as back-up after operations. There
was, he says, also a sense of "this is the way we always do it here we
don't need to operate then".
"I said 'Hang on'
" Sir Gerry still sounds as shocked now as he did on camera confronting
Mr James " 'What do you mean we don't need it?' If you have waiting
lists, surely the best thing any hospital can do is to utilise any available time
and space to bring those numbers down.
"Not having them
running on Friday afternoons was effectively cutting out 10 per cent of the
hospital's work time. Not only was it wasteful in itself, but as the NHS system
now means that money follows a patient so the trust hospital where a patient
is diagnosed as needing surgery must pay for that procedure even if it is
carried out elsewhere you are not earning the money you could be. It didn't
make any sense." . . .
www.telegraph.co.uk/health/main.jhtml?xml=/health/2007/01/09/ngerry06.xml
'Can Gerry Robinson Fix
the NHS?' starts on BBC2 on Monday at 9pm.
Here's his formula:
1. Hire a
chief executive a businessman or woman with a proven track record, not a
civil servant or politician to run the NHS and pay whatever it takes
2. Depoliticise
theNHS; Whitehall should be left to formulate strategies, not implement it.
3. Sack
all management consultants
4. End
contracting out of staff
5. Improve
moral listen to the staff
6. Make
doctors choose between working in the NHS or in private practice
7. Cut
red tape
8. Ensure
every operating theatre is in use every weekday.
9. Focus
on cutting waiting lists.
10. Ban
penny pinching; car park charges, vending cards for bedside telephones and TVs,
etc.
Signed:
Sr Gerry, Jan 6, 2007
If
you'll forgive a little nepotism, here is another view point of how Europe must
also change.
A novel approach to ensure Europe prospers, By Julie Meyer, Financial Times, January 16, 2007
On my
way to learn Spanish, almost a decade ago, I picked up Atlas Shrugged by Ayn
Rand in Barcelona airport. I read the first sentence - "Who is John
Galt?" - and hardly put down the 1,100-page book till I read the last. I
missed the opening day of my courses, read through the night, missed dinner and
slept in my clothes. Nothing has affected me more than that book (unlike
Charles Pretzlik's critical view of it on this page on January 6/7). . .
In
2007, the 50th anniversary of Atlas Shrugged, you may well be asked: "Who
is John Galt?" The answer is to get the book and read it. Let me know if
you find him. I have been looking for him all my life.
www.ft.com/cms/s/7c3c8d46-a4d8-11db-b0ef-0000779e2340.html
The writer is chief executive of Ariadne Capital, a London-based
investment and advisory firm. She is the co-founder of First Tuesday, an
international network of entrepreneurs.
The NHS does not give timely
access to healthcare, it only gives access to a waiting list.
* * * * *
4.
Medicare: The
Medicare and Health Care Debate from Commentary
Health Care in Three Acts By Eric Cohen and Yuval Levin, February 2007
Americans say they are very worried about health care: on generic lists of voter
concerns, health issues regularly rank just behind terrorism and the Iraq war.
And politicians are eager to do something about it. To empower consumers, the
White House has advanced the idea of Health Savings Accounts; to help the
uninsured, it has explored using Medicaid more creatively. Senator Edward
Kennedy of Massachusetts, the Democrats' leader on this issue, has backed
"Medicare for all." The American Medical Association has called for
tax credits to put private coverage within reach of more Americans. A number of
recent books have proposed solutions to our health-care problems ranging from
socialized medicine on the Left to laissez-faire schemes of cost containment on
the Right. In Washington and in the state capitals, pressure is building for
serious reforms.
But what exactly are Americans worried about? Untangling that question is
harder than it looks. In a 2006 poll, the Kaiser Family Foundation found that
while a majority proclaimed themselves dissatisfied with both the quality and
the cost of health care in general, fully 89 percent said they were satisfied
with the quality of care they themselves receive. Eighty-eight percent of those
with health insurance rated their coverage good or excellent - the highest
approval rating since the survey began 15 years ago. A modest majority, 57
percent, were satisfied even with its cost.
Evidently, though, this widespread contentment with one's own lot coexists with
concern on two other fronts. Thus, in the very same Kaiser poll, nearly 90
percent considered the number of Americans without health insurance to
be a serious or critical national problem. Similarly, a majority of those with
insurance of their own fear that they will lose their coverage if they change
jobs, or that, "in the next few years," they will no longer be able
to afford the coverage they have. At least as troubling is what the public does
not seem terribly bothered about - namely, the dilemmas of end-of-life care in
a rapidly aging society and the exploding costs of Medicare as the baby-boom
generation hits age sixty-five.
All of this makes it difficult to speak of health care as a single coherent
challenge, let alone to propose a single workable solution. In fact, America
faces three fairly distinct predicaments, affecting three fairly distinct
portions of the population - the poor, the middle class, and the elderly - and
each of them calls for a distinct approach.
For the poor, the problem is affording coverage. Forty-six million
Americans were uninsured in 2005, according to the Census Bureau. This is about
15.9 percent of the population, which has been the general range now for more
than a decade, peaking at 16.3 percent in 1998.
But that stark figure fails to convey the shifting face and varied make-up of
the uninsured. On average, a family that loses its coverage will become insured
again in about five months, and only one-sixth of the uninsured lack coverage
for two years or more. In addition, about a fifth of the uninsured are not
American citizens, and therefore could not readily benefit from most proposed
reforms. Roughly a third of the uninsured are eligible for public-assistance
programs (especially Medicaid) but have not signed up, while another fifth
(many of them young adults, under thirty-five) earn more than $50,000 a year
but choose not to buy coverage.
It is also crucial to distinguish between a lack of insurance coverage and a
lack of health care. American hospitals cannot refuse patients in need who are
without insurance; roughly $100 billion is spent annually on care for such
patients, above and beyond state and federal spending on Medicaid. The trouble
is that most of this is emergency care, which includes both acute situations
that might have been prevented and minor problems that could have been treated
in a doctor's office for considerably less money. The real problem of the
uninsured poor, then, is not that they are going without care, but that their
lack of regular and reliable coverage works greatly to the detriment of their
family stability and physical well-being, and is also costly to government.
For the middle class, the problem is different: the uncertainty caused in part
by the rigid link between insurance and employment and in part by the
vicissitudes of health itself. America's employment-based insurance system is
unique in the world, a product of historical circumstances and incremental
reforms that have made health care an element of compensation for work rather
than either a simple marketplace commodity or a government entitlement. This
system now covers roughly 180 million Americans. It works well for the vast
majority of them, but the link it creates between one's job and one's health
coverage, and the peculiar economic inefficiencies it yields, result in
ever-mounting costs for employers and, in an age of high job mobility, leave
many families anxious about future coverage even in good times.
The old, finally, face yet another set of problems: the steep cost of
increasingly advanced care (which threatens to paralyze the government) and the
painful decisions that come at the limits of medicine and the end of life.
Every American over sixty-five is eligible for at least some coverage by the
federal Medicare program, which pays much of the cost of most hospital stays,
physician visits, laboratory services, diagnostic tests, outpatient services,
and, as of 2006, prescription drugs. Established in 1965, Medicare is funded in
part by a flat payroll tax of 2.9 percent on nearly every American worker and,
beyond that, by general federal revenue. Most recipients pay only a monthly
premium that now stands at $88.50, plus co-payments on many procedures and
hospital stays.
But precisely because Medicare is largely funded by a payroll tax, it suffers
acutely from the problems of an aging society. In 1950, just over 8 percent of
Americans were over sixty-five. Today that figure stands at nearly 15 percent,
and by 2030 it is expected to reach over 20 percent, or 71 million Americans.
Moreover, the oldest of the old, those above the age of eighty-five, who
require the most intense and costly care, are now the fastest growing segment
of the population; their number is expected to quadruple in the next
half-century.
For Medicare, therefore, just as for Social Security, the number of recipients
is increasing while the number of younger workers to pay the bills is
declining. But Medicare faces a greater danger still. Its costs are a function
not only of the number of eligible recipients but of the price of the services
they use. Over the past few years, health-care spending in America has
increased by about 8 percent each year, most steeply for older Americans who
have the most serious health problems. As these costs continue to rise much
faster than the wages on which Medicare's funding is based, the program's
fiscal decline will be drastic, with commensurately drastic consequences for
the federal budget.
Three different "crises," then, each of a different weight and
character. The crisis of the uninsured, while surely a serious challenge, has
often been overstated, especially on the Left, in an effort to promote more
radical reforms than are necessary. The crisis of insured middle-class families
has been misdiagnosed both by the Right, which sees it purely as a function of
economic inefficiency, and by the Left, which sees it as an indictment of
free-market medicine. And the crisis of Medicare has been vastly understated by
everyone, in an effort to avoid taking the painful measures necessary to
prevent catastrophe. In each case, a clearer understanding may help point the
way to more reasonable reforms
.
No less odd is the character of what we call health insurance.
Insurance usually means coverage for extreme emergencies or losses. We expect
auto insurance to kick in when our car is badly damaged in an accident, not
when we need a routine oil change; homeowner's insurance covers us after a
fire, flood, or break-in, not when we need to repair the deck or unclog the
gutters. But when it comes to health, we expect some element of virtually every
expense to be covered, including routine doctor checkups and regular care.
America's insurance system is largely a historical accident. During World War
II, the federal government imposed wage controls on American employers. No
longer able to raise salaries to compete for employees, companies turned
instead to offering the lure of fringe benefits, and the era of employer-based
health care was born. Thanks to a 1943 IRS ruling allowing an exemption for
money spent by employers on health insurance, an enormous tax incentive was
created as well. Rather than giving a portion of every dollar to the
government, employees could get a full dollar's worth of insurance through
their company. . . .
Even as we pursue practical options for reform, however, it behooves us to
remember that health itself will always remain out of our ultimate
control. Medicine works at the boundaries of life, and its limits remind us of
our own. While our health-care system can be improved, our unease about health
can never truly be quieted. And while reform will require hard decisions,
solutions that would balance the books by treating the disabled and debilitated
as unworthy of care are no solutions at all. In no small measure, America's
future vitality and character will depend upon our ability to rise to this
challenge with the right mix of creativity and sobriety.
To read the entire treatise, please go to www.commentarymagazine.com/cm/main/printArticle.aip?article=com.commentarymagazine.content.Article::10826
Government is not the solution to our problems,
government is the problem.
- Ronald Reagan
* * * * *
5.
Medical Gluttony:
I Fell Out of Bed, So I Called the Emergency Squad
Recently a patient fell out of bed and couldn't get
back into the bed. He was a little heavy and he couldn't make his legs work. He
assessed his body and saw that he was able to raise both arms and legs
individually and thus determined he didn't have a stroke so just lay on the
carpet beside his bed and took a nap. When he awakened a couple of hours later,
he got up and sat on the side of the bed. Not remembering if he took his blood
pressure medications, he reached into the bedside table and took his blood
pressure. He found that it was 90/50. He reasoned that he not only had taken
his blood pressure medication, but may have taken an extra dose. Since it was
now perfect, he retired for the night. Health care costs: Zero. Loss of sleep:
none.
It just so happened that on the same day, a second
patient had fallen by his bed on the way from the bath room. Even though he
felt fine, he was too weak, and his wife just couldn't lift him. She called 911
and had the emergency squad come out. They checked him over, decided that he
was fine, and the EMT ambulance driver placed him in his own bed for the night.
Estimated cost: between $450 and $600. Loss of sleep: about an hour.
A third patient on a different day experienced a
similar problem. He had gotten dizzy getting up and slid to the carpeted floor.
Between his weight, weakness and dizziness, neither he nor his wife could get
him into bed. She called the resuscitation squad and he was transported to the
hospital. In the hospital, his blood pressure was 80/40 which explained his
weakness and dizziness, and he was given several glasses of water and several
cans of juice that he drank over several hours. His blood pressure increased to
90/60 during that time and he was sent home. Estimated health care costs: The
ambulance charge was the same as in patient no 2 plus a $1500 emergency room
charge or about $1950 to $2100. Loss of sleep: about 6 hours.
The above is a very frequent problem seen in practice.
We can blame obesity or treatment for hypertension and they do share some of
the blame. But the variations are primarily determined by who pays the bill.
The higher the deductible, the more responsible the patient becomes. With
universal government coverage, the higher the health care costs become, the
more irresponsible the patient becomes and the lower is the quality of health care.
When you fall out of bed, there are alternatives
depending on who pays the bill.
* * * * *
6.
Medical Myths:
Medical Guidelines Are Unbiased
Inside Medicine: System is built for conflict, By Dr. Michael Wilkes, Sacramento Bee, Jan 27, 2007
At long last, both the U.S. Senate and the House of
Representatives have passed a version of ethics legislation limiting payola and
conflicts of interest. It is high time that those working in medical research
do the same.
At stake is our national health, our confidence in
both science and government, and huge amounts of public money.
Here is just one very recent example. The National
Institutes of Health, the world's leader in medical research, is scheduled to
hold a national conference on neonatal herpes infections. The goal of the
meeting is to develop recommendations on how to manage a pregnancy in which the
mother has a herpes infection. While herpes infections in pregnant women are
rare, the medical community is divided on whether all pregnant women should be
screened for the disease. The cost of such a screening program would be
enormous, and it is unclear what impact the screening would have on the unborn
baby.
Not surprisingly, at least for those of us who follow
conflicts of interest in medicine, the push to screen all women is not being
fought on an even scientific playing field, nor is it being moderated fairly.
GlaxoSmithKline is leading the charge for screening
(guess who manufactures the drug used to prevent herpes from being passed from
mother to infant) and is using some effective approaches to push its cause. The
pharmaceutical industry has heavily influenced the selection of the expert
speakers and panel members at the NIH herpes meeting.
Of the five "experts" who have been asked to
speak on neonatal herpes transmission, four received substantial gifts or
funding from Glaxo. The drug company is also paying for classes to
"teach" doctors the importance of testing for herpes.
As health-care costs increase, doctors all over
America are being asked to follow scientifically based practice guidelines
intended to improve the quality of medical care. These guidelines are the
result of experts distilling scientific evidence into specific suggestions on
how physicians should manage diseases.
Recently, we've discovered that many of these
guidelines are heavily corrupted by industry influence -- to the point at which
patients have been injured and colossal amounts of money wasted on drugs and
procedures that just don't work.
The marketing power of drug companies is astoundingly
effective at persuading physicians to follow expensive medical practices, which
maximize company profits but often turn out worse health outcomes than cheaper
alternatives.
How can insurers and hospitals insist doctors follow
practice guidelines when the guidelines, even those from our own government,
are not scientific and unbiased?
By no means is the herpes conference an isolated case
or an administrative oversight. For example, nine of the 11 physicians on the
NIH committee developing guidelines on the control of high blood pressure had
industry ties to manufacturers of medicines for high blood pressure. The same
was true for cholesterol-reduction guidelines. The NIH recommendations on
treating high cholesterol were written by a committee on which eight out of
nine doctors had ties to the companies that make cholesterol-lowering drugs. .
.
The solution is simple: No one with a conflict of
interest should serve on NIH expert panels. I'd even go one step further and
say that no one with a financial conflict of interest should be working at the
NIH.
I recently testified at a House hearing at which a top
Food and Drug Administration expert claimed he just couldn't find experts with
no industry ties. This is hogwash and only reflects where government officials
are looking for their "experts." If you're looking for guards to
protect the henhouse and you look only for candidates in fox holes, I guess
you'll only find foxes.
www.sacbee.com/107/v-print/story/113605.html
Medical Practice Guidelines may be the most
prejudicial way to treat a suffering patient.
* * * * *
7.
Overheard in the
Medical Staff Lounge: How Long Does It Take to Corrupt a Politician?
Dr. Edwards: How
long do you think it took for Governor Schwarzenegger to be become corrupt?
Dr. Yancy: When
he thought he could have a special election to implement logical reform.
Dr. Edwards:
Wasn't that about half way into his first term?
Dr. Rosen: Is
about a half-term the usual time for a politician to lose all his principles?
Dr. Edwards: How
many days did it take President Clinton to place his wife Hillary in charge of
socializing health care?
Dr. Milton: How
long do you think it will take Hillary to become corrupt if she gets elected?
Dr.Yancy: Since
she's already corrupt, in her case it preceded election.
Dr. Edwards: Why do
you think politicians corrupt so easily?
Dr. Rosen: Remember
the congressman from the Northeast who was such an honest man that he was
really going to straighten out this country? He even was going to end pork
barrel legislation.
Dr. Milton: Well,
did it take him half way through his term?
Dr. Rosen: The
interesting, and tragic circumstance in this case was that the Congress placed
him in charge of the pork barrel. He was beginning to wonder about the cost of
getting re-elected when he became so enamored with the ease of getting
taxpayers' money into his district, that he became the pork champ. This was a
very shrewd maneuver on the part of those that live off of pork - a little
temptation is a dangerous thing.
* * * * *
8.
Voices of
Medicine: From the San Mateo County Medical Society
You've Been Subpoenaed, What
Can You Do? By Alberto Bolanos, M.D.
Imagine being in
your office one day and being served with a subpoena to appear at a nearby
hospital a week later to provide a deposition on your patient's injury and
prognosis. Because of the short notice, you have to cancel surgery or office
hours or your vacation. This is onerous, but you have to appear because it's
been ordered by the Superior Court in the name of The People of the State of
California. If you don't appear, "you may be punished for contempt of the
court and will be liable for up to five hundred dollars and all damages
resulting from your failure to obey." So you have no choice but to succumb
to this mandatory burden, right? Wrong!
An understanding
of subpoenas and court proceedings reveals that you actually have recourse and
many options to the demands placed on you by a surprise subpoena.
First, you
should be aware that a deposition is an elective legal proceeding that can be
scheduled at any time and place convenient for the parties involved. A good
attorney would be considerate of your schedule and call you in advance to
obtain convenient times for your deposition. This approach is less likely to
cause the physician to be resentful, combative, or otherwise taint proceedings
and possible outcomes of the lawsuit. Lawyers who serve you with a subpoena without
the courtesy of contacting you first are hoping that you are so ignorant about
legal matters that you will simply show up at the time and place that is
convenient for them and will be so scared of possible penalties that you will
just answer all questions posed to the best of your abilities.
Are there really
any penalties if you don't comply with the subpoena? Only if you don't respond!
If you do nothing and don't appear, the attorney will report you to the
Superior Court judge who will then issue sanctions for a lack of response.
Instead, simply notify the attorney that you have other commitments that
preclude your appearance. Don't make the phone call yourself; have your office
staff contact the attorney's staff so that you have witnesses in case the attorney
claims you did not respond to the subpoena. You don't have to provide an
explanation to the attorney, only to the judge if the attorney unwisely decides
to report you. If the attorney reports you, a typical response from the judge
would be "you subpoenaed the doctor for a deposition with no notice
and then learned of a schedule conflict? I presume you rescheduled the
deposition for a time convenient to the doctor, correct?" If you are
reported at this point, simply provide a reasonable explanation to the judge,
who would then reprimand the attorney for abusing subpoena powers. To
read the entire article, please go to www.smcma.org/Bulletin/BulletinIssues/Sept06issue/Subpoenaed.html.
Dr. Bolanos
practices orthopaedic surgery in San Mateo.
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9.
Book Review:
America's Charity Divide Who Gives, Who Doesn't, and Why It Matters
WHO REALLY CARES America's Charity Divide Who Gives, Who Doesn't,
and Why It Matters by Arthur C. Brooks, Basic Books, New York, 250 pp,
$26 © 2006, by Arthur Brooks, ISBN-13: 978-0-465-00821-6
"Now abideth faith, hope, charity, these
three;" said the Apostle Paul, "but the greatest of these is
charity."
When I served on the stewardship committee of my
parish, which was responsible for obtaining every member's pledge, I noted that
there were large differences in pledges. It also seemed that the giving
percentages were higher for the poorer members of our parish. Although the congregation
thrive on the large givers, we remember the widow's mite in Jerusalem that was
looked on with favor by our Lord since it was all she had.
The expressed opinion in many political circles is
that the conservatives are not compassionate. The pre-elections income tax
filings by our wealthy lawmakers were also very enlightening. The charitable
giving of some of our rich senators seem to calculate out at about one or two
percent of their listed income. But they seemed to be generous in raising taxes
to make everyone "charitable." Thus, only liberals view themselves as
truly compassionate.
Reader's Digest published a poll several years ago on
what Americans thought would be an appropriate maximum tax rate. The consensus,
as I recall, was that all taxes should never add up to more than 25 percent of
their income. Meanwhile the marginal tax rate is approaching 50 percent and the
rich senators and representatives want to further increase it - to make America
more compassionate.
Now comes Arthur C Brooks with the documented truth
about liberals and conservatives and his detailed analysis of the charity
divide. He found the reverse was actually the truth. Being a liberal, he had
difficulty accepting the results of his own research. America's working poor are,
relative to their income, far more generous than their liberal counterparts
including the middle class and rich. Not so surprising, the nonworking poor -
those on public assistance instead of earning low wages - give at lower levels
than any other group. In other words, poverty does not discourage charity in
America, but welfare does.
In 2004, former president Jimmy Carter claimed that
Americans are indifferent to suffering around the world - we don't really care.
Brooks cites a foreign businessman who comes to this country to become better
informed about giving and volunteering because many foreigners admire the
philanthropic zeal of Americans and consider it the secret of our success.
Another famous foreign visitor to America some 170
years ago was Alexis de Tocqueville. When he came to the United States in 1835,
he found a spirit of voluntarism and charity unlike anything he had encountered
before. In his classic book Democracy in America, Tocqueville marveled
at America's many civic associations, which were supported through voluntary
gifts of time and money: "Americans of all ages, all conditions, and all
dispositions constantly form associations," Tocqueville reported.
"The Americans make associations to give entertainments, to found
seminaries, to build inns, to construct churches, to diffuse books, to send
missionaries to the antipodes; in this many found hospitals, prisons, and
schools."
Who is correct about American charity - Alexis de
Tocqueville or Jimmy Carter? To a certain extent, they're both right, according
to Brooks. When it comes to charity, America is two nations - one charitable,
and the other uncharitable. Most Americans are generous, compassionate people.
However, there is also an identifiable slice of the population that does not donate
to people in need, does not volunteer, does not give in formal ways, and does
not even feel compassion toward others.
Brooks states his book is about these two Americas and
the reason they behave so differently. In the process of investigating the forces
of charity and selfishness, he uncovered some hard truths about American
culture, politics and economics. But the stakes are higher than showing a few
surprising truths. It matters a lot that we are two nations. Charity, he feels,
is essential to our health and happiness, community vitality, national
prosperity, and even to our ability to govern ourselves as a free people. America's greatest glory lies ahead - if we
become more charitable. But just as America, the Charitable spills abundance
onto the rest of us, America the Selfish threatens our prosperity as a nation
through the policies it supports and the culture it encourages. It is important
to understand what makes people charitable and what makes them uncharitable.
Our strength as a nation is affected by our ability to bring more people into
the ranks of the generous - for their good and for ours.
Fortunately, Tocqueville's America is bigger than
Jimmy Carter's. There are far more charitable Americans than uncharitable ones.
Approximately three out of four families make charitable donations each year.
The average amount given by these families is $1800 or about 3.5 percent of
household income. About a third goes to religious activities and the rest goes
to education, health and social welfare. Charitable donations in the United
States add up to about quarter trillion dollars per year. To read the entire
review, please go to www.delmeyer.net/bkrev_WhoReallyCares.htm.
* * * * *
10. Hippocrates & His Kin: Miss Universe Has the
Answer to Global Warming.
I'm so concerned about environmentalism, so as Miss
Universe, my first official act will be to find another suitable planet for us
to live on. -Dan Piraro
Now who said you can't have both beauty and brains.
The British NHS: Sir Gerry Robinson recommends that
hospital car parking lots should be free. "Car-park fees are fine if you
want to ration space. But to make money from patient parking fees, patient telephones
and patient vending machines? I hate it."
But Sir Gerry, when the NHHNS can't charge patients, is
bankrupt, mismanaged, don't you have to make your money where you can?
Gerry Robinson, a Labour donor who was knighted in
2004 and a former chairman of the Arts Council, is adamant that simple
techniques work. 'We have this really precious thing which is free delivery of
healthcare when you are ill. We shouldn't pretend it is a business, because
it's not, but, my God, we should be running it well.
But isn't it interesting that all his remedies are
based on good business principles?
There are now 40,000 managers within the NHS and their
numbers have increased in recent years, but spending on management consultants
has jumped more than fifteen-fold from £31m to more than £500m in two years.
Incompetence only breeds incompetence in any
bureaucracy. That's why government medicine will never work. Every government
says it just hasn't been done right. But our memory is so short.
To read more vignettes, visit the archives at www.healthcarecom.net/hhk2001.htm.
* * * * *
11. Organizations Restoring Accountability in HealthCare,
Government and Society: