1.
Featured Article:
Genomes for All
Next-generation technologies
that make reading DNA fast, cheap and widely accessible are coming in less than
a decade. Their potential to revolutionize research and bring about the era of
truly personalized medicine means the time to start preparing is now. By George M. Church,
Professor of Genetics at
When the World Wide Web launched in 1993, it seemed to catch on and spread overnight, unlike most new technologies, which typically take at least a decade to move from first "proof of concept" to broad acceptance. But the Web did not really emerge in a single year. It built on infrastructure, including the construction of the Internet between 1965 and 1993, as well as a sudden recognition that resources, such as personal computers, had passed a critical threshold.
Vision and market forces also push the development and spread of
new technologies. The space program, for example, started with a government
vision, and only much later did military and civilian uses for satellites
propel the industry to commercial viability. Looking forward to the next
technological revolution, which may be in biotechnology, one can begin to
imagine what markets, visions, discoveries and inventions may shape its outcome
and what critical thresholds in infrastructure and resources will make it
possible. . . .
The "$1,000 genome" has become shorthand for the promise
of DNA-sequencing made so affordable that individuals might think the once-in-a-lifetime
expenditure to have a full personal genome sequence read to a disk for doctors
to reference is worth while. Cheap sequencing technology will also make that
information more meaningful by multiplying the number of researchers able to
study genomes and the number of genomes that can compare to understand
variations among individuals in both sickness and health. .
"Human" genomics extends beyond humans, as well, to an
environment full of pathogens, allergens and beneficial microbes in our food
and our bodies. . . .
To read the entire article (Subscription required) go to www.scientificamerican.com/issue.cfm?issuedate=Jan-06.
* * * * *
2.
In the News: Beating the Odds - The Real Jackpot Was Being
Defibrillated
How a gamble on
defibrillators turned
When he thinks of all the places
he might have suffered cardiac arrest, Jack Barlich feels lucky. If his heart
had stopped at home, in a store or at city hall in Del Rey Oaks,
Instead, it stopped as he
was playing a winning poker hand at the MGM Grand in
At a time when some big
companies such as Wal-Mart Stores Inc. are just experimenting with keeping
portable defibrillators around, a pioneer and the unrivaled model of the
practice is the casino industry.
Medical research shows that
casino visitors whose hearts suddenly stop survive at higher rates even than
people who happen to go into cardiac arrest while visiting a hospital.
"The safest place in
All along the Strip, large
casinos have the devices, technically known as automatic external
defibrillators. Casinos’ security officers have become so adept with them that
they usually decline offers of aid from physician bystanders. "The average
radiologist or obstetrician isn't as well trained as our security
officers," says David Slattery, an emergency-medicine physician who
oversees the defibrillator program at MGM Mirage's 23 casinos. Mirage security
officers Dave Kurau and Craig Kahrs have shocked five stalled hearts back to
life each, as has Jeff Fiti at Harrah's Entertainment Inc.'s
Casinos' experience is
contributing to calls for wider distribution and use of defibrillators across
the country. The American Heart Association has just endorsed use of the
devices by lay people, shifting from a policy that called for oversight by
doctors. Singling out the casinos’ experience, the AHA said in a published
statement last month that lay-person use of the devices is now shown to improve
survival.
Defibrillation is far from a
foolproof response to the dramatic crisis of sudden heart stoppage. Researchers
have found that about 53% of people who suffer sudden cardiac arrest at casinos
survive. While that rate far outstrips the national average survival from
sudden cardiac arrest of well under 10%, even the best efforts of casino staffs
mean that nearly half of stricken gamblers don't make it. Defibrillation works
best in concert with chest compressions. . . .
Jim Alexander was working
security at the Stardust about five years ago when a call sent him running to
the stage of a ballroom-dancing competition, defibrillator in hand. The male
half of a dancing pair had collapsed. After the defibrillator showed the man
had no heartbeat, Mr. Alexander pushed a button and stood back while the device
delivered a shock that brought back a pulse - and an ovation from onlookers.
"I felt like I'd won the whole contest," Mr. Alexander says. . . .
[A] 63-year-old
In less than three minutes,
Stardust security officers were delivering a shock to Mr. Austin's chest. He
remembers coming to. "I could hear everybody, especially my wife, but at
first I couldn’t see anything," he says.
When Mr. Austin learned that
the Stardust was one of just seven casinos taking part in the defibrillator
experiment, he marveled at his good fortune: He wasn't even staying at that
hotel but had dropped by to play just moments before the attack. "I really
hit the jackpot that day," he says. . . .
Casinos' embrace of the devices owes a big debt to the
efforts of a paramedic at the Clark County Fire Department, Richard Hardman. A
decade ago, he realized that about 50% of the cardiac-arrest episodes his
department dealt with took place at casinos. Mr. Hardman and fellow paramedics
often found themselves arriving too late to help at the scene of a casino
cardiac-arrest case. Invariably, standing next to the deceased victim was a
casino security officer. . . .
Mr. Hardman, still a
fire-department paramedic, also now does some consulting for casino industry,
which he says earns him less than $10,000 a year. He says he no longer feels
haunted by his failure to become a doctor. He was listed as an author on the
New England Journal of Medicine study, and doubts that as a physician he could
have been involved in anything more important. "To be thanked by people
who say you saved their lives—that's extremely gratifying," he says.
To read the entire article
(subscription required), please go to http://online.wsj.com/article/SB113841670933859017.html.
Write to Kevin Helliker at kevin.helliker@wsj.com.1
* * * * *
3.
International
News: The Truth Is Dazzling: Capitalism = Prosperity
John Blundell, Director of
England’s Institute for Economic Affairs, praises The Heritage Foundation's
Index of Economic Freedom
THERE
are endless recipe books on how to make a soufflé, roast a pheasant, bake a
walnut cake or create an exquisite salad. But this is the ultimate recipe book,
and it is very different. It might be entitled The Wealth of Nations, but
someone nicked that. Instead it carries the unlovely but apt title, 2006 Index
of Economic Freedom - the link between economic opportunity and prosperity. It
contains more than 400 pages of detailed figures and it comes from perhaps the
most influential thinktank the world has seen, namely The Heritage Foundation
in
I admit I am dazzled. I am intrigued. Here is the most exacting analysis of the
nature of society of every nation from the mighty
Why do some nations, often in adverse locations, prosper? Why are some, with
lush soils and huge mineral resources, destitute?
The answers may be highly complex in detail but they could hardly be more plain
in nature. Humanity prospers when it has freedom of trade. This could also be
expressed as freedom of contract - that people can swap their goods and wares
and services without control, regulations and taxes . . .
Who is top of the league of such
virtues?
I applaud
It is worth being emphatic - there is no link whatsoever to natural resources.
What has
I would love to see the Index of Economic Freedom as a compulsory book in every
classroom - except, of course, we do not believe in compulsion.
So, I assert what we all know intuitively, that prosperity and its first
cousins productivity, security, clean water, or any other desirable civic
blessing, is derived from trade. This may be expressed in the great engine that
unites all of mankind, or at least those open enough to trade. This is the vast
price mechanism that allows us to learn who wants what and when and where.
I think it close to a miracle that I can buy Chilean wines, Ghanaian chocolate,
Kenyan beans and Australia beef at Tesco's prices, buy petrol from Kuwaiti,
watch my Japanese television and play on my Californian keyboard. Expressed
individually these are banalities, but in aggregate they are a marvel. . . .
But the index also alerts us to the hazard of interest groups always trying to
compromise or pollute freedom of trade. The EU's agricultural autarchy is not
merely corrupt. It brutalizes (sic) those people locked out. The authors of the
Index of Economic Freedom eschew policy prescriptions, but I offer the insight
Note the migrations of humanity too. Nobody aspires to live in wretched lawless
nations. We seek out the law-rich locations.
So here is a perfect birthday present if you know any aspiring politicians.
They might grasp the crucial lesson, which is to focus on what only you can do,
such as the rule of law, do it well, and by and large leave the rest to the
market.
To
read the entire article, please go to http://www.iea.org.uk/record.jsp?type=news&ID=313.
John Blundell
is Director General of the
Buy now: The
Index of Economic Freedom Heritage Foundation,
20 pounds.
* * * * *
4.
Medicare: Doctors feel the pain, too.
Frustration over dealing
with new Medicare drug plan goes beyond patients. By Nancy Weaver Teichert—Bee
Staff Writer,
Dr. Holly Leeds of
"I
was on the phone for an hour trying to get a prior authorization," said
A
patient may have chosen a Part D drug plan because it covers their medications.
But the plan may require the doctor to get a prior authorization to prescribe
the drug.
[It
is an insult to a physician to discuss with the insurance carrier the medical
needs of a patient.]
With
more than 40 private plans with different drugs and procedures covered, much of
the burden is falling on physicians to figure out how they work, said Dr. Jack
Lewin, president of the California Medical Association.
"There
are an awful lot of barriers to getting medication," said Lewin. "The
bureaucratic complexity is very cumbersome."
While
the drug plan gives many seniors and disabled people prescription coverage for
the first time, Lewin predicted it will have to become less complicated to
succeed. . . .
While
health plans acknowledge there have been problems implementing drug coverage,
officials said things are improving each day as they hire more staff and update
data in the computer systems.
On
Thursday,
"The
denial does not come with a telephone number, a list of alternatives or any
other information to allow me to even start the process" to appeal, said
Dr.
Francisco Prieto of Sutter Medical Group in south
"I
was pretty startled. How can you say no to insulin?" said Prieto, who had
to fax a form to get the refill approved two days later. "I wrote some
fairly snide comments. ‘Diabetic! On insulin! What more do you need!'" . .
.
She
believes the root of the problem is the drug plans have a financial incentive
to put up hurdles to access to drugs, especially when they’re not paying for
the consequences of hospitalization. . . .
Margaret
Reilly, assistant director of the Health Insurance Counseling and Advocacy
Program, anticipates more calls from patients too. She said her counselors
aren’t yet familiar with all the appeal processes.
"Not
only are the physicians frustrated," she said, "by the time the poor
patient gets to the physician there’s a huge level of frustration too."
www.sacbee.com/content/news/v-print/story/14124825p-14953873c.html
Government is
not the solution to our problems; government is the problem.
- Ronald Reagan
* * * * *
5.
Medical Gluttony:
Medical Tragedy
Some time ago, I was taking my medical students on
rounds teaching them physical diagnosis or how to examine patients. For patients
that gave their permission, the students interviewed them to obtain their
medical history and examined them to confirm the expected findings. As we were
completing a patient in the cardiac unit, the students became curious about the
lady in the next bed who glazed at the ceiling while her family was gathered
around the bed conversing with each other. She seemed oblivious to their
presence.
Her nurse was at the foot of the bed and we stopped
and introduced ourselves. She explained that this 78-year-old patient was
recovering from a 5-vessel coronary artery bypass graft (5V-CABG) operation.
She also had Alzheimer's and had not recognized her family in five years. That
was why she didn't know the members of her family around the bed. "Then
why," we asked, "did she have this life prolonging procedure?"
The nurse replied that her staff was also struggling with the same question.
For personal or primary care physicians, when the
cognitive brain is no longer functioning as in dementia, especially of the
Alzheimer's type, the management consists of providing appropriate supportive
care to the patient until such time as a vital organ, such as the heart, lung
or liver, fails. Support to the family continues while their loved one is kept
comfortable until the end. Under no circumstances should life be extended by
rejuvenating the heart for another decade or so, as with the 5V-CABG. Not only
does this not benefit the patient, but it is an unnecessary burden on the
family, and the hundreds of thousands
of dollars of unnecessary health care costs will eventually compromise health
care for the more needy.
What is the answer to this excess or abuse?
Conventional wisdom says we need more regulations to prevent this from
happening. Medicare should police surgeons and hospitals to prevent this sort
of unnecessary cost. However, this occurred under Medicare’s watch and the
patient and her family were totally outside the decision-making process.
Medicare is already the most micromanaged government health care system known
-- far more abusive than any socialized national health service in the world.
But conventional wisdom is unwise and wrong.
This sort of abuse and excessive use can only be
controlled by placing health care in a market environment (Medical MarketPlace)
where the patient is responsible for a percentage of all costs. In our running
draft of the ideal HealthPlan, the Medical MarketPlace controls costs with only
a 10 percent co-payment on hospital care. That forces the hospital and the
cardiac surgeon to provide full disclosure for all procedures. With a 10
percent co-payment for the $6500 surgical fee, the family would discuss whether
or not their 10 percent portion or $650 was cost-beneficial for their mother.
The hospital would also have to provide full disclosure of their bill, which
would be on the order of $100,000. The family would then be able to determine
if their 10 percent or $10,000 was cost beneficial to them. Excessive health
care costs would have been stopped in its track and quality of care and quality
of life would have improved dramatically.
Quality of care rises and healthcare costs fall when
medicine operates in the Medical MarketPlace.
Health Care costs rise and Quality of Life diminished
in a managed care environment.
* * * * *
6.
Medical Myths:
Physicians Lose Their Skills Quickly
After 35 years, the Physician-in-Chief of Wayne County
General Hospital in Eloise, Michigan, fell out of favor with the politicians
and returned to the practice of medicine. He said he maintained his scientific
acumen by reading Scientific American, which he deemed the best running
textbook of biology and medicine available. He was one of the best professors
of medicine I had. Skills that are a part of us may be temporarily diminished,
but never lost, and are quickly reclaimed.
At a recent medical meeting, I met a Pulmonologist
that had practiced for 25 years and decided to relocate. He took time out to
obtain a master's degree and then applied for hospital privileges. He was
denied privileges to do bronchoscopies even though he had done more than a
thousand. The hospital alleged that over the several years, he had lost his
skills. None of the physicians, including a Pulmonologist, would verify his
expertise. The doctors who were convinced of his skills had been so frightened
by the hospital lawyers who advised them that they could be held liable for any
therapeutic misadventures (which are part of the practice of medicine for all
of us) that they all refused to authorize him to practice.
Although having completed his pulmonary fellowship,
and being board certified in pulmonary medicine, the hospital made him repeat
five months of his fellowship so they could be absolutely sure he had the
appropriate skills. After moving again, this time to a
Why do physicians make their
colleagues jump through unnecessary hoops, losing five months income and paying
five months of tuition, because of legal paranoia? Does any other profession
even presume they lose their skills while taking time off for an additional
degree? Or just time off for family or leisure?
It's time for physicians to
rise to the occasions, to call the shots for their own profession and be
willing to support and defend each other – to be willing to take legal action
against those that want to destroy our profession and our relationship with our
patients.
* * * * *
The Mayor of Los Angeles is trying to cut the $90,000
the city spent on bottled water with a $1 million ad campaign praising the
virtues of what comes out of its taps. (Government solutions always cost ten
times as much as the problem. Both the $90,000 and the $1 million could be
eliminated with just a stroke of the budget pen.)
I wonder if anyone in SF has thought of putting
drinking fountains in the City Offices and Agencies?
Coverage issues should occur between the Insurance
Company and the patient, not the doctor!
Doctors should only have to deal with their patient's
diagnostic and therapeutic needs. If the patient has a problem with his
insurance carrier, it should be the patient's responsibility to obtain the
specifics about what is covered and then make another appointment with his
doctors to re-discuss his medical problems and therapeutic alternatives. He/she
can then write the appropriate prescriptions with the patient and the medical
record in front of him/her.
It is totally inappropriate to tract a physician down
during lunch or after hours to rehash the appropriate treatment without either
the patient or the medical record in front of him/her. Why do we allow the
inadequacies of insurance carriers and their formularies to force us to spend
additional time with no pay when we've already evaluated the patient at half
our usual fee? Would any other profession spend 50 percent more time on a
client for bureaucratic hassling with no additional fees?
* * * * *
8.
Voices of
Medicine: The 1918 Spanish Flu Pandemic in
The
"It
must have seemed a far-fetched notion in 1905.
"In
a few years these medical men were faced with a worldwide scourge: the Spanish
influenza pandemic of 1918. Within less than a month of the county's first case
being reported, 2000 cases were diagnosed and hospitals were full to
overflowing. There was little to be done but let the contagion run its course.
Tuberculosis was another disease that was afflicting
Florida
"One of the most challenging aspects of medical
practice is communication with patients and their relatives, the touchstone for
all doctor-patient interactions. Sad to say that the sacred relationship
between the doctor and his patient has deteriorated considerably over the past
few years. There seems to be a constant erosion of this mutual trust which is
why they are asking for second and third opinions. I had my share of woes as
well. Let me tell you my recent experiences.
"65 year-old, just-retired, somewhat obese business man whom I shall call
Mr. Dugan, drove to the ER with chest pain one night. The first EKG showed
extensive anterior wall myocardial infarction. He immediately suffered a
cardiac arrest, but was promptly resuscitated and was put on a ventilator. His
sons, executives from Long Island , showed up the next
day, deeply upset and furious and demanded a conference with me right away.
They had just one question, 'Our father has never been sick a day in his life.
He walked into this hospital. Now he is in a coma! We want to know what
happened.'
"I tried to tell them that their father had received excellent care. In
fact, the ER crew worked diligently to resuscitate him. Finally, it took the
combined public relation skills of the whole staff to pacify the family. I
didn't have the heart to tell them that if their father had regular preventive
medical check-ups and screenings for common cardiac risk factors, perhaps this
catastrophe could have been averted. I expected them to be grateful for what we
did, but their words implied negligence on the part of the ER staff!
"Suddenly my thoughts went back to some 30 years ago when I was a fellow
in cardiology at the New Jersey College of Medicine, Newark ,
NJ
To read about other Doctor-Patient episodes, go to www.fmaonline.org/pubs/quarterly/oct05_middle.asp.
The
Trends come and trends
go. However, the continued experimentation and use of alcohol, tobacco, and
other illicit drugs by our young people remains a real problem. Whether as a
clinician or as a parent, many of us have witnessed firsthand the devastation
and destruction that these can inflict on our patients and loved ones. Much
frustration is generated when we cannot seem to help or "cure" those
affected by alcohol, tobacco, or other illicit drugs.
How should we approach
our teens and young adults about their (mis)adventures in experimentation?
Should we present the "facts" about the dangers of drug use and abuse
or should we "frame" the issue as a legal issue or a moral one? Although
there may be no easy answer, especially in a 15-minute office visit, recent
studies may help you focus your brief intervention with patients and their
families.
In August 2005 The
National Center on Addiction and Substance Abuse (CASA) at Columbia University
reported that "teen perceptions of immorality, parental disapproval, and
harm to health are far more powerful deterrents to teen smoking, drinking, and
drug use than legal restrictions on the purchase of cigarettes and alcohol or
the illegality of using drugs like marijuana, LSD, cocaine, and heroin."
• Teens who say their parents would be
"a little upset" or "not upset at all" if they used
marijuana are six times likelier to try marijuana than those whose parents
would be "extremely upset."
• Teens who consider marijuana to be
"not too harmful" or "not harmful at all" are eight times
likelier to try marijuana than those who consider marijuana "very
harmful" to the health of someone their age.
• Most teens say that legal restrictions have
no effect on their decision to smoke cigarettes (58 percent) or drink alcohol
(54 percent), and nearly half say that illegality has no effect on their
decision to use marijuana (48 percent) or LSD, cocaine, and heroin (46
percent).
"Laws restricting smoking and drinking
and making illegal the use of drugs like marijuana and cocaine play a
significant role, but we must recognize that morality trumps illegality in
deterring teen smoking, drinking, and drug use," according to Joseph A.
Califano, Jr., CASA's chairman and president and former U.S. Secretary of
Health, Education, and Welfare.
An additional survey
outcome that offers some interesting consideration is the relationship between
R-rated movie viewing and drug use. This year's survey also found that 43
percent of 12 to 17 year olds see three or more R-rated movies each month
either in theaters or on home video. These teens are seven times likelier to
smoke cigarettes, six times likelier to try marijuana, and five times likelier
to drink alcohol, compared with those who do not watch R-rated movies in a
typical month. . . .
In the 2004 NSDUH, 60.3
percent of youths aged 12 to 17 reported that they had talked at least once in
the past year with at least one of their parents about the dangers of drug,
tobacco, or alcohol use. Among youths who reported having had such
conversations with their parents, rates of current alcohol and cigarette use
and past year and lifetime use of alcohol, cigarettes, and illicit drugs were
lower than among youths who did not report such conversations.
So, where does all this
leave us? These two recent reports seem to suggest that interventions that
enhance the interaction of parents and their young adults do make a difference.
Getting young adult patients and their parents to talk about drug use and abuse
may be a great challenge, but proves necessary and effective. . . . To read the
entire article, please go to www.smcma.org/Bulletin/BulletinIssues/Sept05issue/ReachTeens.html.
Dr. Glatt practices internal and addiction
medicine in
* * * * *
9.
Book Review: Healthy
Competition - What's Holding Back Health Care and How to Free It by Michael
Cannon, & Michael D Tanner, Cato Institute, Washington, DC © 2005, ISBN
1-930865-81-3, 173 pp, $10. Part III - Underlying Diseases, Strong Medicine:
Chapter 5 - Tax Policy and Health Care
Since World War II, the federal government has maintained
an uneven playing field in health insurance markets. During the war, employers
offered health benefits as a way to attract workers without running afoul of
wartime wage controls. The federal government treated such benefits as a
business expense exempt from taxation.
Eventually written into law, the tax exemption of
employer-provided health insurance has two principal effects. First, it lowers
the cost of employer-provided health insurance (including any medical care
financed through such "insurance") relative to other goods and
services. On the one hand, at a tax rate of 50 percent, purchasing $1 of goods
requires $2 of pretax earnings. On the other hand, the same amount of pretax
earnings buys $2 of health coverage. This preferential tax treatment makes the
price of health insurance and medical care appear much lower relative to other
expenditures, and encourages workers to purchase more coverage and consume more
care than they otherwise would.
The second effect is that most Americans get their
health insurance through employers, and most of their medical bills are paid by
employers or insurers. In 2003, an estimated 60.4 percent of Americans obtained
health insurance through an employer.
Already encouraged to over consume health care by distorted prices,
workers are further insulated from the cost of their health care consumption
because someone else is paying the bill.
Effects
of the Tax Exclusion
The
cost of health care has placed a steadily rising burden on employers and
workers. For the past 16 years, the cost of health insurance has risen faster
than both workers' earnings and inflation. Health insurance premiums for a
family of four increased by more than 10 percentage points in each of the past
4 years and in at least 7 of the past 16 years. A study by Katherine Baicker
and Amitabh Chandra of
Because
employers see these higher costs in their budgets, they have attempted to
constrain unnecessary spending with administrative controls that interfere with
patients' medical decisions and how providers practice medicine. Employers have
turned to managed care to control costs by restricting the number of providers
and services eligible for coverage. In 1988, 27 percent of insured Americans
were enrolled in some form of managed care plan. By 2004, that figure had risen
to 95 percent. As a result, more patients must comply with bureaucratic rules
over how their own health care dollars may be spent. One survey found that the
strongest predictor of dissatisfaction with a health plan, as measured by
unwillingness to recommend the plan to others, is lack of choice with respect
to providers. In effect, managed care employs bureaucracies to constrain the
consumption of patients who would constrain themselves if they were spending
their own money. Managed care is a predictable outgrowth of
Encouraging
most Americans to purchase employer-provided health insurance has led to fewer
choices both in the employer market and in the market for individual (as
opposed to group) health insurance.
As
noted earlier, 53 percent of workers offered employer-provided coverage have at
most two options. Nearly 90 percent of companies with fewer than 200 employees
offer only a single health plan. Consumers shopping in the individual health
insurance market have their choices restricted by higher premiums and the
necessity of paying with after-tax dollars.
The
rising cost of health benefits is considered a significant factor behind wage
stagnation and the reluctance of employers to hire more full-time workers. From
1989 to 2004, overall compensation rose by 12.7 percent, adjusted for
inflation. But wages rose just 7.5 percent, while nonwage benefits increased
26.2 percent. Industry sectors that are most likely to offer health insurance
to employees and offer the
most
generous plans have suffered the biggest job losses in the past few years.
Conversely, the greatest job growth has been in industries that offer few or
less comprehensive health benefits.
Unlike
nearly every other type of insurance, health insurance in the
progressively
decreases labor mobility and entrepreneurship by workers who fear losing health
benefits. Studies have estimated that "job lock" reduces job mobility
among married men by 22 percent and
married
women by 33 percent and is growing.
By
encouraging overreliance on health coverage, the tax exclusion leads to moral
hazard. It not only encourages riskier behaviors (smoking, overeating,
inactivity), it also discourages prudent behaviors (saving for future medical
expenses, exercise, preventive care) by creating the expectation that one’s
medical expenses are another’s responsibility.
Finally,
it leavesAmericans substantially poorer. Harvard economist Martin Feldstein has
estimated that the tax exclusion misallocates resources to health care that
would have provided greater value if applied elsewhere. As a result, it cost
Americans an estimated $126 billion in 2004.19 This amounts to a hidden tax of
nearly $1,000 per household.
Despite
the damage the tax exclusion does by promoting health coverage well beyond the
value it provides, it enjoys considerable support. Many workers and employers
oppose removing the exclusion
because
doing so understandably appears to be a tax increase. Yet as
expenditure,
it can misallocate huge amounts of society’s resources, yet be entirely
painless at the level of individual producers and consumers." The fact
that the exclusion's $126 billion hidden tax is hidden makes it no less real.
To read the rest of Part III, Chapter 5 –
Tax Policy and Health Care, please go to the Cato Bookstore: www.catostore.org/index.asp?fa=ProductDetails&method=cats&scid=33&pid=1441272. The price is only $10. At that rate, consider purchasing two or
three and surprise your friends, who don't understand that government
involvement in health care is destroying affordable health care, with a gift
that keeps on giving. There are other excellent recent titles you may want to
consider.
For Next month, read Part III: Chapter
6 - Government Health Programs
To read some of the other book reviews that are
available, please go to www.delmeyer.net/PhysicianPatientBookshelf.htm.
* * * * *
10. Hippocrates & His Kin: Just When I Thought I'd
Heard It All, There Comes a New One.
Mrs. Marta came in a month or so ago to discuss not
only her allergies, but also her bowel evacuation problem. She ate a lot of
fiber and normally had large long stools. It became apparent that dietary
changes would be difficult to implement. She stated that her stool had gotten
so large that it was difficult to flush. Even with a Johnny plunger it clogged
her water closet. It appeared that she emptied her entire sigmoid and left
colon as one large long stool. Finally, she said the most irritating part was
that the stool "slapped" against her thigh at the end of evacuation.
This was a problem I couldn't recall Cecil & Loeb having discussed in their
entire 2,376 page Textbook of Medicine, which we devoured as medical
students. Not knowing what advice I could give, I suggested that she start the
flush when her stool hit the water and perhaps both problems could be solved.
Well, she came in again last week and announced a
success story. Not only did the stool flush down the sewer head first, but also
so smoothly and completely that her thigh was spared the "slap." She
thanked me profusely.
How can feigned
Schizophrenia get you a medical discharge from the
Mr George came in for a
pulmonary consultation. In going over his personal history, he related that he
had spent three years in the United States Army, which he disliked so badly
that he feigned schizophrenia to get out. He complained about auditory and
visual hallucinations which he convince a psychiatrist were real. He was
immediately given a medical discharge. He declined all service-connected
benefits, was placed under the supervision of his parents and then proceeded to
gainful employment. He rapidly advanced in his chosen field. He still ruminates
on occasion if his subterfuge would haunt him someday, but after 18 years he
feels he's home free. But still, every time there’s a fire in
Running for Governor on a Tax-the-Rich Platform? The
Education is the largest item in the
Since private and parochial schools score higher on
achievement tests than public schools, maybe we should reduce the
How can family discord kill
a parent?
Mr. Jones came in yesterday
for his annual pulmonary review, chest x-ray, and pulmonary function tests in
view of his 35 years of smoking. As I was completing the medical review of his
family history, he told me that he was living with and taking care of his
mother who was quite self sufficient for her 83 years. She had some mental
lapses, which he thought were not unusual. His sister had been to visit her
mother less than once a year for the past decade. After her last visit in
August, she called out Adult Protective Services, who place his mother in a
board and care with his sister in charge. After one week, it was too much for
his sister, and she found a psychiatrist and attorney who had her declared
incompetent and committed to an institution. His sister prevented my patient from
visiting his mother whom he loved dearly. His mother deteriorated in just a few
months to death by
His mother had frequently
asked why her daughter disliked her so. All attempts at reconciliation were
unsuccessful. He thinks his mother, who enjoyed her own home for 47 years
before she was forced out, just gave up and died with no significant medical
problems except some mild loss of memory.
He also observed that his mother was similarly estranged from her own
mother in the previous generation. He stated he had observed in other cases
that children treat their own parents similarly to how they observe their
parents treat their grandparents.
Not a bad observation for a
computer techie.
* * * * *
11. Restoring Accountability in HealthCare, Government and
Society: