MEDICAL TUESDAY . NET	NEWSLETTER
Community For Better Health Care	Vol IX, No 22, Feb 22, 2011

In This Issue:

11. Related Organizations: Restoring Accountability in Medical Practice and Society

Words of Wisdom, Recent Postings, In Memoriam . . .

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Remember: Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, or any single payer initiative, was born for the benefit of the state and of a contemptuous disregard for people's welfare.

Thus we must remember that ObamaCare has nothing to do with appropriate healthcare; it was projected to gain loyalty by making citizens depended on the government and eliminating their choice and chance in improving their welfare or healthcare.

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1. Featured Article: The Neuroscience of True Grit

By Gary Stix | Scientific American | February 15, 2011 |

When tragedy strikes, most of us ultimately rebound surprisingly well.
Where does such resilience come from?

Toning Down the Brain's Alarm System
When faced with danger, the brain initiates a chemical cascade that primes you to put 'em up or run away. In turn, a series of chemicals in the brain can dampen this response, thereby promoting resilience to stress. One key chemical cycle begins when the hypothalamus releases corticotropin-releasing hormone (CRH), causing the pituitary gland to secrete adrenocorticotropin hormone (ACTH) into the bloodstream, which triggers the adrenal glands (near the kidneys) to release the hormone cortisol. Cortisol heightens the body's ability to respond to challenging situations, but too much can over time cause lasting damage. To help keep things in check, a series of chemicals (two shown below) dampens the stress response. Drugs or psychotherapy might stimulate production of these stress busters.

In fall 2009 Jeannine Brown Miller was driving home with her husband after a visit with her mother in Niagara Falls, N.Y. She came upon a police roadblock near the entrance to the Niagara University campus. Ambulance lights flashed up ahead. Miller knew her 17-year-old son, Jonathan, had been out in his car. Even though she couldn't make out what was happening clearly, something told her she should stop. She asked one of the emergency workers on the scene to check whether the car had the license plate "J Mill." A few minutes later a policeman and a chaplain approached, and she knew, even before they reached her, what they would say.

The loss of her son—the result of an undiagnosed medical problem that caused his sudden death even before his car rammed a tree—proved devastating. Time slowed to a crawl in the days immediately after Jonathan's death. "The first week was like an eternity," she says. "I lived minute by minute, not even hour by hour. I would just wake up and not think beyond what was in front of me."

Support came from multiple places, including her own personal decisions. Five hundred of Jonathan's classmates from Lewiston-Porter High School attended the wake and funeral, a demonstration of sentiment that helped to assuage the pain. She also found solace in her devout Catholic faith. After two weeks she returned to work as a human resources consultant. A couple of months after the accident she could visit the restaurant where she and her son had breakfasted the day he died. Support from the community never wavered. A ceremony honored Jonathan at the high school graduation, a Jonathan "J Mill" Miller Facebook page receives regular updates, and a local coffee shop serves "76" coffee in memory of his now retired football number. A year on she still cries every day, but she has found many ways to cope.

When the worst happens—a death in the family, a terrorist attack, an epidemic of virulent disease, paralyzing fear in the midst of battle—we experience a sense of profound shock and disorientation. Yet neuroscientists and psychologists who look back at the consequences of these horrific events have learned something surprising: most victims of tragedy soon begin to recover and ultimately emerge largely emotionally intact. Most of us demonstrate astonishing natural resilience to the worst that life throws our way.

The Mechanisms of Resilience

Sigmund Freud had written in 1917 of the necessity of "grief work" in which we take back the emotional energy, or libido, as he called it, that had been invested in the now "non-existent object"—in other words, the deceased. This century-old view of the psyche as a plumbing system for channeling subliminal life forces prevailed, in the absence of evidence to the contrary, until recent decades. That is when psychologists and neurobiologists began to probe for alternative explanations.

One of the things they began to look at is the nature of resilience. The term "resilience" (from the Latin re for "back" and salire for "to leap") joined the psychological lexicon from the physical sciences. . .

Resilience begins at a primal level. If someone takes a swing at you, the hypothalamus—a relay station in the brain that links the nervous and endocrine systems—churns out a stress signal in the form of corticotropin-releasing hormone, which begins a chemical deluge telling you to put up your dukes or head for the hills. Your brain pulsates like a flashing light: fight or flight, fight or flight. Afterward, the biological typhoon subsides. If you are constantly called on to defend your turf, a set of stress hormones gush constantly. One of them, cortisol, produced by the adrenal glands near the kidneys, can actually damage brain cells in the hippocampus and amygdala, regions involved with memory and emotion. So you end up an emotional and physical wreck. Luckily, the vast majority of us have resilience on our side . . .

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2. In the News: Personalized Medicine adding an extra nine years of life.

Dying breast cancer patient calls for personalized medicine By Maureen Martino

New England-based biotech publicist Adriana Jenkins passed away . . . following a 10-year battle with breast cancer. In her 15 years in public relations she represented many well-known biotechs, including Alnylam Pharmaceuticals, Alkermes, Avila Therapeutics, Constellation Pharmaceuticals, ImmunoGen, Pulmatrix and Synta Pharmaceuticals, notes Xconomy.

Jenkins was diagnosed with an aggressive form of breast cancer when she was just 31. Her doctors discovered that she had HER2-positive cancer, which accounts for about 25 percent of all breast cancer cases. And at that time Genentech was enrolling patients in clinical trials of a groundbreaking new cancer treatment called Hercepti; it's accompanied by a diagnostic test that determines whether the drug will be effective based on cancer type. The personalized medicine worked for Jenkins, giving her another nine years before the disease spread and finally claimed her life.

Before she died, Jenkins wrote an editorial in Forbes calling for pharma to embrace personalized medicine. Drugmakers waste billions on drugs aimed at a broad population when it's more likely success can be found in a treatment targeted to a specific patient population, she notes. Biotechs both large and small are pushed to become profitable quickly, and they fear narrowing a drug's potential sales with a diagnostic test. "The result of the focus on testing cancer drugs on all patients is painful trial and error," observes Jenkins.

To remedy the situation, Jenkins suggests a new law similar to the 1983 Orphan Drug Act that gives drugmakers developing rare disease treatments seven year of exclusivity and "fast track" regulatory review. "A comparable law could push drugmakers to develop PM drugs for cancer and other deadly ailments. It could combine additional market exclusivity with assurance of accelerated regulatory review," she states in her editorial. "I am so grateful for the extra time a PM drug gave me. My hope is that future patients have the same chance to benefit from personalized medicine."

Read more about: breast cancer, Herceptin, personalized medicine, Adriana Jenkins
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3. International Medicine: Pilot Schemes in Government Medicine

In case of overdose, consult a lifeguard

Ben Goldacre , The Guardian, Saturday 19 February 2011

The authorities have just finished a lengthy consultation to decide how homeopathy pills should be labelled. How amusing

For the last two weeks we've followed the government's misuse of evidence on NHS reforms, remembering that it is perfectly permitted to reform things with no evidence at all, like everyone else does – it just shouldn't pretend to have evidence. On Thursday, the health minister, Simon Burns, appeared before a BMA meeting in London.

He tried to persuade a room full of nerds that the pathfinder initiative was a pilot scheme, to test the reforms before national introduction, even though it covers more than half of all the patients in England. Then he explained that doctors obviously don't understand what the word "pilot" means. Then he explained that the evidence of what doctors say to him when he meets them is more reliable than good quality survey data.

Things get tricky when evidence collides with what people would simply like to crack on and do anyway. At midnight, the Medicines and Healthcare Regulatory Authority (MRHA) closed its consultation on how it should label homeopathy sugar pills. You may not think this is a difficult task, but politics makes it so.

To recap: homeopathy pills don't work better than placebo dummy pills in trials. They are made by taking one drop of the original substance and diluting it in 1,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000 drops of water, then taking one drop of that solution, which is now just water, and shaking it near some pills, which you then buy to treat an illness.

Current MHRA wording says "a homeopathic medicinal product used within the homeopathic tradition for the treatment of [whatever condition]". Homeopaths like this because it's ambiguous. Their internal lobbying document (which I have posted on the internet for everyone) explains that this wording "avoids the need to prove the science" and so "allows us to practise as normal".

Can the MHRA walk the line between evidence, politics, and clarity? It's my view that quacks are welcome to be quacks, but since regulators invite us to take them seriously, we are allowed higher expectations. Lacking optimisim, I have conducted my own consultation online. Here are the suggestions.

On instructions, we have "take as many as you like", since there are no ingredients. The proposed belladonna homeopathy pill ingredients label simply reads "no belladonna", which is a convention the MHRA could adapt for all its different homeopathy labels. Other suggestions include "none", "belief", "false hopes", "shattered dreams", and "the tears of unicorns".

For warnings, we have: "not to be taken seriously", "in case of overdose, consult a lifeguard", and "contains chemicals, including dihydrogen monoxide". This, of course, is a scary name for water, which became an internet meme after Nathan Zohner's school science project: he successfully gathered a petition to ban this chemical on the grounds that it is fatal when inhaled, contributes to the erosion of our natural landscape, may cause electrical failures, and has been found in the excised tumours of terminal cancer patients.

These label suggestions are clear, unambiguous, and they do not mislead anyone. If you think they are funny, I invite you to notice that besuited people in your medicines regulator have just run a lengthy official consultation on how to label sugar pills so as not to mislead the public. People who claim to be serious should be serious.

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The NHS does not give timely access to Health Care, it only gives access to Faux Care

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4. Medicare: An Account of Political Self-Destruction by Tevi Troy

Commentary Magazine | January 2011: The Democrats and Health Care

The passage of Barack Obama's health-care legislation in the spring of 2010 proved profoundly injurious to the president and his party in the November midterm elections. Studies conducted at Stanford University and the University of Minnesota agree that at least one-third of the 63-seat Democratic loss in the House of Representatives can be attributed to the electorate's negative reaction to the health-care bill—which suggests that the legislation was responsible for taking a bad election and turning it into a historic disaster.

Indeed, the determination of Democrats to push for the passage of health-care legislation may have created a new political dynamic in the United States. Since 1991, as I explained in an article published in the March 2010 issue of Commentary called "Health Care: A Two-Decade Blunder," Democrats have operated under a misperception—the misperception that health care was a winning issue for them. It has repeatedly led them to mistake voter concern for the economy for support for the Democratic health-care vision. In both 1992 and 2008, Democrats won the presidency in the midst of economic turmoil. And following both elections, Bill Clinton and Barack Obama saw their respective victories as a mandate to make a government-run health-care system—the final desideratum of the New Deal welfare state—a reality. Clinton's failure to get it and Obama's success in getting it led both men to spectacular midterm defeats.

But while the health-care issue has been problematic for the Democrats, it hasn't worked particularly well for Republicans either, 1994 notwithstanding. That may have just changed. The Democratic Party's association with unpopular government-run health care has now become so complete on a political level that the issue now may become a distinct advantage for Republicans going forward. That would be revolutionary.

It is all the more striking that Democrats have allowed this to happen to them when they had all the advance warning anyone could have needed to steer them away from the shoals on which they would founder in November 2010. And the person who wouldn't heed the warnings was the captain of the ship of state. . .

In August 2009, Vice President Joe Biden and White House Chief of Staff Rahm Emanuel suggested that they turn away from health care to spare the party a political disaster. Obama refused, telling some of his aides, "I feel lucky." A month later, according to David Paul Kuhn of Real Clear Politics, Virginia Senator James Webb visited President Obama in the White House and "told him this was going to be a disaster." As Webb described it, Obama somewhat blithely "believed it was all going to work out." In retrospect, the preternaturally calm-in-a-crisis Obama celebrated in best-selling books like Game Change seemed less calm than bizarrely oblivious. . .

The behind-the-scenes worries proved prescient at the beginning of 2010, when an insurgent Republican candidate running for Ted Kennedy's Senate seat in Massachusetts secured a stunning victory in a special election. Scott Brown had explicitly run as an opponent of the health-care bill. "One thing is clear," he said, "voters do not want the trillion-dollar health-care bill that is being forced on the American people." Some prominent House liberals, including Barney Frank and Anthony Wiener, assumed that the health-care reform moment was over. Emanuel started pushing once again for an exit strategy. Nevertheless, Obama and outgoing Speaker of the House Nancy Pelosi proceeded. "We'll never have a better majority in your presidency in numbers than we've got right now,"

Pelosi told the president. "We can make this work."

And they did, in a strictly legislative sense. . .

Alas for Obama . . . it turned out that the more people tasted it, the less they liked it. . . .

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

- Ronald Reagan

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5. Medical Gluttony: I want my Gastric Bypass

We have a number of patients requesting gastric bypass surgery for weight loss. Only three patients requesting a gastric bypass qualified for the surgery. They went all the way through the qualifying program with the six months of physician monitored diet program, six months of physician monitored exercise program and a full psychiatric evaluation with psychometrics. These programs could be done in series, which would take 18 months, or they could be done in parallel in six months, which would preclude gainful employment.

One patient that proceeded with the surgery was very happy. She went from her normal 360 pounds to 160 pounds over the first year and only regained to 200 the second year, which was her new weight. She was thrilled.

Another one who had decided not to proceed after going through the full preparatory program said she changed her mind when she saw one of her friends in the Gym after the surgery. She had so much loose skin that it could no longer be stuffed into her shorts. She was the only woman wearing bloomers in the gym.

The third one didn't lose any weight after the 40 pounds she lost in the qualifying exercise program. She liked her figure much better at 220 pounds than at 260 pounds. But she was thrilled. She said that she just loved to eat and she no longer had to worry about eating too much. She loved desserts and had one at each meal. She loved afternoon snacks with her fat friends and felt she was very trim in comparison. She was still plump, but kept the 40 pounds off even though all those sweets passed straight through into the sewer system without appreciably going through her adipose system. And she didn't mind the smell. She had fragrances in each bathroom to remedy that.

Now, that's real food gluttony.

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Medical Gluttony thrives in Government and Health Insurance Programs.

Gluttony Disappears with Appropriate Deductibles and Co-payments on Every Service.

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6. Medical Myths: Peer review improves health care.

Fifth Circuit Court of Appeals provided AAPS with a victory in the lawsuit
AAPS v. Texas Medical Board et al.
The full decision is attached so you can read it for yourself.

In its primary mission to protect the patient-doctor relationship, AAPS often Takes Action to protect its members from "arbitrary and unlawful governmental action" (from the decision). The lower Court's decision has been vacated, and the case is remanded for further proceedings. We anticipate that discovery should provide some very interesting material.

As a U.S. Supreme Court Justice once said: "Sunlight is a wonderful disinfectant."

AAPS stands firm in insisting that the constitutional rights of physicians be upheld.

This is a victory not only for Texas physicians but for physicians everywhere, as this lawsuit may pave the way for providing due process and fundamental fairness, consistent with our U.S. Constitution, in dealing with medical boards in all other states.

[Our general counsel, Andy Schlafly, did a fantastic job in oral argument]

L.R. Huntoon, M.D., Ph.D., F.A.A.N. Editor-in-Chief
Journal of American Physicians and Surgeons
Error! Hyperlink reference not valid.
AAPS website: Error! Hyperlink reference not valid.
AAPS, "The Delta Force of Medicine"

IN THE UNITED STATES COURT OF APPEALS FOR THE FIFTH CIRCUIT

No. 09-50953

ASSOCIATION OF AMERICAN PHYSICIANS & SURGEONS INC,

Plaintiff – Appellant
v.

TEXAS MEDICAL BOARD, (TMB); ROBERTA M. KALAFUT, Individually and in her Official Capacity; LAWRENCE L. ANDERSON, Individually and in his Official Capacity; MICHAEL ARAMBULA, Individually and in his Official Capacity; JULIE K. ATTEBURY, Individually and in her Official Capacity; JOSE BENAVIDES, Individually and in his Official Capacity; PATRICIA S. BLACKWELL, Individually and in her Official Capacity; MELINDA S. FREDRICKS, Individually and in her Official Capacity; MANUAL G. GUARJARDO, Individually and in his Official Capacity; AMANULLAH KAHN, Individually and in his Official Capacity; MELINDA MCMICHAEL, Individually and in her Official Capacity; MARGARET MCNEESE, Individually and in her Official Capacity; CHARLES E. OSWALT, Individually and in his Official Capacity; LARRY PRICE, Individually and in his Official Capacity; ANNETTE P. RAGGETT, Individually and in her Official Capacity; PAULETTE BARKER SOUTHARD, Individually and in her Official Capacity; TIMOTHY J. TURNER, Individually and in his Official Capacity; TIMOTHY WEBB, Individually and in his Official Capacity; IRVIN E. ZEITLER, Individually and in his Official Capacity; DONALD PATRICK, Individually and in his Official Capacity; JOHN DOES 1-10, Who are working for the TMB, Individually and in their Official Capacities, Defendants –

Appellees Appeal from the United States District Court for the Western District of Texas

Before JONES, Chief Judge, and REAVLEY and HAYNES, Circuit Judges.

United States Court of Appeals Fifth Circuit
F I L E D December 2, 2010, Lyle W. Cayce, Clerk No. 09-50953

EDITH H. JONES, Chief Judge:

The Association of American Physician and Surgeons ("AAPS") sued the Texas State Board of Medical Examiners ("the Board") under 42 U.S.C. § 1983 for declaratory and injunctive relief against alleged constitutional violations including the Board's use of anonymous complaints and retaliatory actions against physicians. The district court dismissed the case based on AAPS's lack of standing, noting an absence of "Fifth Circuit authority directly on point for the types of claims raised in this cause."

Weighing in on this issue, we conclude that AAPS has standing to bring this suit on behalf of its members. The judgment is therefore vacated and the case remanded for further proceedings.

I. BACKGROUND

AAPS is a not-for-profit membership organization incorporated under the laws of Indiana and headquartered in Tucson, Arizona. Its membership includes thousands of physicians in nearly every state, including Texas. AAPS asserts that part of its mission is to protect its members from arbitrary and unlawful governmental action.

The Board "is an agency of the executive branch of state government with the power to regulate the practice of medicine." TEX. OCC. CODE § 152.001. The Board consists of nineteen members appointed by the governor – twelve physicians and seven members of the public. Id. § 152.002. At the time this case was filed, Dr. Roberta Kalafut was the Board's president, and Lawrence Anderson was chair of the Disciplinary Process Review Committee. The other named and unnamed defendants were Board members and employees. The Board has statutory authority to discipline physicians for misconduct. See, e.g., id. § 164.001. No. 09-50953

AAPS sued the Board on behalf of its members for what it describes as pervasive and continuing violations of members' constitutional rights. AAPS alleged first that the Board manipulated anonymous complaints. Illustratively, Kalafut targeted physicians using anonymous complaints filed by her husband, and anonymous complaints allegedly were filed by a New York insurance company seeking to avoid paying a physician for claims. Second, AAPS alleged that the Board knew that the former chairman of its Disciplinary Process Review Committee, Keith Miller, was operating with a significant conflict of interest, but it took no corrective action and failed to disclose the conflict to the public or the physicians subject to discipline. Dr. Miller was allegedly an expert witness for plaintiffs in up to fifty malpractice cases during his tenure as chair of the committee and generated business for himself as an expert by improperly disciplining physicians.

Third, AAPS alleged that the Board arbitrarily rejected a decision in favor of a doctor by an administrative law judge from the State Office of Administrative Hearings, and then issued a sanction that damaged the physician's reputation. Fourth, AAPS asserted that the Board violated AAPS members' privacy by releasing unproven facts and records concerning disciplinary cases. Finally, AAPS alleged that the Board has retaliated against physicians who have complained about the Board by subjecting them to disciplinary proceedings and derogatory public comments. AAPS alleged violations of the confrontation clause and the due process, equal protection, and free speech provisions of the Constitution, and violation of federal statutory privacy equirements.1

The Board's answer included a number of affirmative defenses and sought dismissal under Fed. Rule Civ. Pro. 12(b)(1), arguing that AAPS lacked standing AAPS's complaint cites the Health Insurance Portability and Accountability Act 1 (HIPPA), codified at 29 U.S.C. § 1181 et seq. No. 09-50953 to sue on behalf of its members. In the midst of ongoing discovery disputes, the district court granted the motion to dismiss. AAPS appeals under 28 U.S.C. § 1291.

II. STANDARD OF REVIEW

"We review de novo motions to dismiss and motions for judgment on the pleadings." Jebaco, Inc. v. Harrah's Operating Co., Inc., 587 F.3d 314, 318 (5^th Cir. 2009) (citations omitted). "[W]hen standing is challenged on the basis of the pleadings," we must "accept as true all material allegations of the complaint and . . . construe the complaint in favor of the complaining party." Pennell v.City of San Jose, 485 U.S. 1, 7, 108 S. Ct. 849, 855 (1988) (citations and internal quotation omitted).

III. DISCUSSION

"There is no question that an association may have standing in its own right to seek judicial relief from injury to itself and to vindicate whatever rights and immunities the association itself may enjoy", but "[e]ven in the absence of injury to itself, an association may have standing solely as the representative of its members." Warth v. Seldin, 422 U.S. 490, 511, 95 S. Ct. 2197, 2211 (1975).

AAPS's standing here depends on its ability to sue for redress of its members' grievances. Thus, [A]n association has standing to bring suit on behalf of its members when: (a) its members would otherwise have standing to sue in their own right; (b) the interests it seeks to protect are germane to the organization's purpose; and (c) neither the claim asserted nor the relief requested requires the participation of individual members in the lawsuit.

See Hunt v. Wash. St. Apple Adver. Comm'n, 432 U.S. 333, 343, 97 S. Ct. 2434, 2441 (1977). The first two components of Hunt address constitutional requirements, while the third prong is solely prudential. See United Food & No. 09-50953 Commercial Workers Union Local 751 v. Brown Grp., Inc., 517 U.S. 544, 555, 116 S. Ct. 1529, 1535 (1996).

Beyond question, AAPS satisfies the first and second Hunt prongs. As to 2 the third prong, the Board argued that because AAPS's claims require the participation of individual members, it cannot meet that test. The district court agreed that AAPS's allegations about anonymous complaints, conflicts of interest, arbitrary administrative rulings, breaches of privacy, and retaliation cannot be sustained without the extensive participation of individual members and therefore render associational standing improper. We hold otherwise.

Because Hunt's third prong is prudential, "the general prohibition on a litigant's raising another person's legal rights is a judicially self-imposed limi[t] on the exercise of federal jurisdiction, not a constitutional mandate." Brown Grp., 517 U.S. at 557, 116 S. Ct. at 1536 (citations and quotations omitted). The third prong focuses importantly on "matters of administrative convenience and efficiency." Id. Courts assess this prong by examining both the relief requested and the claims asserted. Cornerstone Christian Schs. v. Univ. InterscholasticLeague, 563 F.3d 127, 134 n.5 (5th Cir. 2009). In general, "an association's action for damages running solely to its members would be barred for want of the association's standing to sue." Brown Grp., 517 U.S. at 546, 116 S. Ct. at 1531. But in this case, AAPS seeks declaratory and injunctive relief.

The first prong never has been in question, but the second prong was disputed at the 2 dismissal stage, when the Board argued that the individual interests at issue are not germane to AAPS's purpose. The district court did not address that argument because it found the third Hunt prong dispositive. The Board, however, neither briefed nor argued the germaneness requirement before this court and therefore abandoned it. Regardless, the germaneness requirement is "undemanding" and requires "mere pertinence" between the litigation at issue and the organization's purpose. See Bldg. & Constr. Trades Council of Buffalo v. Downtown Dev., Inc., 448 F.3d 138, 148 (2nd Cir. 2006). Through its affidavits and acts, AAPS has demonstrated its obvious interest in representing its members against alleged governmental abuse. AAPS easily surpasses the low threshold of Hunt's germaneness prong. No. 09-50953

As the district court noted, this court has not had occasion to consider Hunt's third prong with respect to claims similar to those AAPS alleges. Other 3 circuits have diverged in analogous cases. AAPS relies on precedents from the Third and Seventh Circuits, which allow standing if an association plaintiff can prove its case with a sampling of evidence from its members. See Pa. Psychiatric Soc'y v. Green Spring Health Servs., Inc., 280 F.3d 278 (3d Cir. 2002); Hosp. Council of W. Pa. v. City of Pittsburgh, 949 F.2d 83 (3d Cir. 1991); Retired Chi. Police Ass'n v. City of Chi., 7 F.3d 584, 601–02, 608 (7th Cir. 1993). The Board, in contrast, emphasizes the Tenth Circuit's rejection of an association's standing in Kansas Health Care Association, Inc. v. Kansas Department of Social & Rehabilitation Services, 958 F.2d 1018 (10th Cir. 1992).

The Third Circuit's approach is instructive. In Hospital Council, a constitutional challenge was filed against certain cities' alleged practice of coercing tax-exempt hospitals into making payments in order to obtain zoning approval, protect their tax-exempt status, and secure other governmental benefits. Id. at 85. Then-Judge Alito explained that although evidence would be needed from certain individual hospitals and their employees in order to prove whether the challenged policy had been enforced, the participation of all of the individual members was unnecessary and thus associational standing was appropriate. Id. at 89–90; see also Pa. Psychiatric Soc'y, 280 F.3d at 287 (holding that plaintiff could attempt to establish associational standing with limited individual member participation).

We rejected associational 3 standing in Friends for American Free Enterprise Association v. Wal-Mart Stores, Inc., because the plaintiff's common law tortious interference claims at issue were wholly fact-specific as to the individual members. 284 F.3d 575 (5th Cir. 2002). Likewise, in Cornerstone Christian Schools v. University Scholastic League, associational standing was rejected for plaintiffs asserting a free exercise claim. 563 F.3d 127 (2009) (citing Harris v. McRae, 448 U.S. 297, 100 S. Ct. 2671 (1980)). Neither case is particularly instructive here. No. 09-50953

The Seventh Circuit expressly adopted the Third Circuit's reasoning in Retired Chicago Police Association, a suit seeking to prohibit the city from changing the terms of annuitant health care costs under the city's pension plan. 7 F.3d at 590. To prove the case for a contract breach, some retirees would need to submit evidence, but the active participation of each annuitant would not be required. Id. at 601–03. The court noted: We can discern no indication in Warth, Hunt, or Brock that the Supreme Court intended to limit representational standing to cases in which it would not be necessary to take any evidence from individual members of an association. Such a stringent limitation on representational standing cannot be squared with the Court's assessment in Brock of the efficiencies for both the litigant and the judicial system from the use of representational standing. Id. at 601-02.

Both of these circuits interpret Hunt to mean, in light of the Court's previous decision in Warth, that as long as resolution of the claims benefits the association's members and the claims can be proven by evidence from representative injured members, without a fact-intensive-individual inquiry, the participation of those individual members will not thwart associational standing.

See also Pa. Psychiatric Soc'y, 280 F.3d at 286.

The Tenth Circuit, however, refused to grant associational standing to a medical services provider association that sought a preliminary injunction against Kansas's planned Medicaid reimbursement rate freeze. See Kansas Health Care Ass'n, 958 F.2d at 1018. Among other things, the association argued that the state's findings as to reimbursement rates did not comply with federal law. Id. at 1020. The Tenth Circuit held that determining the adequacy of the rates would "necessarily require individual participation of the associations' members." Id. at 1023. Further, to assess the state's compliance with federally prescribed procedures in arriving at its reimbursement rate, the No. 09-50953 district court would be required to make a detailed economic examination of individual providers. The court acknowledged that "minimal participation" from individual members might not defeat associational standing, Id. at 1022 (citing AMISUB (PSL), Inc. v. Colo. Dep't of Soc. Servs., 879 F.2d 789 (10th Cir.1989)), but it held that the amount of individual participation necessary to prove the association's specific claims foreclosed associational standing.

The differences between these decisions' approach to associational standing are more of degree than kind. Hunt's prudential inquiry concerns both claims alleged and the relief sought because only a case-specific analysis will reveal whether an association or its individual members are better positioned to present a case. See Int'l Union, UAW v. Brock, 477 U.S. 274, 289-90, 106 S. Ct. 2523, 2532-33 (1986) (comparing associational standing with class action criteria). In Hospital Council and Retired Chicago Police Association, a discrete pattern of conduct or contract breach was alleged to have applied equally against a large number of association members. Proving the illegality of the pattern or breach of contract required some evidence from members, but once proved as to some, the violations would be proved as to all.

In Kansas Health Care Association, however, the court carefully distinguished between claims of administrative illegality that would be apparent with minimal factual development and those that could only be proven by intensive analysis of individual hospitals. Because of their fact-sensitivity, the ratemaking inquiries before the court did not lend themselves to proof that would readily apply to all of the members.

The present case, on balance, more closely resembles Hospital Council than Kansas Health Care Association. AAPS's complaint alleged, among other things, abuses perpetrated on physicians by means of anonymous complaints, harassment of doctors who complained about the Board, and conflicts of interest by decision-makers. If practiced systemically, such abuses may have violated or No. 09-50953 chilled AAPS members' constitutional rights. Proof of these misdeeds could establish a pattern with evidence from the Board's witnesses and files and from a small but significant sample of physicians. Because AAPS also seeks only equitable relief from these alleged violations, both the claims and relief appear to support judicially efficient management if associational standing is granted.

In so holding, we "accept as true all material allegations of the complaint and . . . construe the complaint in favor of the complaining party," Pennell, supra, but we express no opinion on whether AAPS will ultimately be able to prove its rather dramatic claims. Under these circumstances, dismissal under Rule 12(b)(1) was improper.

III. CONCLUSION

Because AAPS was entitled to claim associational standing on behalf of its members, we vacate and remand for further proceedings not inconsistent with this opinion.

VACATED AND REMANDED.

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Much of Peer Review is Sham Peer Review – Economic Credentialing

AAPS stands firm on insisting that the constitutional rights of physicians be upheld.

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7. Overheard in the Medical Staff Lounge: What is changing in health care?

Dr. Sam: It seems that there are new forces afoot in the practice of medicine since the composition of our patients has changed dramatically.

Dr. Dave: Our HMO apparently has contracted with the state for their welfare load and has tried to deluge our practice with Medicaid patients under the illusion that they are the same as the other HMO patients.

Dr. Yancy: We've noticed that the HMO-Medicaid population is a time bomb. We were promised HMO rates, which are below the market rates to begin with, but then it seems that the rates aren't even HMO rates but Medicaid rates after the first visit.

Dr. Sam: For internal medicine that's about $18 after the first evaluation.

Dr. Dave: In other words, you are only receiving as much for a face-to-face evaluation, examination, differential diagnosis and diagnostic and treatment plan as attorneys receive for a phone call.

Dr. Sam: Much of what we do could also be taken care of by a phone call after the first lengthy exam if we could charge like attorneys do, which is the same hourly rate by phone as in the office. But the procedure book does not list clinical phone calls without more justification than they are worth and insurance carriers don't pay for them.

Dr. Dave: Don't you long for the days when we charged patients directly, rather than this circuitous route through insurance carriers, HMOs, CPT codes and anyone else that wants to get a percentage of our work.

Dr. Rosen: I remember the days when we did workers compensation exams for an intermediary service. They were paying us for a consultation on par with other consultations. Once we got to see a statement for what the WC intermediary received from the system, we were appalled. It was about 5 times our charge. They were really raking in the profits off of our backs.

Dr. Dave: I sometimes feel guilty doing a $200 consultation that takes more than an hour. But then after it passed through the intermediary, the insurance company paid more than a $1000 to the group that hired me for my consultation. What a markup.

Dr. Milton: Doesn't look like a 10% surcharge, but like a 500% or more processing fee. I don't understand why the workers compensation insurance companies pay so generously when Medical Insurance companies keep reducing our fee.

Dr. Sam: Doesn't it astound you when as doctors we are so concerned about our charges, but when hospitals or service groups charge others five times as much for our services than patient insurance companies pay us, aren't they in effect saying we are worth five times what the medical insurance company pays us?

Dr. Ruth: I did a couple of workers compensation exams several years ago. After I saw what the workers compensation group charged for my consult, I no longer wanted to be a party to such gouging. In fact, I can't think of a better word for the scheme.

Dr. Patricia: I've been very concerned about cigarette smoking. I once tried to do cigarette withdrawals in my office. I was trying to run this as a brief office visit since it occurred in the office and vital signs, including oxygen saturation, were checked for each patient. When the insurance company found out about my program, they became unhinged. They said I had to send these patients to a reputable cigarette withdrawal program such as Smokenders in order to be covered. My program was far superior to their program. I even had people go to Smokenders after checking me out. They said that if they went to Smokenders, they would just keep on smoking; whereas, if they came to my clinic, they knew they were expected to quit smoking.

Dr. Milton: Now that wouldn't be any fun to really stop smoking cigarettes, would it?

Dr. Rosen: I guess doctors just spoil the fun. Doctors just can't get it through their heads that these programs are social programs, not medical programs with a healthy ending.

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The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.

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8. Voices of Medicine: A Review of Local and Regional Medical Journals and Online Articles

Informed Spousal Consent: A Great Idea Worth Spreading by Jeff Segal, MD, JD, FACS
Published by S under Healthcare Reform

I was thumbing through General Surgery News recently and read an article espousing a great idea; an idea worth spreading. Philip Schaurer, MD, and Jim Saxton, Esq. wrote about adding a spouse's name to the informed consent document. Informed consent, of course, is a process, and not a document. But, by engaging the family, you address several issues.

Sometimes the person filing a lawsuit is not the patient, but a family member. The patient might be incapacitated, unresponsive, or even dead. Sometimes the spouse, left out of the loop, might have objected to the procedure being performed – perhaps because of risk; perhaps because of cost; or perhaps a million other reasons. Securing the spouse's buy in can go a long way to preventing a lawsuit or ending a lawsuit once filed.

Words that occasionally pass a spouse's lips: "I must have told my husband fifteen times that the surgery was a mistake. It was too risky. And the problem being solved was not that bad." Or "I had no idea that this surgery was anything other than routine." You get the picture.

When a spouse's signature is embedded in the informed consent document, such statements lack any credibility. More important, the process engages a family member to understand the risks, benefits, and options, ask pointed questions, and manage expectations.

If a spouse refuses to sign, then you will be alerted, up front, that there may be challenges down the road. Better to learn that today — than down the road.

Obtaining a spouse or family member's consent may not always be appropriate. Sometimes a patient might not want their spouse to know they are having a procedure done. Also, many procedures are low risk and the extra time required to bring all parties on board might be an inefficient use of time and resources. But, the riskier the procedure and the more options available to treat a condition, the more it makes sense to expand the signature line.

Read the responses at MedicalJustice . . .
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VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about.

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9. Book Review: Death Orders by Anna Geifman

When Terrorists Become State Leaders

[Editor's note: The following is the first half of chapter 8 of Anna Geifman's powerful new book, Death Orders, which exposes the chilling parallels between Soviet and Islamic terrorism. Unfortunately, as Professor Geifman explains, events unfolding today in Egypt are all too familiar, harkening back to the Bolshevik takeover of Russia in 1917. Part II of chapter 8 will appear in our next issue.]

We must execute not only the guilty. Execution of the innocent will impress the masses even more.
–Bolshevik Commissar of Justice Nikolai Krylenko

Execute mercilessly.
–Lev Trotsky´s telegram to comrades in Astrakhan´, March 1919

The first time in history terrorists seized control of a state in 1917–in Russia, the birthplace of modern political extremism. There, adherents of a totalist ideology, men with extensive radical background and subversive experience, set out to rule by way of genocidal "Red Terror" against designated "class enemies."¹ A similar situation developed next in Afghanistan, where the Sunni Islamist Taliban held power from 1996 to 2001, relying on state-sponsored violence against "enemies of Islam´. In recent years, Hamas has been using similar methods for consolidating Islamist rule in Gaza. Radical Shiite Hezbollah has made major advances in controlling Lebanon. Present-day dramatic events in Cairo are alarming indeed: are Egypt´s own jihadists to imitate the terrorists-come-to-power scenario? The concern is valid especially because Egyptian developments over the past two weeks seem to replicate—sometimes to astonishing detail—the initial events of the 1917 revolution in Russia. Is Egypt to emulate a fateful twist of transitory politics in a far-away land hundred years ago, where following the collapse of the autocratic regime, the extremists usurped control via a coup that toppled the ineffectual provisional government? Since then, the cardinal feature of the newly-established Soviet rule was its dependence terrorist mentality and on unremitting state-sponsored political violence. Terror manifested itself immediately after the Bolshevik takeover and escalated into sanguinary years of the Russian Civil War of 1918-1921 and beyond.

Lenin and his associates relied on the pre-1917 terrorist mentality and practices while building their "Communist paradise." Aside from defending expropriations as legitimate methods of revolutionary fundraising, prior to the Bolshevik takeover, Lenin had urged his followers to establish armed combat detachments for the purpose of killing the gendarmes and Cossacks and blowing up their headquarters. Since 1905, he also advocated the use of explosives, boiling water and acid against soldiers, the police, and supporters of the tsarist regime. Throughout the empire the Bolsheviks took part in terrorist activities, including those of major political significance, such as the 1907 murder of celebrated poet and social reformer Count Il'ia Chavchavadze, arguably the most popular national figure in turn-of-the-century Georgia.

Having taken over the Russian administration, Lenin and Trotsky labeled opponents of violence "eunuchs and pharisees" and proceeded to implement government-sponsored machinery of state terror—projecting the conspiratorial and semicriminal nature of the Bolshevik fraction onto the new dictatorial regime. The Bolsheviks endorsed a policy they called the "Red Terror"—an instrument of repression in the hands of the revolutionary government– as a precondition for success in a seemingly visionary endeavor by a handful of political extremists to establish control over Russia's population. For this purpose, the Bolsheviks must to "put an end once and for all of the papist-Quaker babble about the sanctity of human life," Trotsky proclaimed. . .

This book review is found at FrontPageMag.com . . .
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The Book Review Section Is an Insider's View of What Doctors are Reading about.
Or Perhaps should be reading about to understand Evil in the world

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10. Hippocrates & His Kin: Hospital Directives

All patients discharged after an Anterior Myocardial Infarction, will receive Statin. Exceptions will include patients who have expired.

That way if they wake up, they won't have another AMI down under.

Asthma

He had a severe asthma attack in Washington in December and had noticed cats in the Lodge where he was staying. He was very allergic to cats. He was using his inhaler as frequently as he dared, at least hourly and was losing ground in trying to catch his breath. Since he didn't have his nebulizer with him, he went to the hospital Emergency Room.

He tried to tell the doctor that he was just having an asthma attack and needed a nebulizer treatment. However, the ER doctor was more interested in his heart and when the CXR showed a small degree of alveolar collapse, he was given a CT scan of the lung despite his telling the doctor he's had asthma all his life and has some mucous plugs that needed to be removed by a nebulizer. When they tried to admit him overnight, despite the fact that he was clear by this time, he decided that he had played their game long enough, and he left the ER to go home rather than upstairs overnight.

He had no further difficulty without any cats in another motel.

Be sure to listen to patients - especially those that have lived their disease their entire life.

Senator on the Couch! (After Frank & Ernest by Bob Thaves)

Psychiatrist: There Senator, I think you're back in touch with reality.

Senator: "Back in Touch with Reality!" . . . But that will ruin my political career.

Did we just observe reality thinking in Washington?

One benefit not mentioned in the weight-loss brochures.

Two women on observing a friend after a 200-pound weight loss with loose skin down to her knees - I think she could get by with a one piece bathing suit - the top piece.

Weight-Loss - the Fad of the Day.

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Hippocrates and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Today & Tomorrow

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11. Professionals Restoring Accountability in Medical Practice, Government and Society:

• John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?," go to www.healthplanusa.net/AE-AreYouReallyInsured.htm.

• Medi-Share Medi-Share is based on the biblical principles of caring for and sharing in one another's burdens (as outlined in Galatians 6:2). And as such, adhering to biblical principles of health and lifestyle are important requirements for membership in Medi-Share. This is not insurance. Read more . . .

• PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist, practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.patmosemergiclinic.com/ To read more on Dr Berry, please click on the various topics at his website. To review How to Start a Third-Party Free Medical Practice . . .

• PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. (http://home.earthlink.net/~doctorlrhuntoon/) Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. I also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.

• FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder, www.westandfirm.org, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance. Read Lin Zinser's view on today's health care problem: In today's proposals for sweeping changes in the field of medicine, the term "socialized medicine" is never used. Instead we hear demands for "universal," "mandatory," "singlepayer," and/or "comprehensive" systems. These demands aim to force one healthcare plan (sometimes with options) onto all Americans; it is a plan under which all medical services are paid for, and thus controlled, by government agencies. Sometimes, proponents call this "nationalized financing" or "nationalized health insurance." In a more honest day, it was called socialized medicine.

• 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."

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

• Dr David MacDonald started Liberty Health Group. To compare the traditional health insurance model with the Liberty high-deductible model, go to www.libertyhealthgroup.com/Liberty_Solutions.htm. There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.

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

• ReflectiveMedical Information Systems (RMIS), delivering information that empowers patients, is a new venture by Dr. Gibson, one of our regular contributors, and his research group which will go far in making health care costs transparent. This site provides access to information related to medical costs as an informational and educational service to users of the website. This site contains general information regarding the historical, estimates, actual and Medicare range of amounts paid to providers and billed by providers to treat the procedures listed. These amounts were calculated based on actual claims paid. These amounts are not estimates of costs that may be incurred in the future. Although national or regional representations and estimates may be displayed, data from certain areas may not be included. You may want to follow this development at www.ReflectiveMedical.com. During your visit you may wish to enroll your own data to attract patients to your practice. This is truly innovative and has been needed for a long time. Congratulations to Dr. Gibson and staff for being at the cutting edge of healthcare reform with transparency.

• 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.

• 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 read News of the Day in Perspective: Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. Browse the archives of their 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.

•

The AAPS California Chapter is an unincorporated association made up of members. The Goal of the AAPS California Chapter is to carry on the activities of the Association of American Physicians and Surgeons (AAPS) on a statewide basis. This is accomplished by having meetings and providing communications that support the medical professional needs and interests of independent physicians in private practice. To join the AAPS California Chapter, all you need to do is join national AAPS and be a physician licensed to practice in the State of California. There is no additional cost or fee to be a member of the AAPS California State Chapter.
Go to California Chapter Web Page . . .

Bottom line: "We are the best deal Physicians can get from a statewide physician based organization!"

PA-AAPS is the Pennsylvania Chapter of the Association of American Physicians and Surgeons (AAPS), a non-partisan professional association of physicians in all types of practices and specialties across the country. Since 1943, AAPS has been dedicated to the highest ethical standards of the Oath of Hippocrates and to preserving the sanctity of the patient-physician relationship and the practice of private medicine. We welcome all physicians (M.D. and D.O.) as members. Podiatrists, dentists, chiropractors and other medical professionals are welcome to join as professional associate members. Staff members and the public are welcome as associate members. Medical students are welcome to join free of charge.

Our motto, "omnia pro aegroto" means "all for the patient."

Words of Wisdom

The trouble is not in science but in the uses men make of it. Doctor and layman alike must learn wisdom in their employment of science, whether this applies to atom bombs or blood transfusion. –Wilder Penfield.

All who are benefited by community life, especially the physician, owe something to the community. –Charles H. Mayo

The purpose of medicine is to prevent significant disease, to decrease pain, and to postpone death when it is meaningful to do so. Technology has to support these goals—if not, it may even be counterproductive. –Joel J. Nobel

The technology of medicine has outrun its sociology. –Henry E. Sigerist

Some Recent Postings

In The February 8, 2011 Medical Tuesday Issue:

In case of overdose, consult a lifeguard

When Terrorists Become State Leaders

In Memoriam

Daniel Bell, who died on January 25th, was one of the great sociologists of capitalism

Schumpeter Ahead of the curve | Feb 3rd 2011 |The Economist | PRINT EDITION