1. Featured Article: Don't Even Think About Lying

How brain scans are reinventing the science of lie detection by Steve Silberman

I'm flat on my back in a very loud machine, trying to keep my mind quiet. It's not easy. The inside of an fMRI scanner is narrow and dark, with only a sliver of the world visible in a tilted mirror above my eyes. Despite a set of earplugs, I'm bathed in a dull roar punctuated by a racket like a dryer full of sneakers.

Functional magnetic resonance imaging - fMRI for short - enables researchers to create maps of the brain's networks in action as they process thoughts, sensations, memories, and motor commands. Since its debut in experimental medicine 10 years ago, functional imaging has opened a window onto the cognitive operations behind such complex and subtle behavior as feeling transported by a piece of music or recognizing the face of a loved one in a crowd. As it migrates into clinical practice, fMRI is making it possible for neurologists to detect early signs of Alzheimer's disease and other disorders, evaluate drug treatments, and pinpoint tissue housing critical abilities like speech before venturing into a patient's brain with a scalpel.

Now fMRI is also poised to transform the security industry, the judicial system, and our fundamental notions of privacy. I'm in a lab at Columbia University, where scientists are using the technology to analyze the cognitive differences between truth and lies. By mapping the neural circuits behind deception, researchers are turning fMRI into a new kind of lie detector that's more probing and accurate than the polygraph, the standard lie-detection tool employed by law enforcement and intelligence agencies for nearly a century.

The polygraph is widely considered unreliable in scientific circles, partly because its effectiveness depends heavily on the intimidation skills of the interrogator. What a polygraph actually measures is the stress of telling a lie, as reflected in accelerated heart rate, rapid breathing, rising blood pressure, and increased sweating. Sociopaths who don't feel guilt and people who learn to inhibit their reactions to stress can slip through a polygrapher's net. Gary Ridgway, known as the Green River Killer, and CIA double agent Aldrich Ames passed polygraph tests and resumed their criminal activities. While evidence based on polygraph tests is barred from most US trials, the device is being used more frequently in parole and child-custody hearings and as a counterintelligence tool in the war on terrorism. Researchers believe that fMRI should be tougher to outwit because it detects something much harder to suppress: neurological evidence of the decision to lie.

My host for the morning's experiment is Joy Hirsch, a neuroscientist and founder of Columbia's fMRI Research Center, who has offered me time in the scanner as a preview of the near future. . . .

"The caudate is your inner editor, helping you manage the conflict between telling the truth and creating the lie," Hirsch explains. "Look here - when you're telling the truth, this area is asleep. But when you're trying to deceive, the signals are loud and clear."

I not only failed to fool the invisible inquisitor, I managed to incriminate myself without even opening my mouth.

The science behind fMRI lie detection has matured with astonishing speed. The notion of mapping regions of the brain that become active during deception first appeared in obscure radiology journals less than five years ago. The purpose of these studies was not to create a better lie detector but simply to understand how the brain works. . . .

"The whole area of research around deception and credibility assessment had been minimal, to say the least, over the last half-century," says Andrew Ryan, head of research at the Department of Defense Polygraph Institute. DoDPI put out a call for funding requests to scientists investigating lie detection, noting that "central nervous system activity related to deception may prove to be a viable area of research." Grants from DoDPI, the Department of Homeland Security, Darpa, and other agencies triggered a wave of research into new lie-detection technologies. . . .

Through their grants, federal agencies began to influence the direction of the research. The early studies focused on discovering "underlying principles," as Columbia's Hirsch puts it - the basic neuromechanisms shared by all acts of deception - by averaging data obtained from scanning many subjects. But once government agencies like DoDPI started looking into fMRI, what began as an exploration of the brain became a race to build a better lie detector. . . .

By the end of 2006, two companies, No Lie MRI and Cephos, will bring fMRI's ability to detect deception to market. Both startups originated in the world of medical diagnostics. Cephos founder Steven Laken helped develop the first commercial DNA test for colorectal cancer. "FMRI lie detection is where DNA diagnostics were 10 or 15 years ago," he says. "The biggest challenge is that this is new to a lot of different groups of people. You have to get lawyers and district attorneys to understand this isn't a polygraph. I view it as no different than developing a diagnostic test."

. . . For No Lie MRI founder Joel Huizenga, scanner-based lie detection represents a significant upgrade in "the arms race between truth-tellers and deceivers."

Both Laken and Huizenga play up the potential power of their technologies to exonerate the innocent and downplay the potential for aiding prosecution of the guilty. . . .

The guardians of another Philadelphia innovation that changed the judicial system - the US Constitution - are already sounding the alarm. In September, the Cornell Law Review weighed the legal implications of the use of brain imaging in courtrooms and federal detention centers, calling fMRI "one of the few technologies to which the now clichéd moniker of 'Orwellian' legitimately applies."

When lawyers representing Cephos' and No Lie MRI's clients come to court, the first legal obstacles they'll have to overcome are the precedents barring so-called junk science. Polygraph evidence was excluded from most US courtrooms by a 1923 circuit court decision that became known as the Frye test. The ruling set a high bar for the admission of new types of scientific evidence, requiring that a technology have "general acceptance" and "scientific recognition among physiological and psychological authorities" to be considered. When the polygraph first came before the courts, it had almost no paper trail of independent verification.

FMRI lie detection, however, has evolved in the open, with each new advance subjected to peer review. The Supreme Court has already demonstrated that it is inclined to look favorably on brain imaging: A landmark 2005 decision outlawing the execution of those who commit capital crimes as juveniles was influenced by fMRI studies showing that adolescent brains are wired differently than those of adults. The acceptance of DNA profiling may be another bellwether. Highly controversial when introduced in the 1980s, it had the support of the scientific community and is now widely accepted in the courts. . . .

The technological innovations that produce sweeping changes often evolve beyond their designers' original intentions - the Internet, the cloud chamber, a 19th-century doctor's cuff for measuring blood pressure that, when incorporated into the polygraph, became the unsteady foundation of the modern counterintelligence industry.

So what began as a neurological inquiry into why kids with ADHD blurt out embarrassing truths may end up forcing the legal system to define more clearly the inviolable boundaries of the self.

"My concern is precisely with the civil and commercial uses of fMRI lie detection," says ethicist Paul Root Wolpe. "When this technology is available on the market, it will be in places like Guantánamo Bay and Abu Ghraib in a heartbeat.

"Once people begin to think that police can look right into their brains and tell whether they're lying," he adds, "it's going to be 1984 in their minds, and there could be a significant backlash. The goal of detecting deception requires far more public scrutiny than it has had up until now. As a society, we need to have a very serious conversation about this."

The Cortex Cop

Your flight is now boarding. Please walk through the "mental detector."

For all the promise of fMRI lie detection, some practical obstacles stand in the way of its widespread use: The scanners are huge and therefore not portable, and a slight shake of the head - let alone outright refusal to be scanned - can disrupt the procedure. Britton Chance, a professor emeritus of biophysics at the University of Pennsylvania, has developed an instrument that records much of the same brain activity as fMRI lie detection - but fits in a briefcase and can be deployed on an unwilling subject. . .

He explains that his goal is to create a wearable device "that lets me know what you're thinking without you telling me. If I ask you a question, I'd like to know before you answer whether you're going to be truthful." . . .

Chance believes the virtues of what he calls "a network to detect malevolence" outweigh the impact on personal liberties. "It would certainly represent an invasion of privacy," he says. "I'm sure there may be people who, for very good reasons, would not want to come near this device - and they're the interesting ones. But we'll all feel a bit safer if this kind of technology is used in places like airports. If you don't want to take the test, you can turn around and fly another day." Then he smiles. "Of course, that's the biggest selector of guilt you could want." - S.S.

www.wired.com/wired/archive/14.01/lying_pr.html

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2. In the News: For $200 a Month, You Can Have Your Doctor's Expertise Around the Clock

Doctor Is In -- For A Price – by David Lazarus, SF Chronicle, Sunday, January 8, 2006

David Ogden, a doctor in Marin County's affluent Greenbrae, says he wants more time to spend with his nearly 3,000 patients, and he knows his patients want more face time with him.

Ogden's solution: a $2,400 annual retainer to be paid by "several hundred" patients who want round-the-clock access to his expertise, no waiting for appointments, plus more leisurely visits with him in the examining room.

Everyone else -- in other words, at least 2,000 current patients -- will no longer see Ogden during routine checkups or for most ailments. Instead, they'll have to make do with a nurse practitioner.

This is the latest trend in health care -- variously called "concierge medicine" or "boutique medicine." For an additional fee, patients receive more access to, and attention from, their physician, on top of the normal cost of treatment.

For those who can't (or won't) pay the extra charge, health care can be less convenient, less comprehensive and possibly less skillful. And that's if the concierge doctor will still accommodate patients who aren't paying retainers.

Most of the estimated 200 concierge doctors nationwide are making such people look elsewhere for primary care. Ogden is one of a relative few attempting to maintain a full practice through expanded use of nurse practitioners.

"This is about spending more time with patients," he told me. "It's what I want, and it's what my patients want." . . .

"It's not how I want to practice medicine," Ogden said. . .

In Greenbrae, Ogden said, he feels comfortable that all his patients -- retainer-paying and otherwise -- will receive appropriate care.

"If someone needs me, I'm here," he said. "I'm still a doctor."

And, increasingly, a businessman.

Send tips or feedback to dlazarus@sfchronicle.com. Read the entire article at www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2006/01/08/BUG7IGJHEC1.DTL.

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3. International Medicine: Europe's Ailing Drug Industry by Grace-Marie Turner The Wall Street Journal Europe 12/28/2005

What happened to Europe's vibrant drug industry? Just a decade ago, more than two-thirds of all drug research was conducted in Europe. Now, 60% is conducted in the United States. Major European drug makers such as Aventis, Novartis and GlaxoSmithKline have shifted significant portions of their research operations from the Continent to the U.S. and beyond. And human talent continues to follow the research money: Some 400,000 European science and technology graduates now live in the U.S., with thousands more leaving every year.

For all this, European investors, scientists and patients have their own political leaders to blame. Deliberate government policy, in the form of price controls imposed by national health-care systems, is slowly choking off a once-thriving sector.

Europe's government-run and -dominated health-care systems are virtually monopsonies. As the primary buyers in their national markets, they have the power to set drug prices 40% to 60% lower than the free-market prices in the United States. These price controls have a serious impact on innovation.

Research and development are expensive. Researchers at Tufts University in Boston determined that drug makers spend at least $800 million just to develop a new medicine, and there is a high risk that a drug could fail after years of testing or flunk the government approval process. In the United States, companies are allowed to recoup their investments and make a profit by charging a price that incorporates their research costs. In Europe, that is seldom the case.

The loss to research caused by price controls was quantified in a recent study by the U.S. Department of Commerce. The study looked at the impact of pharmaceutical price controls in 11 countries, among them Holland, France and Germany, and found that price controls caused a $5 billion to $8 billion annual reduction in funding for drug research and development.

What could that amount buy? According to the study, it could lead to the discovery of three or four new potentially life-saving chemicals each year. So it's no surprise that from 1998 to 2002 there were only 44 new drug launches in Europe, compared to 85 in the U.S.

But now is no time for Americans to be smug. Ironically, there is a bipartisan move afoot in the United States to implement the same policies that have dried up pharmaceutical research in Europe by having the government "negotiate" drug prices. . . .

We've already seen such policies force drug makers out of Europe. Roche chairman Franz Humer has pointed out that the research-based pharmaceutical companies could just as easily move on to Asia, where technology and education are steadily improving. In fact, Roche has just opened a research center in Shanghai, while other drug makers are flocking to Singapore and India.

Of course, if the U.S. gives drug makers a reason to go on the move again, European governments could make their own pitch by eliminating the interventionist policies that have been undercutting drug innovation in their countries. They just might be able to lure talented drug researchers and pharmaceutical investments back home by recognizing the value of pharmaceutical research -- not only in creating new medicines but in reviving a valuable industry.

Ms. Turner is president of the Galen Institute, a health-research organization based in Alexandria, Virginia. To read the entire report, go to www.galen.org/healthabroad.asp?docID=854.

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4. Medicare: The Prescription Drug Plan Has Been and Continues to Be a Disaster

Medicare Part D (for Disaster) has been such a huge disappointment that some state governments have passed emergency legislation as a bridge for their senior citizens. Our office has been averaging two hours on the phone almost daily trying to help patients obtain the drugs they've been on for years. At conventional rent, overhead and staffing rates, that amounts to well over $250 per week ($1000 per month) of physician office expense donated to the Medicare Fiasco. To read an article that would have solved the Pharmacy Benefit Plan and the Medicare Reform problem, go to www.delmeyer.net/hmc2005.htm.

Well-meaning people who may have even supported the patient-driven health plans (PDHP) now sweeping the country, tried to mix this high-deductible health insurance (HDHI) with the Medicare Pharmacy Benefit Plan. Medicare recipients may not necessarily have bought into this concept and Medicaid patients definitely have not. The stratified deductibles eliminate pharmacy coverage for the second half of the nearly $5,000 deductible portion. This could well be the undoing of the entire concept of PDHP and HDHI.

The bureaucrats will probably take issue arguing that their complicated plan is being misinterpreted. The exact numbers are irrelevant whether the patients start paying at $2600, or $2800, or $3,000. If you think a few hundred dollars here and there make a difference, then you don't understand the health-care issues. Patients that complain about the $25 deductibles and co-payments don't care whether that bare portion is $2000 or $3000. They will complain to their congressmen and health-care reform will be in jeopardy. Health-care reform will continue to be in jeopardy as long as Congress, physician senators, and medical and physician bureaucrats make adjustments without a graduated market-based control. Thus, the very people who thought they were doing the most good implemented the greatest harm to our patients and their health care.

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

Ronald Reagan

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5. Medical Gluttony: Doctors Gouging the System and Delivering Bad Care

In the last issue, a Physician Assistant wrote that doctors cause much of Medical Gluttony. Our brief response was that the lack of financial responsibility allowed this perversion by all members of the health-care establishment. Just as patients overutilize health-care resources because of lack of financial disincentives, physicians and surgeons overutilize because physicians no longer serve their patients. Patients are just a commodity that can be manipulated for financial greed because they are totally outside the Medical MarketPlace. If patients were in a market environment, they would then control their own utilization, whether of physician or surgical services or hospitalizations.

Mrs. Annette, a 50-year-old white, married female had been suffering from chronic rhino-sinusitis. She had nasal congestion with green purulent nasal secretions and changes in her voice reflecting secondary laryngitis. Her physician had treated her with several courses of anti-microbial medications recommended by the ENT Consultants in their Medical Grand Rounds presentation. None of the three recommended antibiotics cleared her for more than a week. She also did nasal douching and used sprays.

After several months, she was sent to the ENT (Otorhinolaryngolist) consultants. A medical assistant interviewed her and entered the medical information into their electronic medical record. An MRI of her sinuses failed to reveal sinusitis or an operable condition. She then saw the ENT surgeon who examined her ears, nose and throat. Within about five minutes, she ordered allergy skin tests that failed to reveal any significant allergies. After two hours and a thousand dollars worth of testing, she was told they could operate on her nose and sinuses, but it probably would not be of significant benefit to her. She was then given a prescription for nasal allergy sprays. The ENT surgeon made no recommendations concerning the pus that was flowing out of her sinuses through her nose.

The patient used the allergy nasal sprays faithfully without any improvement. At this time, three months later, she still raises purulent material on a rather continual basis. She has increased her Kleenex purchases from the two-inch, to the four-inch and now the six-inch tall boxes, going through a box daily. She has to excuse herself several times an hour from polite company to clear her nasal passages. She goes to the restroom, turns the exhaust fan on and flushes the toilet so her company can’t hear the noise of her clearing her rhinosinusitis drainage.

Mrs. Annette refuses to see another ENT surgeon because they are all in the same group. She is sure they all have the same pressures to put charges on their books to support the huge office that employs numerous secretaries, technicians, medical assistants, and nurses, and includes X-ray and MRI equipment. Additional courses of antibiotics are only helpful for a few weeks before the condition recurs.

Mrs. Annette has received a courtesy bill and her insurance was charged about $1000. Payments by her insurance carrier were about $500 or about half the charges. Conventional wisdom suggests that we should be thankful that the insurance companies are protecting the patient from financial abuse. Why are health-care costs increasing with the massive insurance oversight? The fact remains: This constant cutting of the insurance payments for the past several decades has not really reduced health-care costs. Conventional wisdom again suggests that the insurance companies, or in case of senior citizens, the Medicare Government bureaucracy, should just police doctors and hospitals more stringently.

Conventional wisdom in this case is not only unwise, but also totally wrong.

Only a market-based health care system would correct these huge errors. If Mrs. Annette were held responsible, say, for 30 percent of these outpatient charges, the ENT office would have provided full disclosure before embarking with any of the testing. Mrs. Annette would have inquired at each step of the process about the risks vs. the benefits and the costs vs. the benefits, because the benefits would have to at least equal 30 percent of the costs. She then would have made an informed decision about having the test. Without testing, she would have had the benefit of tapping into the ENT surgeon's brain filled with medical and surgical knowledge to fully evaluate the symptoms, which she feels the surgeon never fully understood. With some understanding, the ENT surgeon would have proceeded to a full medical regimen of treatment. In other words, she would have benefited from a consultation, the surgeon’s best opinion, without the falderal that big things were being done for two hours in her absence when the testing added nothing to the diagnosis or treatment. The charges would have dropped from $1000 to perhaps $200 for the ENT surgeon’s medical expertise, and the insurance company could have paid their entire portion of the consultation fee (70 percent) without any discount or forced reduction. This would be a savings of $300 in health-care costs over what was paid for unnecessary testing and a 50 percent reduction in fees charged. Thus, market-based medicine [The Medical MarketPlace] would have delivered a much better level of care at approximately 20 percent of the charges or 40 percent of the eventual payment. The patient, even with the 30 percent co-payment or $60, would have benefited and been pleased with the service and coverage. And she most likely would now be well, instead of suffering nearly six-months with chronic rhino-sinusitis, which may eventually lead to chronic destructive sinusitis requiring sinus surgery. [I had one patient who after her third sinus operation told me that the chronic pain made her wish she were dead.]

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6. Medical Myths: Universal Health Care Improves Health

A common wisdom of those that believe poverty can be eliminated by giving out money is that disease can be eliminated, or at least reduced, by giving out free health care. One social planner mentioned that if we could only tax the wealthy adequately enough and give everyone in poverty $100,000, we’d eliminate poverty instantly. His theory was that everyone would pay off their debts, obtain a dependable car, and make a down payment on a home. Such populist lack of understanding of human nature is difficult to comprehend or countermand.

The Reverend Brian James of Tampa, Florida, reports the story of a lottery winner of more than $100 million. Within five years, he was fighting off creditors. The $100 million had brought him neither wealth nor happiness.

The Washington Post reports last week that William "Bud" Post III, whose $16.2 million in lottery winnings brought him debt, despair and heartache, causing the kind of trouble often recounted in country songs, died of respiratory failure in a Pittsburgh area hospital. After one bankruptcy, he was left with one million dollars clear. He died at 66 living on a $450 a month disability check. His six marriages ended in divorce. His seventh wife outlived him.

www.washingtonpost.com/wp-dyn/content/article/2006/01/19/AR2006011903124_pf.html

Mr. Williams, a poor man without health insurance, was in rather good health. Just like the lottery winners above who purchased expensive cars, homes, international vacations because they thought they could afford it with all the free money given to them, Mr. Williams, when he obtained his free Medicare, thought he would purchase every type of medical consultation available. He also obtained the Free For-Profit HMO so that he wouldn't even have to pay the Medicare 20 percent deductible. He made the rounds to every medical specialist for pains and discomforts that are part of being sixty-five. Every specialist was able to fine something abnormal in his field and do a few thousand dollars worth of testing. Many were also able to convince Mr. Williams to have tests done “just to be sure” and “put your mind at ease.” Although considered routine, each test has a small complication rate and thus can be hazardous.

A routine colonoscopy was complicated by a perforated colon, and he required abdominal surgery for repair. A cystometric exam found an enlarged prostate and prostate surgery caused impotence. His second wife, being much younger than he, decided to obtain a divorce and he paid a third of his social insecurity in alimony payments for life. He developed angina over his new stress and a cardiologist found some narrowing in one of his coronaries. The cardiologist placed a stent to keep it open. The angina recurred the following year and a repeat cardiac catheterization and coronary angiogram revealed the stent was occluded and a new one could not be placed. The cardiologist also found further disease in another coronary. So, Mr. Williams saw a cardiac surgeon who took some blood vessels from his legs and bypassed both coronaries. After the heart surgery, he developed fungicemia (fungus infection in his blood stream) and spent another month in the hospital to clear this difficult infection. He went home in 28 days rather than in the five days the surgeon had promised, but he was glad to be alive.

Although only 68 by now, he felt like he'd aged ten years during the first three of his golden years. So, he decided to visit his family in Southern California. Living on a partial social insecurity check, which he stated preclude flying, he thought he would drive. He drove it in two four-hour stretches, even though he was advised not to sit for prolonged periods of time in order to prevent blood clots. When he arrived at his daughter’s home, as he got out of his car, he started gasping for breath. His daughter rushed him to the hospital emergency room and he was found to have a pulmonary embolus, a blood clot to his lung that originated in his legs. He was anticoagulated and, after six days, discharged to his daughter’s home. He was happy to be alive and pleased that his daughter did not seem to mind attending to his needs after her workday.

He began to worry about his house in Sacramento being unattended for several weeks, and his worry caused him to awaken at night with severe heartburn. He disregarded this until about a week later when he vomited dark, coffee ground-like material, confirmed to be blood. He was rushed back to the hospital and given blood transfusions. A gastroenterologist performed an emergency gastroscopy and diagnosed a bleeding ulcer. This was treated and the bleeding stopped. He was eventually discharged and recuperated at his daughter’s home.

It was now six weeks since he left his home, and he decided to drive to see his son in Phoenix. On his trip, he remembered to do as he was told: get out of the car every two hours at a rest stop, use the facilities and walk around his car five times. He arrived at his son’s house and was glad to have some time with him. His son was the CEO of his firm but was able to spend some time with him every evening. Mr. Williams thought that life was good.

He decided to return through Nevada, stopping at Reno to test his luck. His luck at the casino never became apparent. He spent all his cash and depleted his bank account, figuring that he could always get home with his gas credit cards. He was able to eat because his VISA was still good.

He arrived at his apartment after being away for ten weeks. He found his key no longer opened his apartment door and his name was no longer on his mailbox. It dawned on him that he had not made arrangements to pay his rent. He went to the apartment manager and was told that after two months, they sold his furniture for the back rent and leased it to another couple. He couldn’t take this and after he collapsed, the landlord called the resuscitation squad (911) and Mr. Williams was hauled off to the hospital.

Free Universal Senior Citizen health care, known as Medicare, had not brought this man either health or happiness. Universal free health care will not buy health or happiness either—it will only extend this misery to the younger generation.

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7. Overheard in the Medical Staff Lounge: "Hoka Hey, It's A Good Day To Die"

Clarence Ray Allen was convicted of masterminding the murders of three people in 1980, while he was serving a life sentence in Folsom Prison for ordering an earlier killing. Allen wanted Bryon Schletewitz slain because he testified against him in the first murder case, and the other two victims happened to be there when the hit man showed up at the Schletewitz family store to carry out the killing. All three were shot to death, and a fourth man was wounded.

Allen's was the fourth clemency petition Schwarzenegger has rejected as governor. The last time a California governor granted clemency was in 1967. “Anything less than a death sentence for Mr. Allen is inappropriate," said Deputy Attorney General Ward Campbell. He said he rejected Allen's contention that the inmate no longer is a threat to society, noting that the victims' survivors are still afraid he might order reprisals from his cell as he did in 1980. "Nothing about his condition affects his ability to communicate or manipulate," Campbell said.

Frail from heart trouble and diabetes, legally blind and nearly deaf, he uses a wheelchair and probably will have to be lifted by guards onto the gurney where he'll receive his lethal injection. www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2006/01/14/MNGA5GNG181.DTL&type=printable

In final moments, killer didn't seem so frail. It only took a few seconds after Clarence Ray Allen walked into the heavily glassed, apple-green death chamber in San Quentin State Prison at precisely 12:05 a.m. Tuesday to figure out that this was not going to be the pitiable execution many had predicted.

At 76, the quadruple murderer was the oldest man ever executed in California. Allen was said to be so ill from 23 years on Death Row with heart trouble and diabetes that he was blind, nearly deaf and could not walk. And indeed, when the oval door of the death chamber clanged open to begin the procedure, he was in a wheelchair.

But then he stood up. Such robust ability in someone whose eyesight was compromised by diabetes and who suffered a flat-line heart attack just four months ago may have surprised some in the witness room -- but not prison officials.

"Hoka Hey, it's a good day to die," Allen, who turned 76 on Monday, wrote in his last statement, handed to the warden after his last meal of buffalo steak, pecan pie and black walnut ice cream. "Hoka Hey" is a traditional Indian saying meaning, "It's a good day to die."

Allen had ordered Mary Sue Kitts killed because she told Schletewitz that Allen had led a burglary of the Schletewitz family store in Fresno, Fran's Market. Then, while in Folsom Prison for that murder, Allen met fellow inmate Billie Ray Hamilton -- and when Hamilton was paroled, Allen hired him to go after Schletewitz and seven others who testified against him, promising him $25,000 to slay them all.

www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2006/01/18/MNG9IGP0I91.DTL&type=printable

[With all the diseases and infirmities that had been mentioned in recent weeks, Allen could have been transported to a hospital in the state of Oregon or other foreign countries where the healers in white are authorized to kill the sick and infirmed under the tragic concept of physician-assisted suicide, a euphemistic term for execution by the healers who have given an oath to do no harm. Executions should remain in the death chambers of prisons and not in hospital rooms, becoming death chambers - where patients are executed by the very people they trust.]

Are Doctors Guilty Of Insider Trading?

Many physicians invest in pharmaceutical and scientific equipment companies stating that it is an appropriate way to build a pension plan. An OBG specialist invested in a pharmaceutical company that developed one of the first birth control drugs in the 1970s because he felt the market was unlimited. Competition soon brought out other products by a number of companies that reduced the dose and side effects of the drug. However, he kept on prescribing this somewhat out-of-date BC pill because he had a vested interest. When challenged that this type of investment was inappropriate for a physician with insider information, not only on a medical ethics basis, but also on a malpractice basis, he felt we were "picking at straws." However, if one of his patients developed fatal pulmonary embolism, it would not take an attorney long to discover that the patient was at undue or higher risk for developing this complication from the older drug that the physician prescribed because it was financially beneficial to him.

Last week a Texas physician examined a CEO of a major company who had a serious illness not disclosed to the shareholders. He asked Randy Cohen, Ethics adviser columnist of the NY Times, whether he could ethically sell his shares because of information he gleaned as a doctor?

Mr. Cohen replied: Medical ethics do not forbid this trade, but investor ethics do—so you may not make this sale. What the AMA allows, the SEC does not, he continued. "The physician runs a very serious risk that his stock trade could be deemed illegal insider trading under what we call the ‘misappropriation’ theory." That is, material gained in a confidential relationship such as that between a doctor and patient may not be used to trade stock.

The Greyhound commuter between Sacramento and San Francisco, a money-losing operation for four years, will be terminated on January 31, 2006, despite a hundred angry bus commuters that use it daily. Davis residents organized a protest and sent petitions to the mayors of the three cities hoping elected officials would intervene. Greyhound responded that although they value their customers, they couldn't compete with the state subsidized rail system that has grown to 1.26 million passengers during the same four years. www.sacbee.com/content/news/traffic/story/14098809p-14928580c.html

Government subsidies always have to hurt one party at the expense of another and increase taxes to both. Aren't we capable of learning such a simple straightforward equation? We're holding our breath before the mayors force the company to lose more money. Seems like the hundred Greyhound commuters should join the other 1.26 million train commuters that the state is forcing taxpayers to support involuntarily.

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8. Voices of Medicine: “It does not get any better than this” by Andrew Schlafly, Esq.

Psychiatrist David Springer Wins A Million Against All Odds

"It does not get any better than this. Longtime AAPS [American Association of Physician and Surgeons] member Dr. David Springer courageously spoke out for patients and against incompetence at the Delaware Psychiatric Center. I once addressed its medical staff in a meeting he arranged. But the administration refused to renew Dr. Springer's contract after he spoke out. Dr. Springer sued and had to overcome sovereign immunity. Thank God, eventually a federal jury found in favor of Dr. Springer. He won a judgment for about one million dollars against the administrator, in her individual and official capacity as an employee of the State of Delaware."

"But the government never accepts defeat and it appealed the verdict, refusing to settle or pay. I filed an amicus brief for AAPS in favor of Dr. Springer. The State objected to our amicus brief, but the Court of Appeals allowed it.

"Our effort paid off. The Court's opinion, released this afternoon, cited us favorably in its very first paragraph. I have never seen a court do that before for any amicus party. The Court then proceeded to uphold the verdict and even spanked the government attorneys by expressing concern over whether they acted with a conflict of interest in representing both the State and the hospital administrator (fnote 13). The full opinion is here: www.ca3.uscourts.gov/opinarch/044124p.pdf.

"The Court labeled its decision as "Precedential", enabling courts nationwide to cite this terrific victory in favor of physicians who stand up to administrators.

"Dr. Springer called me this evening to thank AAPS profusely. I suggested that he would make a good speaker in Phoenix and he welcomed the possibility.

"Thanks to all of you for supporting projects like this one."

Andy Schlafly, Esq, Counsel, American Association of Physicians and Surgeons, January 18, 2006.

[Plan now to put the AAPS Annual Meeting, Sept 14-16, 2006 in Phoenix, on your schedule: www.aapsonline.org/membership.php. This is history in the making. Also, thanks to the Semmelweis Society and Peer Review Justice for raising everyone’s awareness of physician abuse by hospitals, Medicare, and medical boards.]

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9. Book/Movie Review: "Match Point," A Modern Macbeth, Depicts Mayhem with a Twist by James J. Murtagh, M.D.

Woody Allen vividly portrays a lower circle of hell for a guilty conscience.

Warning: movie spoiler alert. If you have not seen Match Point, do not read further. The film contains a major plot twist, which is discussed in this Op- Ed.

"Corruptio optimi pessima," Latin proverb for "corruption of the best is the worst of all."

Could a guilty man suffer more than Macbeth? Could it be possible? I always thought that Macbeth, tortured by his conscience, by his wife’s suicide, and by cackling witches, then slaughtered, head on MacDuff’s pike, had suffered everything a cold-blooded murderer should possibly suffer.

Wrong! Woody Allen shows in Match Point that fate reserves circles in hell for murderers even below Macbeth’s. Not being caught appears in this film infinitely crueler than having your head stuck on a pike.

Chris Wilton (played coolly by Jonathan Rhys-Meyers) is the modern Macbeth. Desperately driven by greed, ambition and lust, Wilton, backed into a corner, decides to murder his girlfriend (pregnant with his child), to maintain his upper class lifestyle, prestigious job, and loveless marriage.

Wilton's conscience kicks in. Racked by guilt, he confesses to himself (and to his victim's murdered ghosts, including an innocent murdered in "collateral damage") that it would be just and comforting if he were caught. His crimes were sloppy; clues were left. Wilton more than half-wanted to be caught; that would be at least evidence of a cosmic justice that Wilton despairs is absent. He stoically waits, even yearns, to be caught and punished.

But fate denies the just punishment he deserves. The evidence disappears in repeated twists of improbable fate, mocking Wilton even worse than the weird sister’s gibes against Macbeth. Wilton is left in frozen, existential hell, and he must endure a long unhappy life, wallowing in ill-gotten bourgeois opulence on the Thames.

Could Macbeth have endured a hollow life if he had survived as tyrant, surrounded by luxuries won by murder? Macbeth preferred the pike to life in bloody Inverness. Verdi's opera Macbeth ties together these themes in the background film music.

Shakespeare, like Woody, often "played it again, Sam," repeating over and over variations of a single story, namely, regicide, guilt and consequences. Kings not being what they were, Woody's films substitutes the guilt of the eternal love triangle. In each of Woody's triangles, it seems, one person must be sacrificed. At first, Woody took his cue from Casablanca, and, like Rick, the lead in Play it again, Sam sacrifices himself. Later, Allen's triangles become progressively darker, as in Manhattan. Finally, in Match Point Wilton shoots his lover. Even Wilton cannot comprehend why he kills the one person he loves, rather than himself or his wife.

Shakespeare granted the release of death as the greatest boon to both regicidal heroes and villains. Was there really much difference between the crimes of Hamlet and Macbeth? Both were commanded from beyond to kill their king. Hamlet was lucky; his father’s ghost told the truth, while Macbeth unluckily listened to scheming witches. Apparently, the justice of these men depended almost solely on the quality of their other-wordly intelligence. But could Hamlet/Macbeth know in advance if ghostly apparitions told the truth or not? Both men shed innocent blood as "collateral damage," and both men’s actions led to the suicides of the women they loved. Both realized their worlds were “rotten” and death was their reward, not punishment. Was the difference between hero and villain just a "Match Point," as the film calls a small quirk of fate?

"To never have been born may be the greatest boon of all." Wilton, paralyzed beyond Hamlet, not even able to ask "to be, or not to be," instead murders what he loves, learning the Socratic truth, "Doing injustice happens to be the greatest of evils."

Not all villains could be punished by no punishment. The Iagos and Richard IIIs delight in escape. Could fitting punishment depend more on the nature of the criminal, than on the crime? For some criminals, capital punishment is devoutly to be wished. Does the state ironically thus reward the evil man? How to know? Hamlet worried that if he killed Claudius in the church, he might send the evil man to heaven. Either way, something remains rotten.

Do we, in the modern world, including our leaders, suffer even more because the possibility of punishment often seems remote?

Macbeth won redemption after being caught. For Woody Allen's modern Macbeth, there is no punishment, which turns out to be, for at least one criminal, the worst punishment of all.

James J. Murtagh Jr., MD, jmurtag@mindspring.com

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10. Hippocrates & His Kin: NASA Pisses Away Millions Hauling H2O into Orbit. But There's a Better Way - Recycle Astronaut Urine. Just One Question: How Does It Taste? by Tom McNichol

Human waste has bedeviled NASA engineers from the get-go. Alan Shepard's first 15-minute suborbital flight was so short that no one thought to install a urine receptacle in his space suit. At T-minus 15 minutes, an electrical problem caused an 86-minute delay on the launchpad. Shepard's bladder soon reached the bursting point, and he radioed the first-ever "Houston, we have a problem" message. After some deliberation, mission control had an answer: "Do it in the suit

Back at Water Security HQ, the contents of the bucket get a final stir, and the experiment begins. The water is sucked through an intake hose and into the purification system - prefilter, carbon filter, iodinated resin, disinfectant holding tank, iodine scrub, and a polish. (Don't be shy with the polish, guys.)

After 30 seconds, water dribbles out of a nozzle and into a plastic cup. I raise it with a trembling hand. A toast to Alan Shepard and all the brave astronauts who endured the wrong stuff in their space suits for the advancement of science: This number one's for you. I take a big astronaut gulp, lower the cup, and wait for the noxious aftertaste. Nothing.

The water tastes pretty good - it's definitely not Evian, but it is better than most city tap. Certainly more palatable than many light beers I've had, and not at all, uh, urinous. Move over, Tang: There's a new space drink in town!

To read the rest of Tom McNichol in WIRED on How does it taste, go to www.wired.com/wired/archive/13.08/urine_pr.html.

Three Things To Think About: Cows, The Constitution, and Ten Commandments --Submitted by a reader of MedicalTuesday.

COWS

Is it just me, or does anyone else find it amazing that our government can track a cow born in Canada almost three years ago, right to the stall where she sleeps in the state of Washington? And, they tracked her calves to their stalls. But they are unable to locate 11 million illegal aliens wandering around our country. Maybe we should give them all a cow.

THE CONSTITUTION

They keep talking about drafting a Constitution for Iraq. Why don't we just give them ours? It was written by a lot of really smart guys, it's worked for over 200 years and we're not using it anymore.

TEN COMMANDMENTS

The real reason that we can't have the Ten Commandments in a courthouse: You cannot post "Thou Shalt Not Steal,"  "Thou Shalt Not Commit Adultery" and "Thou Shall Not Lie" in a building full of lawyers, judges and politicians -- it creates a hostile work environment!

Couldn’t We At Least Pass Out Some Haldol To The Lawyers, Judges And Politicians?

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• PATMOS EmergiClinic - http://www.emergiclinic.com/ - where Robert Berry, MD, an emergency physician and internist practices. Here is his story: Three years ago, I left ER medicine to establish a primary care clinic in a town of about 15,000 in northeast Tennessee - primarily for the uninsured, but also for anyone willing to pay me for my care at the time of service. I named the clinic PATMOS EmergiClinic - for the island where John was exiled and an acronym for "payment at time of service." I have no third party contracts. not commercial, not Medicare, TennCare or worker's compensation. My practice today has over 4,000 patient charts. My patients are typically between 5-50 years old, but I do have a significant number of Medicare patients. But even those with insurance learn a simple lesson when they come to me: health insurance does not equal healthcare, at least not at my clinic. I clearly tell my patients how much a visit will cost. Everything is up front and honest. I will prepare a billing claim for my patients with insurance, for a small fee, but I expect them to pay me when I see them. Because I need only one employee in my office, my costs are low. For the same services, I charge about 60 percent of charges made by other local clinics, 40 percent of what the local urgent care clinic charges and less than 20 percent of what the local ER charges. To read more on Dr Berry, please to go www.emergiclinic.com/.

• 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.

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

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

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

• Madeleine Pelner Cosman, JD, PhD, Esq, has made important efforts in restoring accountability in health care. She has now published her important work, Who Owns Your Body. To read a review, go to www.delmeyer.net/bkrev_WhoOwnsYourBody.htm. Please go to www.healthplanusa.net/MPCosman.htm to view some of her articles that highlight the government's efforts in criminalizing medicine. For other OpEd articles that are important to the practice of medicine and health care in general, click on her name at www.healthcarecom.net/OpEd.htm.

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

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

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

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

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

• Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column at NewsMax. Please log on to review the last five weeks’ topics or click on archives to see the last two years' topics at www.newsmax.com/pundits/Medicine_Men.shtml. This week's column is on "Emergency Medicine Armageddon" at http://www.newsmax.com/archives/articles/2006/1/16/210652.shtml

• The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to scroll down on the left to departments and click on News of the Day: How to avoid Medicare Part D at www.aapsonline.org/nod/newsofday243.php. How to have a Medicare and Insurance free practice at www.aapsonline.org/freemarket/. The "AAPS News," written by Jane Orient, MD, and archived on this site, provides valuable information on a monthly basis. This month read Standard of Care at http://www.aapsonline.org/newsletters/jan06.php. Also, read about Medicare’s hidden costs at http://www.aapsonline.org/nod/newsofday255.php. Scroll further to the official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents page of the current issue at www.aapsonline.org/jpands/jpands1004.htm.

MEDICAL TUESDAY . NET	NEWSLETTER
Community For Better Health Care	Vol IV, No 20, Jan 24, 2006

The Cortex Cop

In Memoriam