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MEDICAL TUESDAY . NET |
NEWSLETTER |
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Community For Better Health Care |
Vol VII, No 20, Jan 27, 2009 |
In This Issue:
1.
Featured Article:
Can you imagine your Cell Phone, PDA, and Laptop with no cords?
2.
In
the News: AARP rakes
in cash from Seniors' Insurance
3.
International Medicine: NHS Constitution Ends Era Of
'Doctor Knows Best'
4.
Medicare: A
Lesson from Industry Magnates
5.
Medical Gluttony:
It Is Only Possible With Government And Other Third Party Programs
6.
Medical Myths:
Concierge Medicine is all about Money?
7.
Overheard in the Medical Staff Lounge: Quality Health Care versus Quantity Health Care
8.
Voices
of Medicine: Take Two
Sugar Pills and Call Me in the Morning
9.
The Bookshelf: Inside the
AARP by Dale Van Atta
10.
Hippocrates
& His Kin: Russian Comrade Says the End
is Near!
11.
Related Organizations: Restoring Accountability in Medical Practice and Society
* * * * *
MOVIE
EXPLAINING SOCIALIZED MEDICINE TO COUNTER MICHAEL MOORE's SiCKO
Logan Clements, a pro-liberty filmmaker in Los Angeles, seeks
funding for a movie exposing the truth about socialized medicine. Clements is
the former publisher of "American Venture" magazine who made news in
2005 for a property rights project against eminent domain called the "Lost
Liberty Hotel."
For more information visit www.sickandsickermovie.com or
email logan@freestarmovie.com.
* * * * *
1.
Featured Article:
Can you imagine your Cell Phone, PDA, and Laptop never requiring a cord?
Wireless Electricity Is Here (Seriously) By: Paul Hochman,
Fast
Company, Wed Jan 14,
2009
I'm standing next to a
Croatian-born American genius in a half-empty office in Watertown,
Massachusetts, and I'm about to be fried to a crisp. Or I'm about to witness
the greatest advance in electrical science in a hundred years. Maybe both.
Either way, all I can think of
is my electrician, Billy Sullivan. Sullivan has 11 tattoos and a voice
marinated in Jack Daniels. During my recent home renovation, he roared at me
when I got too close to his open electrical panel: "I'm the Juice
Man!" he shouted. "Stay the hell away from my juice!"
He was right. Only gods mess
with electrons. Only a fool would shoot them into the air. And yet, I'm in a
conference room with a scientist who is going to let 120 volts fly out of the
wall, on purpose.
"Don't worry," says
the MIT assistant professor and a 2008 MacArthur genius-grant winner, Marin
Soljacic (pronounced SOLE-ya-cheech), who designed the box he's about
to turn on. "You will be okay."
We both shift our gaze to an
unplugged Toshiba television set sitting 5 feet away on a folding table. He's
got to be kidding: There is no power cord attached to it. It's off. Dark.
Silent. "You ready?" he asks.
If Soljacic is correct -- if his free-range electrons can power up this
untethered TV from across a room -- he will have performed a feat of physics so
subtle and so profound it could change the world. It could also make him a
billionaire. I hold my breath and cover my crotch. Soljacic flips the switch.
Soljacic isn't the
first man to try to power
distant electronic devices by sending electrons through the air. He isn't even
the first man from the Balkans to try. Most agree that Serbian inventor Nikola
Tesla, who went on to father many of the inventions that define the modern
electronic era, was the first to let electrons off their leash, in 1890.
Tesla based his wireless
electricity idea on a concept known as electromagnetic induction, which was
discovered by Michael Faraday in 1831 and holds that electric current flowing
through one wire can induce current to flow in another wire, nearby. To
illustrate that principle, Tesla built two huge "World Power" towers
that would broadcast current into the American air, to be received remotely by
electrical devices around the globe.
Few believed it could work.
And to be fair to the doubters, it didn't, exactly. When Tesla first switched
on his 200-foot-tall, 1,000,000-volt Colorado Springs tower, 130-foot-long
bolts of electricity shot out of it, sparks leaped up at the toes of passersby,
and the grass around the lab glowed blue. It was too much, too soon.
But strap on your rubber
boots; Tesla's dream has come true. After more than 100 years of dashed hopes,
several companies are coming to market with technologies that can safely
transmit power through the air -- a breakthrough that portends the literal and
figurative untethering of our electronic age. Until this development, after
all, the phrase "mobile electronics" has been a lie: How portable is
your laptop if it has to feed every four hours, like an embryo, through a cord?
How mobile is your phone if it shuts down after too long away from a plug? And
how flexible is your business if your production area can't shift because you
can't move the ceiling lights?
The world is about to be cured
of its attachment disorder.
WIRELESS JUICE: A
PRIMER; Inductive Coupling. Read the entire
article . . .
* * * * *
2. In the News: AARP rakes in cash from Seniors'
Insurance, AAPS News in Perspective, January
16th, 2009
Seniors may think they save money when they buy AARP
insurance, but if they take the trouble to compare competing products, they may
be paying twice as much.
AARP brought in nearly half a billion dollars in 2007
from fees insurers pay for AARP endorsement. It also gained about $40 million
from holding the clients' premiums for a month and investing them.
The revenue helps pay down the $200 million bond debt
that funded the organization's brass and marble headquarters in Washington,
D.C. - which is closed to visitors, purportedly so staff can work.
Royalties and fees now constitute about 43% of AARP's
revenue, up from 11% in 1999.
According to a 2007 Harris poll, AARP ranks third
behind Consumer Reports and the American Red Cross as a trusted large advocacy
group influencing U.S. politics. AARP is considered the most powerful interest
group in the United States.
"They don't even have to give any campaign
contributions," observes James Thurber, director of the Center for
Congressional and Presidential Studies at American University in Washington.
"AARP's enormous clout comes from the threat that they could defeat people
in Congress who don't do what they want."
AARP lobbied against Bush's proposed overhaul of
Social Security, and for the Medicare prescription drug benefit. When Part D
passed, AARP was able to expand its contract with UnitedHealth Group, which
underwrites its Medicare supplemental insurance plan.
"I was kind of shocked," said one member,
who found out he was paying $1,079 more for his AARP auto insurance than he
would have paid for a Mutual of Omaha policy. "They're making money on the
backs of old people" (Gary
Cohn and Darrell Preston, Bloomberg.com 12/4/08). Source . . .
* * * * *
3. International News: NHS
Constitution Ends Era Of 'Doctor Knows Best' by John Carvel, social affairs
editor, The Guardian, Wednesday 21
January 2009
A legally binding NHS constitution that is
designed to end the era of "doctor knows best" will be unveiled today
by Alan Johnson, the health
secretary.
In a Guardian interview,
he said patients will gain a new legal right to information about the options
available for free treatment on the NHS in England.
It will no longer be
enough for a doctor to recommend painkillers for chronic backache without
informing the patient of the benefits and risks of physiotherapy or surgery, if
these are medically appropriate alternatives.
The constitution will for
the first time set out the rights and responsibilities of patients, NHS staff
and the organisations that deliver services, including private hospitals and
voluntary bodies that provide care for NHS patients.
A draft version, published
for consultation last year, said patients should have the right to make choices
about the type of treatment that may be appropriate. Johnson said the public
thought the right to choose was meaningless if it was not accompanied by a
right to information about the choices available.
The constitution will
say: "You have the right to choice about your NHS care and to information
to support these choices. The options available to you will develop over time
and depend on your needs."
A senior Department of Health
source said: "Gone will be the paternalistic days of being told by the
doctor that you can't have physiotherapy for your back pain, or referral to an
orthopaedic consultant. If you have prostate cancer, you will get the
information you need to choose whether to go for an operation or opt for a
period of watchful waiting. If you need a hysterectomy, you will be told about
the benefits and risks of minimally invasive surgery."
The constitution will
give patients limited rights to be treated in other EU countries. Other rights
include:
Choice of GP practice and preference for using a particular doctor;
Access to drugs and
treatments that have been recommended by the National Institute for Health and
Clinical Excellence (Nice);
Access to vaccinations
that have been recommended by the Joint Committee on Vaccination and
Immunisation;
Privacy,
confidentiality and an expectation that the NHS will keep confidential
information secure;
Patients will have a
responsibility to:
Register with a GP practice;
Treat NHS staff and
other patients with respect;
Follow the agreed
course of treatment and talk to the clinician if this is difficult;
Keep appointments or
cancel within reasonable time.
The document says people
failing to keep appointments may no longer be entitled to be treated within the
maximum waiting times. But there will be no financial penalties on patients who
fail to meet their responsibilities. Ministers have ruled out withdrawal of
treatment from people who smoke, drink excessive amount of alcohol or are
obese. . .
"Some people have
said this is Tory-proofing the NHS [making it harder for a future government to
take away services or require people to pay for them.] The only way to
Tory-proof the NHS is by electing Labour governments. But much of this
constitution would make it more difficult to change the NHS.
"It says NHS
services should be free of charge, except in limited circumstances sanctioned
by parliament. It says the right of access to NHS services should not be
refused on unreasonable grounds. It should be a comprehensive service available
to all, with a duty to each and every individual it serves."
Haven't Americans accomplished about
the same with informed consent?
Does one need a constitution to be able
to talk to your own doctor?
Are they still practicing medieval
medicine?
The more regimented medicine becomes,
the greater are the hurdles to obtaining care.
The National
Health Service does not give timely access to health care, it only gives access
to a waiting list.
* * * * *
4. Medicare: A Lesson from Industry Magnates
When Congress was cutting payment of
physician fees for Medicare Patients last year, the American Medical
Association (AMA) was advocating for a reversal and increase in payments.
Otherwise, physicians would stop seeing Medicare Patients. The other
physician's organization, the Association of American Physicians and Surgeons
was advocating to allow Congress to do what they want and experience the Market
Forces in Medicine. The AMA won and Medicare continues to micromanage health
care and, in the process, harass doctors. If Congress had not succumbed to advocacy,
which is following the leadership of an organization rather than the rank and
file, the Medicare Patients may have arose in arms against Congress. In the AMA
scenario, physicians received a black eye of gauging the taxpayers and ability
to manipulate Congress. Congress and the AMA won. In the AAPS scenario,
physicians would have looked like winners standing straight and tall and the
Medicare Patients would have given Congress a bad time. In the first scenario,
Congress learned nothing about market forces and just hated physicians more for
their power. In the latter scenario, Congress would have learned that to
manipulate market forces is rather naοve and childish and 37 million Medicare Patients
would threaten to vote them out of office because they no longer could find a
doctor.
We have received a recent exchange between
General Motors and one of its suppliers that shows similar fortitude to the
AAPS, sent in by a MedicalTuesday member and Science Writer.
Very good answer to GM's request for help from their suppliers!!!
As a supplier for the Big 3 Mr. Knox received a letter from the President
of GM North America requesting support for the bail-out program and he responds below the letter. (Verified by SNOPES)
Dear Employees & Suppliers,
Congress and the current Administration will soon determine
whether to provide immediate support to the domestic auto industry to help it
through one of the most difficult economic times in our nation's history. Your
elected officials must hear from all of us now on why this support is critical
to our continuing the progress we began prior to the global financial crisis. .
. As an employee or supplier, you have a lot at stake and continue to be one of
our most effective and passionate voices. I know GM can count on you to have
your voice heard. Thank you for your urgent action and ongoing support.
Signed: Troy
Clarke, President General Motors North America
Response from: Gregory Knox, Pres. Knox Machinery Company
Franklin, Ohio
Gentlemen: In response to your request to contact legislators and ask for a
bailout for the Big Three automakers please consider the following, and please
pass my thoughts on to Troy Clark, President of General Motors North America.
Politicians and Management of the Big 3 are both infected with the
same entitlement mentality that has spread like cancerous germs in UAW halls
for the last countless decades, and whose plague is now sweeping this nation,
awaiting our new "messiah," Pres-elect Obama, to wave his magic wand
and make all our problems go away, while at the same time allowing our once
great nation to keep "living the dream"
Believe me folks, the dream is over! This dream where we can ignore the consumer for years while management
myopically focuses on its personal rewards packages at the same time that our
factories have been filled with the worlds most overpaid, arrogant, ignorant
and laziest entitlement minded "laborers" without paying the price
for these atrocities . . . this dream where you still think the masses will
line up to buy our products for ever and ever. Don't even think about telling
me I'm wrong. Don't accuse me of not knowing of what I speak. I have called on
Ford, GM, Chrysler, TRW, Delphi, Kelsey Hayes, American Axle and countless
other automotive OEM's throughout the Midwest during the past 30 years and what
I've seen over those years in these union shops can only be described as
disgusting.
Troy Clarke, President of
General Motors North America, states: "There is
widespread sentiment throughout this country, and our government, and
especially via the news media, that the current crisis is completely the result
of bad management which it certainly is not."
You're right Mr. Clarke, it's not JUST management...how about the
electricians who walk around the plants like lords in feudal times, making
people wait on them for countless hours while they drag ass...so they can come
in on the weekend and make double and triple time...for a job they easily could
have done within their normal 40 hour work week. How about the line workers who
threaten newbies with all kinds of scare tactics...for putting out too many
parts on a shift...and for being too productive (We certainly must not
expose those lazy bums who have been getting overpaid for decades for their
horrific underproduction, must we?!?) Do you folks really not know about this
stuff?!? How about this great sentiment abridged from Mr. Clarke's sad plea:
"over the last few years 20...we have closed the quality and efficiency
gaps with our competitors." What the hell has Detroit been doing for the
last 40 years?!? Did we really JUST wake up to the gaps in quality and
efficiency between us and them? The K car vs. the Accord? The Pinto vs. the
Civic?!? Do I need to go on? What a joke! We are living through the inevitable
outcome of the actions of the United States auto industry for decades. It's
time to pay for your sins, Detroit.
I attended an economic summit last week where brilliant economist,
Alan Beaulieu, from the Institute of Trend Research, surprised the crowd when
he said he would not have given the banks a penny of "bail-out money." "Yes, he said, this would cause short
term problems," but despite what people like politicians and corporate
magnates would have us believe, the sun would in fact rise the next day... and
the following very important thing would happen...where there had been greedy
and sloppy banks, new efficient ones would pop up...that is how a free market
system works...it does work...if we would only let it work..."
But for some nondescript reason we are now deciding that the rest
of the world is right and that capitalism doesn't work -- that we need the
government to step in and "save us"...
Save us, Hell! -- we're nationalizing...and unfortunately too many
of our once fine nation's citizens don't even have a clue that this is what is
really happening...
But, they sure can tell you the stats on their favorite sports
teams...yeah -- THAT'S really important, isn't it...
Does it ever occur to ANYONE that the "competition" has
been producing vehicles, EXTREMELY PROFITABLY, for decades in this country? ...
How can that be??? Let's see... Fuel efficient... Listening to
customers... Investing in the proper tooling and automation for the long
haul... Not being too complacent or arrogant to listen to Dr. W.
Edwards Deming four decades ago when he taught that by adopting
appropriate principles of management, organizations could increase quality and
simultaneously reduce costs. Ever increased productivity through quality and
intelligent planning... Treating vendors like strategic partners, rather than
like "the enemy"... Efficient front and back offices... Non-union
environment...
Again, I could go on and on, but I really wouldn't be telling
anyone anything they really don't already know down deep in their hearts. I
have six children, so I am not unfamiliar with the concept of wanting someone
to bail you out of a mess that you have gotten yourself into -- my children do
this on a weekly, if not daily basis, as I did when I was their age. I do for
them what my parents did for me (one of their greatest gifts, by the way) -- I
make them stand on their own two feet and accept the consequences of their
actions and work through it. Radical concept, huh... Am I there for them in the
wings? Of course -- but only until such time as
they need to be fully on their own as adults. I don't want to oversimplify a
complex situation, but there certainly are unmistakable parallels here between
the proper role of parenting and government. Detroit and the United States need
to pay for their sins.
Bad news, people -- it's coming whether we like it or not. The
newly elected Messiah really doesn't have a magic wand big enough to "make
it all go away." I laughed as I heard Obama "reeling it back in"
almost immediately after the final vote count was tallied..."we really
might not do it in a year...or in four..."
Where the Hell was that kind of talk when he was RUNNING for
office? Stop trying to put off the inevitable,
folks ... That house in Florida really isn't worth $750,000... People who jump
across a border really don't deserve free health care benefits... That job
driving that forklift for the Big 3 really isn't worth $85,000 a year... We
really shouldn't allow Wal-Mart to stock their shelves with products acquired
from a country that unfairly manipulates their currency and has the most
atrocious human rights infractions on the face of the globe... That couple
whose combined income is less than $50,000 really shouldn't be living in that
$485,000 home... Let the market correct itself, folks -- it will. Yes, it will
be painful, but it's gonna' be painful either way, and the bright side of my
proposal is that on the other side of it all, is a nation that appreciates what
it has...and doesn't live beyond its means...and gets back to basics...and
redevelops the patriotic work ethic that made it the greatest nation in the
history of the world...and probably turns back to God.
Sorry -- don't cut my head off, I'm just the messenger sharing
with you the "bad news." I hope you
take it to heart.
Gregory J. Knox, President
Knox Machinery, Inc.
Franklin, Ohio 45005
The
above letter has been verified by SNOPES.
Do any of us have the fortitude to tell
Congress to get out of micromanaging the health care business and after a few
painful years find that health care corrected it? The
next time the AMA tells us to write our Representatives and Senators, do we
have the courage to write the above letter to the AMA? The worst word in any
AMA promotion is advocacy. But the advocacy recommended is hardly ever in the
best interest of our country or our patients. Now that we've nationalize the
investment banking, retail banking, auto industries, does anyone really think
they are better off? Remember Congress' involvement in the electronics industry
and how the American Companies all disappeared. Now we have Sony, Panasonic,
Toshiba, etc., et. al, who took over. Will the auto industry now disappear?
Then we'll have Toyota, Nissan, Honda and Fiat. With our government having a
$99 trillion entitlement debt that a 200 percent mortgage on our entire country
would still be unable to cover, does anyone have the courage to reduce or
eliminate any of the entitlements, Social Security, Medicare, Medicaid, and
SCHIPS, that continue to enslave not only us, but also our children?
Government is not the solution to our problems, government is
the problem.
- Ronald Reagan
* * * * *
5. Medical Gluttony: It Is Only Possible With Government
And Other Third Party Programs
In
this section, we give examples of excessive health care utilization, which
should be avoided. Although this may seem like a broken record, we hope the
variety of examples will illustrate to different people how they, themselves,
may have unnecessarily increased health care cost while feeling good about the
care they received not realizing that it was gluttonous.
Mary came in today on the advice of the hospital for
follow up after her recent hospital admission. She couldn't remember exactly
why she was admitted and finally said she had become more short of breath. I
then remembered she had called my office on Thursday and was given an
appointment the next day, Friday. She did not show for that appointment because
it was inconvenient for her family. They took her the next day on Saturday to
the hospital emergency room. She got the full cardiac evaluation, which
according to staff members in the ER is about $9,000. In view of possible
slight increase in her congestive heart failure and advanced age, she was then
admitted overnight for further observation, diuresis and discharged. She wasn't
sure, but thinks she felt better this week when I saw her. The $9,000 worth of
tests were normal or unchanged from previous determinations.
This scenario is seen about once or perhaps twice a
week in my practice. At $9,000 of gluttony per week, that adds up to nearly a
half million dollars of gluttony from a one-physician practice out of several
hundred thousand practices. That adds up to $billions for one symptom of one
organ system.
Congress and Medicare are focusing on micromanaging
the practice of medicine, trying to save $10 here and $100 there. They are
unable to control these huge $billions of unnecessary costs that do not improve
health care or well-being. If Congress and Medicare ever controlled the other
200+ million Americans' health care, there would have to be severe rationing
and elimination of health care - the exact reversal of what liberals in
Congress and the country think would happen.
If Mary had to pay even ten percent at the ER desk,
this gluttony would have stopped at the desk and she would have gone home and
rested. And she would have gotten better, also.
Medical Gluttony thrives in Government and Health Insurance Programs.
Gluttony Disappears with Appropriate Deductibles and Co-payments on
Every Service.
* * * * *
6.
Medical Myths:
Concierge Medicine is all about Money?
Money and the Changing Culture of
Medicine
A recent Perspective article in the NEJM,
written by Drs. Hartzband and Groopman, addressed a very interesting dynamic
that relates to the "application of business practices to medicine."
The authors' claim, with supported evidence, that quantifying, in monetary
terms, every aspect of a physician's responsibility and actions has led to a
degradation of professional pride and collegiality. Concierge medicine,
described in the second to last paragraph, has a somewhat counterintuitive
effect. One would think, and the general media would have you believe, that it
is all about the money. However, by removing the volume-based incentive and
reverting to the quality-based incentive in the concierge model, increased
social interaction occurs and a better patient/physician relationship is
fostered. In reality, it is all about the relationship and time. Happy
reading.
Dr. Doucette, President and CEO, ModernMed
Pamela
Hartzband, M.D., and Jerome Groopman, M.D. New
England Journal of Medicine Volume 360 - January 8, 2009 - Number 2 (Subscription
required)
Rapidly
rising health care costs over recent decades have prompted the
application of business practices to medicine, with the goals of
improving efficiency, restraining expenses, and increasing quality.
In the wake of the current economic crisis and the advent of a new
presidential administration, even more attention will be focused on
containing costs in the health care system. Price tags are being
applied to every aspect of a doctor's day, creating an acute
awareness of costs and reimbursement. Physicians are now routinely
provided with profit-and-loss reports reflecting their activity, and
metrics are calculated to measure the cost-effectiveness of their work
. . . Read more
. . .
Medical Myths Originate When Someone Else Pays The Medical Bills.
Myths Disappear When Patients Pay Appropriate Deductibles and
Co-Payments on Every Service.
Or as in Concierge Medicine, Patients Pay the Entire Bill.
* * * * *
7. Overheard in the Medical Staff Lounge: Quality Health
Care versus Quantity Health Care
Dr. Harold: I'm Dr. Harold and have recently obtained hospital
privileges here. My practice is about a half mile from here. I'm an internist
and have decided not to accept any health insurance or Medicare patients.
Dr. Dave: That's very interesting. Are you making it?
Dr. Harold: Yes, I think so. I was in practice with a small group
and they took any insurance plan. Every year or even twice a year we were
notified that the reimbursement rates were changed and they gave us the new
RBRVS numbers and the payment. It was difficult to follow the changes, but in
general, our checks from each company after these notices seem to gradually get
smaller.
Dr. Rosen: So what else is new?
Dr. Harold: The group had an administrator who was following the
bottom line and he was constantly on our tail to work harder, which meant to
see more patients faster. We were seeing three patients an hour and then we
were told to see four an hour. Last year he said we'd have to see five patients
an hour if we wanted to keep our present salary.
Dr. Milton: We have groups here that are routinely at
fifteen-minute appointments or four patients an hour and one group is now at
twelve-minute appointments or five patients an hour.
Dr. Edwards: My clinic has given us all a little timer we wear on
our belts. We squeeze it when we go in for a patient and in 14 minutes, the
vibrator goes off. We then have 60 seconds to get the patient out of the room
and get started on the next one.
Dr. Rosen: I have received three patients that have changed from
your health plan to ours.
Dr. Edwards: Were they unhappy with the care?
Dr. Rosen: One was a 60-year-old lady who had three medical
issues and she was at your clinic for her first appointment. She was nearly
through being diagnosed for her first problem, when she was told her time was
up and the other two issues would have to wait for the next appointment.
Dr. Edwards: Well, I guess that seems logical. We are on a fast
pace to maintain our income.
Dr. Harold: Have you figured out just what is your hourly wage?
Dr. Edwards: The administrator, who leaves at five PM, thinks we
should get paid for a 40-hour week but we work at least 50 hours. So at $12,000
a month, we make about $60 an hour for our 200-hour month.
Dr. Rosen: That's only $15 an hour less that a forklift driver
makes at the Big Three.
Dr. Edwards: But we have a clean air-conditioned job and we're
not out in the heat or snow.
Dr. Rosen: I guess that's one way of looking at it. But it
doesn't measure up professionally. Why should lawyers with four to eight years
less training than doctors, have no difficulty charging $250 to $400 an hour?
Dr. Ruth: But who could stand being on everybody's
"S" list.
Dr. Yancy: For $400 an hour, or $16,000 a week or $800,000 a
year, I wouldn't mind being on anybody's "S" list. That's more every
week than I make every month as a surgeon.
Dr. Harold: You are all making me feel very good that I forsook
your kind of life.
Dr. Dave: So you're making more than when you were part of a
group?
Dr. Harold: I figured that we had a 50 percent markdown by some
of the best insurance companies and Medicare, and even more by HMOs and
Medicaid. By not billing insurance and accepting cash, checks or plastic at the
time of service, I would save the $36,000 that our insurance biller was getting
paid. So I figured if only one-third as many patients would continue with me, I
would make the same income as I did with my group. If I were to get half as
busy, I would make considerable more.
Dr. Edwards: You make a very compelling case for going out on your
own.
Dr. Harold: The other aspect that insurers don't want you to
think about, is if you spend more time with patients, you make less mistakes,
the patients are happier, and your children want to play with you an extra
eight hours a week. That was becoming more important to me.
Dr. Rosen: More time with patients is never looked at with
quality of care in mind. Reminds me of the time when I was recruited by Houston
Diagnostic Clinic when I finished my residency, they allowed one hour for each
new patient and one hour for each follow=up patient. They felt their doctors
probably weren't smarter than the other doctors on the hospital staff, but they
would give them more time to make better decisions since they were a consulting
group and most of their patients had other personal physicians.
Dr. Edwards: I just have a hard time believing that very many
patients would follow me if I charged them $125 an office visit and $200 for a
new-patient consultation.
Dr. Harold: Remember, only one-third have to do that to continue
your same standard of living and when half of them do, you will have 50 percent
more time for your personal life than you have now.
Dr. Michelle: Thank you. You've shed a whole new light on
personalized health care.
Dr. Rosen: I hope we will continue to see you here in the
hospital staff luncheon lounge.
Dr. Harold: Thanks for the invitation. I think you will.
The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.
* * * * *
8. Voices of Medicine: A Review of Local and Regional
Medical Journals
San Mateo County Medical Association Bulletin May-June
2008
Take Two Sugar Pills and
Call Me in the Morning, By Philip R.
Alper, M.D.
Suppose a group of
medications were dirt cheap to produce, had virtually no side effects, and
provided relief to 30 percent of those taking them. And further suppose that
these benefits required no long, costly scientific studies to validate the
medications' effectiveness. Should doctors be allowed to use them?
The miracle drugs I am
describing are placebossham medicineswhose efficacy across a wide range of
symptoms and conditions seems to rest on mobilizing a belief that their use
will prove beneficial. Until a century ago, relatively few commonly used drugs
had scientifically provable utility. Most achieved whatever benefit they
provided through the placebo effect (sometimes called the "healing power
of the mind"), which, while not a panacea, is by any name a surprisingly
powerful force for good.
The prescriber must believe
in what is being prescribed to boost the effectiveness of any medication,
whether it is intrinsically "worthless" or not. Likewise, the patient
must believe in what is being prescribed.
The color, shape, and size of pills and capsules may influence their
effectiveness. Administration by injection may convey an extra measure of
potency that cannot be explained by blood levels or rates of absorption alone.
This is murky territory. Is
it acceptable for physicians to deceive patients by prescribing something they
know has no intrinsic merit? But where
is the actual harm in harnessing a 30-percent placebo benefit, provided
patients do not forgo a more effective treatment? Patients are always free to choose; when the patient's choice is
unwise, how is the physician to respond?
Medical ethicists have tended to avoid these conundrums ever since
Harvard anesthesiologist Henry K.
Beecher published "The Powerful Placebo" in the Journal of
the American Medical Association in 1955. His opening words frame the
dilemma:
"Placebos have
doubtless been used for centuries by wise physicians as well as by
quacks." What is one to make of that proposition?
The placebo
effect touches on many common medical issues. Some analyses suggest that
widely-used cough medicines may help nobody at all. Why, then, have people been
taking them for so long? A recent article in the New England Journal of
Medicine asserts that the selective publication of antidepressant studies
(the most favorable ones were most likely to be printed) exaggerated the
effectiveness of some drugs, thus distorting doctors' and patients'
expectations of their effectiveness. Another recent report, in the Journal
of General Internal Medicine, indicated that almost half of Chicago
physicians surveyed offer placebos to their patientsand just 4 percent let
patients know they're doing it. (Placebos in this case include not only sugar
pills but also drugs that the provider doesn't think are necessary, such as
antibiotics for a viral infection.)
I recently asked two
freshmen medical students what they thought of placebos. The only legitimate
use they knew of was in placebo-controlled drug trials, which compare an actual
medication with an identical-looking sham medication.
Within my own career in
internal medicine, the function of placebos was far broader. In the 1950s, when
I went to medical school, their use was common. Several manufacturers sold
placebo tablets to physicians and pharmacies; patients were not told that the
ingredients were inert. The famed "Kings County Hospital mix" (in
Brooklyn) consisted of powdered charcoal and black pepper in a bitter red
liquid. It sparkled in the light and went straight to the top of your head. One
teaspoon was said to cure anything, probably because nobody wanted another one.
I can attest to its effectiveness in the clinics. I fled from an offer to practice in the 1960s when I discovered
that the office was full of patients getting mostly placebo shots with no
doctor present. This struck me as unsafe, unnecessary, and primarily
financially motivated (interestingly, such practices are found in China today).
Mind
Over Malady . . .
Read the entire article.
To peruse the Bulletin.
This article originally appeared in the Spring 2008
Hoover Digest.
Philip R.
Alper, M.D., is a clinical professor of medicine at the University of California,
San Francisco, and was the Robert Wesson Fellow in Scientific Philosophy and
Public Policy at the Hoover Institution.
VOM Is Where Doctors' Thinking is Crystallized into Writing.
* * * * *
9. Book Review: Inside the AARP by Dale Van Atta
Dale Van Atta wrote a syndicated column with Jack
Anderson that ran in more than 800 newspapers for over seven years. Today, he
is a freelance author and journalist. He dedicates this volume to his aging
mother, Vera Van Atta. We should alert our aging parents, even those under age
50, about this volume and the highly charged promotional campaign of the AARP.
The AARP is the second-largest organization in the
United States, after the Catholic Church. It has thirty-three million members.
Ethel Percy Andrus, a retired schoolteacher, was its founder. Steeped in the
American ethos of God, country, and self-reliance, she explicitly stated that
the "AARP is not a pressure group, petitioning for special privileges
and exemptions because of age and numbers."
Today, the AARP supports higher taxes, disastrous
health care legislation that threatens seniors, and other political causes such
as attempting to defeat property tax reductions, the very thing that allows
many retired seniors to keep their homes. The AARP has numerous business
enterprises, including insurance and pharmaceuticals, that it claims are
nonprofit services for seniors, but which are revenue engines for AARP causes
and profit its business partners. Colonial Penn derives 80% of its profits from
the AARP monopoly.
The AARP, with an income of more than $400 million a
year, spent $83 million for salaries and benefits in 1994. Nineteen of the
AARP's 1,732 employees earn more than $100,000 a year. The executive director,
Horace Deets, is headlined in a 1997 Fortune magazine profile as Washington's
Second Most Powerful Man, making $357,000 a year in salary and benefits
($157,000 more than Washington's Most Powerful Man!) plus $49,000 in expenses.
The block-long office building in DC, which some of its members call a Taj
Mahal, reputedly cost $117 million. And in 1990, the AARP spent more than twice
as much furnishing its posh headquarters than it spent on programs assisting
the elderly.
Dr Ethel Percy Andrus, the founder, first spoke out
against age discrimination in employment more than 30 years ago. The AARP was
instrumental in securing passage of the landmark Age Discrimination in
Employment act in 1967, and its attorneys have initiated or participated in
high-profile class action age discrimination suits. However, this organization,
once run entirely by retired persons, now employs a staff of which 80% are
below the age of 50. Even its own members consider this a shameful practice
that betrays their true commitment.
Not only is there age discrimination in its employment
practices, but there is ethnic discrimination in its membership as well. Only
2% of AARP's members are black, 2% are Hispanic, and 2% are other minorities.
With its members being mostly white, better educated, and richer than the
average, the AARP explains "It's much more expensive to recruit ethnic
groups than it is just your average population."
The AARP is the only lobby so powerful than it can
secure legislation, such as the Medicare catastrophic coverage act, and when
its own membership rebels, secure its repeal. To maintain such clout, each
month the AARP solicits an estimated 40,000 individuals who are too young to
join. To maintain their political and business perspective, AARP can remove
chapter leaders with or without cause, even for taking a stand on a local
political issue without the AARP's approval.
A day of reckoning may be on the horizon. Membership
is dropping at such an embarrassing rate that in a closed-door session in July
1995, the Board agreed that they would multiply the number of households by
1.6, which increased membership by more than 2 million in a single day.
For the innocent elderly who look to the AARP to
defend seniors' interests, Van Atta has a simple message: Your trust has
been betrayed.
This
book review is found at TRUST BETRAYED - Inside the AARP by Dale Van Atta.
To read more book reviews .
. .
To read book reviews topically . . .
* * * * *
10. Hippocrates & His Kin:
Russian Comrade Says the End is Near!
For a decade, Russian academic Igor Panarin has been predicting the U.S.
will fall apart in 2010. Around the
end of June 2010, or early July, he says, the U.S. will break into six pieces
-- with Alaska reverting to Russian control . . . When the going gets tough, he
says, wealthier states will withhold funds from the federal government and
effectively secede from the union . . .
The U.S. will then split along ethnic lines, and foreign powers will
move in . . . "The Californian Republic," will be part of China or
under Chinese influence. . . "The
Central North American Republic" will become part of Canada, and
Washington, D.C., and New York will be part of an "Atlantic America"
that may join the European Union. http://online.wsj.com/article/SB123051100709638419.html?mod=todays_us_page_one
Wishful Thinking,
Comrade!
The New Deal Failed and Prolonged the Depression
In 1939 Franklin D.
Roosevelt's Treasure Secretary, realized that the New Deal economic policies
had failed and stated in his diary: "We have tried spending money. We are
spending more than we have ever spent before and it does not work . . . After eight years of this Administration we
have just as much unemployment as when we started. . . And an enormous debt to
boot!"
Leave the New Deal in the History Books
http://online.wsj.com/article/SB123215398370892313.html?mod=todays_us_opinion
Cut Corporate Taxes To Zero And Create Real
Jobs
. . . the New Deal forced the allocation of money away from the private
sector. As economist Henry Hazlitt wrote back in 1946, New Deal programs
prevented the creation of the types of jobs which have the multiplier effect of
successful businesses. Creating "work" prevented innovation and new
jobs that would create other jobs.
The quickest way to strengthen the credit system and begin the end of this
crisis is to get money into the economy for true job creation, and not into
government work programs. The way to do this is to slash taxes. The U.S.
corporate tax rate, currently the highest in the world, should be cut to 0%
(corporate income would still be taxed, of course, when distributed to
shareholders as dividends).
[The Corporate Income Tax was promised
to be a temporary stopgap measure in 1913 until the 16th Income Tax
Amendment was ratified. However, with Congress and Government, nothing is ever
temporary. Greed knows no Restraints.]
http://online.wsj.com/article/SB123215398370892313.html?mod=todays_us_opinion
The End of
"Freedom of the Press."
The total number of layoffs in American newspapers
alone has topped 15,000 this year, according to Paper Cuts. Columnists and industry
analysts alike now suggest a federal bailout of the press.
Will America
have its own Pravda?
The Cost of Placebos
Patient: (handing the
pharmacist a prescription) "How much is it?" Pharmacist: "That
will be $139.50."
Patient: "How much is the generic?"
Pharmacist: "That would be $39.50."
Patient: "Let me have the placebo. I understand
they are almost as good as the generics."
Read Dr.
Alper in Section 8 as to why they cannot be prescribed any more.
To
read more HHK . . .
To read more
HMC . . .
* * * * *
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 . . .
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.emergiclinic.com. To read more on
Dr Berry, please click on the various topics at his website.
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.
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 2550 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 . . .
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, who has made important efforts in restoring accountability in
health care, has died (1937-2006).
Her obituary is at www.signonsandiego.com/news/obituaries/20060311-9999-1m11cosman.html.
She will be remembered for her
important work, Who Owns Your Body, which is reviewed at 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.
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 . . .
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 . . .
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 . . .
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: Queues cost Canadians
more than $750 million in 2008; more than 30,000 seek treatment abroad. Read more . . . Don't
miss the "AAPS News," written by Jane Orient, MD, and archived
on this site which provides valuable information on a monthly basis. This
month, be sure to read National Health BLITZKRIEG at . . . 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 and
book reviews that can be accessed from the Table of Contents.
* * * * *
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Del Meyer
Del Meyer, MD, Editor & Founder
6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608
Words of Wisdom
We
contend that for a nation to try to tax itself into prosperity is like a man
standing in a bucket and trying to lift himself up by the handle. -Winston Churchill.
The
inherent vice of capitalism is the unequal sharing of the blessings. The
inherent blessing of socialism is the equal sharing of misery. -Winston Churchill.
Some Recent
Postings
Why Sister Aloysius "Doubts" By James J.
Murtagh, M.D, www.healthcarecom.net/JM_Doubts.htm
A
Time for Freedom, by
Lynne Cheney: www.delmeyer.net/bkrev_ATimeForFreedom.htm
We The People
- The Story of Our Constitution, by
Lynne Cheney www.delmeyer.net/bkrev_WeThePeople.htm
In Memoriam
It was with great sadness when I saw in The Economist last week that Dr. Neuhaus had died. I was
referred to him by his Concordia Seminary classmate for assistance in my
Medical Ethics Courses. We have enjoyed and learned much from his Journal,
FIRST THINGS, and perusing his 12,000 word Public Square each month.
Richard John Neuhaus, a turbulent American
priest, died on January 8th, aged 72
WHILE the rest of the world fawned on Barack Obama, Richard
Neuhaus took no joy in him. If Mr Obama truly meant, as he said, to liberalise
abortion rules from his first day in office, Father Neuhaus foresaw an
intensification of the culture wars at every level of American life. But he was
ready to fight his side. For 30 years he had done so in books, manifestos,
studies for the American Enterprise Institute and 12,000-word columns in First
Things, the journal of his own Institute on Religion and Public Life. He
fought his conservative corner in fluent, fervent, gossipy conversations,
smoothed with bourbon and cigars and interrupted by immersion in Bach. George
Bush, among many others, found talking to "Father Richard" on
cloning, or same-sex marriage, superb for clearing the head. And he made his
point even as, day by day, he raised Christ's body at his church on the lower
East Side of Manhattan. For the Eucharist, too, was a "call to
commitment", an "evangelistic" act.
Without Father Neuhaus, the religious right might still have
enjoyed its 20-odd years of ascendancy in American politics. But it would have
lacked much of its intellectual spine. Father Neuhaus, a Lutheran-turned-Catholic
fearsomely well read in both the Church Fathers and the Protestant dissenters,
encouraged evangelicals and Catholics to join forces to fill, with a new moral
philosophy, the empty space at the core of modern American public life. There
was, he wrote in 1984, a "naked public square" from which religion
had been banished, and which "seven demons", all secular, now
competed to control.
The separation of church and state might be enshrined in the
constitution. But Father Neuhaus saw it as impossible in a fundamentally
religious country, whose history had been driven since the Mayflower by
a dynamic conviction of the usefulness of America to the purposes of God. And
by ignoring religion when people were mostly believers, it threatened the
legitimacy of American democracy itself. "Judicial usurpation", was
Father Neuhaus's term for it. He had the Supreme Court in his sights, and much
else. . .
Read the entire obituary
. . .
On This Date in
History - January 23
On this date in 1849, Dr. Elizabeth
Blackwell received the first M.D. awarded to a woman in the United States.
On this date in 1964, the poll tax was
barred in Federal elections in the United States. The
Twenty-fourth Amendment to the Constitution recognized voting as a right, not
simply a privilege.
After Leonard and
Thelma Spinrad
The 6th Annual World
Health Care Congress
Advancing solutions for business and health care CEOs to
implement new models for health care affordability, coverage and quality
Tuesday, April 14 Thursday, April 16, 2009
Marriott Wardman Park Hotel
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Email: amy.wilder@worldcongress.com