MEDICAL TUESDAY . NET
Community For Better Health Care
Vol VI, No 8, July 24, 2007
In This Issue:
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' strategy is to release the documentary this summer at about the time when Michael Moore's pro-socialized medicine movie "Sicko" is released. Clements is seeking 200 doctors willing to make a tax-deductible donation of $5K. Clements is also seeking American doctors willing to perform operations for Canadians on wait lists. 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 or to review a trailer, visit www.sickandsickermovie.com or email email@example.com.
Logan Plans To Release The Movie Before The End Of July 2007. He is currently reviewing distribution plans and seeking distributors for various media and territories. Join the e-mail alert list to get first notice of the movie's release date.
SICK AND SICKER is a feature-length movie in currently in post-production that explores the ethics and realities of a government take over of the medical profession.
SICK AND SICKER will investigate whether government intervention in the U.S. medical system is the cause of, or the solution to, our problems and whether Canada is really the health care utopia that politicians tell us it is.
This won't be a dry documentary that will put you to sleep. Logan Darrow Clements will bring the abstract concepts to life in dramatic and surprising ways. If he can show how a monkey with darts can beat the investment return of Social Security then you know it will be a movie you won't forget.
More on Moore: John Goodman, PhD, President of the NCPA, announces that they have a new Michael Moore site: http://sicko.ncpa.org/. At his own site, Michael invites visitors to send him health horror stories—but only about the U.S. system! To add balance, our site has health horror stories about Canada, France and Britain. Read the reviews at http://sicko.ncpa.org/?c=reviews. Read the testimonials at http://sicko.ncpa.org/?c=Testimonials. Read the Rest of the Story by going directly to http://sicko.ncpa.org/?c=The-Rest-of-the-Story.
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[Psychiatrists using massage therapy and meditation while acupuncturists are treating depression? What's next, chiropractor saying, "Let's talk about your back?" Naturopaths treating congestive heart failure?]
Backlash against antidepressants is fueling new interest in alternative treatments. WSJ, By NANCY KEATES , July 13, 2007
From lobotomies with ice picks to early antidepressants that caused brain hemorrhaging, Americans have a complicated and ever-changing approach to treating mental illness. Now, spurred by the growing disenchantment with antidepressants, an increasing number of people are seeking treatment for depression, anxiety and eating disorders from naturopaths, acupuncturists and even chiropractors. At the same time, more traditional psychiatrists are incorporating massage and meditation in their practices.
The treatments go beyond needles and spinal
manipulation. They include Emotional Freedom Techniques -- tapping on the
body's "energy meridians" as the patient thinks about upsetting
incidents -- and craniosacral therapy, which involves a gentle rocking of the
head, neck, spine and pelvis. In cranial electrotherapy stimulation, a
AA-battery-powered device sends mild electrical currents to the brain. (The
procedure has its roots in ancient Greek medicine, when electric eels were
used.) Clinicians are also prescribing supplements like omega-3 fatty acids,
found in fish oil, or amino acids like L-theanine, found in green tea.
To read more, please go to www.medicaltuesday.net/index.asp .
Sarah Spring had been in therapy with a psychiatrist and on the antidepressant Wellbutrin for four years to work through a childhood trauma, but felt she wasn't making any progress. So she went to a naturopath -- a practitioner trained in holistic therapy and alternative treatments like herbal medicine and nutrition. (They attend a four-year naturopathic school -- a bachelor's degree is a prerequisite -- but only 15 states license naturopaths.) After two sessions of Emotional Freedom Techniques, the tapping treatment that is meant to clear emotions and restore balance, Ms. Spring says she doesn't get the same shortness of breath and accelerated heart rate she used to. "It's remarkable," says the Portland, Ore., marketing manager, who just started to decrease her dose of Wellbutrin.
To address the growing interest from professionals, Harvard Medical School's Department of Continuing Education will have three classes on complementary and alternative medicine in psychiatry over the next year, up from one a year since the class was introduced in 2003. David Mischoulon, an assistant professor of psychiatry at Harvard, says doctors who have attended the class report that more patients are asking for alternative treatments -- due to the side effects of antidepressants, as well as a lack of response to the medication. Only about half of patients who take antidepressants respond, he says. "It is time to broaden the horizons," he says. . .
In any one-year period, 9.5% of the population, or about 20.9 million American adults, suffer from a mood disorder, according to the National Institute of Mental Health. A study by the World Health Organization, Harvard University School of Public Health and the World Bank found that by the year 2030, depression will be second only to HIV/AIDS in terms of disability caused world-wide.
A backlash against antidepressants sparked by concerns about their safety, efficacy and side effects is helping drive patients to alternative methods. Some 80% of antidepressants are currently prescribed by primary doctors who often diagnose depression in a 20-minute visit and don't provide accompanying therapy or help manage side effects. . .
In Los Angeles, naturopath Holly Lucille has seen 30% more patients in the past two years whose chief complaint is mental-health-related, while Sara Thyr, a naturopath in Manchester and Concord, N.H., has seen a 20% rise. Margot Longenecker's naturopathy practice in Branford and Wallingford, Conn., now has half of its patients come for anxiety and depression, compared with 25% three years ago.
"Half the time you feel like you have a psychiatric degree more than a chiropractic degree," says Basking Ridge, N.J., chiropractor Jerry Szych, who's seen a 25% rise in patients seeking counseling services over the same period. Columbus, Ohio, chiropractor Ronald Farabaugh says he has seen an increase of 20% over the past three years in those cases.
Melissa Mannon, a 36-year-old photographer in Bedford, N.H., saw psychologists for years about her depression and anxiety. Then she visited a naturopath for help with infertility, and was diagnosed with an intolerance to 90 different foods, including gluten. She changed her diet and within seven months, she got pregnant and most of her anxiety and depression went away, she says. She still sees her naturopath if she's feeling down and to discuss what's happening in her life. "She understands me," says Ms. Mannon.
Some say the extra time and intimacy of the treatments can encourage patients to open up. Naturopath Mark Sanders, who has seen the number of patients coming for mental health rise threefold to about 60% since he started his practice five years ago, says patients tend to open up when he performs craniosacral therapy. (It is meant to ease stress and improve physical movement.) "I've had people tell me stuff they don't tell their therapist," he says. . .
Some critics say the growing interest is, in a sense, a step backwards. As people become frustrated with the shortcomings of new treatments, they become more inclined to try age-old therapies, regardless of whether they've been rigorously tested. The treatment of depression is "a constant succession of hyped theories and overall pathetically little progress," says John Horgan, director of the Center for Science Writings at the Stevens Institute of Technology in Hoboken, N.J. . . .
Evaluating the Treatments
Alternative medical practitioners say the techniques they use depend upon each individual's history. However, there are some common methods for treating depression and anxiety.
WHAT IT IS
Sticking needles in acupoints
The theory is that acupoints along invisible meridians act as channels for the flow of vital energy. Benefits in treating depression are limited; more research is needed.
A gentle rocking massage of the head, neck, spine and pelvis
It's meant to ease stress and improve physical movement. A 1999 study by the British Columbia Office of Health Technology Assessment concluded that the theory is invalid and that practitioners cannot reliably measure results. A 2002 study found no diagnostic reliability.
Emotional Freedom Techniques
Tapping on the body's "energy meridians"
Several studies (including from Queens College in New York) found that it relieved fear in people with phobias of small animals more effectively than deep breathing relaxation. A larger trial subsequently found that EFT had the same effect as a placebo.
Several studies have reported benefits in reducing non-specific anxiety symptoms. However, most studies have been small and poorly designed, and are considered inconclusive.
A chemical sold as a dietary supplement
Found in all human cells, it's thought to increase levels of serotonin and dopamine. In an analysis of 39 unique studies, SAM-e to was found to be more effective than a placebo in reducing depression but no more effective than treatment with antidepressants.
A chemical in a spray or pill
One of the raw materials that your body needs to make serotonin. Some believe that boosting 5-HTP will elevate levels of serotonin, but there's not enough evidence to determine if it is effective and safe. Larger studies than have been conducted to date are needed.
Omega-3 Fatty Acids
Found in fish oil and certain plants
Several studies on its use in depression don't provide enough evidence to form a clear conclusion. One recent study of 20 children between ages 6 and 12, conducted at Ben Gurion University of the Negev in Israel, reported therapeutic benefits in childhood depression.
St. John's Wort
An herbal preparation from the Hypericum perforatum plant
Recent studies suggest the herb is of no benefit in treating major depression of moderate severity. More research is required to determine whether it is effective in treating other forms of depression, according to the National Institutes of Health.
Sources: National Library of Medicine, Mayo Clinic, American Cancer Society
To read the entire report, go to (subscription required) http://online.wsj.com/article_print/SB118428285736265304.html.
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WASHINGTON -- Diversity is strength.
That sentiment has in recent years emerged as an article of faith in American public life.
But research suggests that faith in diversity is being sorely tested. New studies confirm earlier evidence that, at least in the short- to mid-term, diversity weakens civic ties, fostering mutual mistrust and detachment. Beneath all the "happy talk" about diversity, many Americans harbor a deep ambivalence about where it will lead.
"Most everybody says, 'Yes, I'm in favor of diversity and I really like multiculturalism,' but if there's nothing to pull people together they get kind of nervous. And they really can't articulate where to draw the line," said Joseph Gerteis, a sociologist with the University of Minnesota's American Mosaic Project, which is probing how Americans think about questions of diversity and solidarity.
The Mosaic work is complemented by a massive national study by Harvard sociologist Robert Putnam, who reports that in the face of large-scale immigration, many Americans are overwhelmed by diversity. Putnam calls it "socio-psychological system overload."
With stunning regularity, he found Americans in more
diverse locales tending to "hunker down and pull in like a turtle,"
suspicious not just of the new or different, but of everybody.
To read more, please go to www.medicaltuesday.net/news.asp .
"They don't trust their neighbors or shop clerks, they are not as involved in the community," Putnam said. "The only two things that go up as diversity rises are protest marches and TV watching."
These findings are especially striking because of how quickly and completely the value of diversity seemed to take hold in the last two decades.
As Gerteis and Mosaic colleagues Douglas Hartmann and Penny Edgell put it in work published earlier this year: "We are at a crucial and unprecedented moment. Across otherwise deep political and social divisions, Americans have come to appreciate diversity and to explicitly promote it."
In their study, based on a national survey of more than 2,000 respondents conducted in 2003, they found that fewer than 5 percent considered diversity mostly a weakness in American life.
Forty-three percent said it was mostly a source of strength, and 50 percent replied that it was equally a source of strength and weakness.
But that doesn't tell the whole story. The authors note that in school and on the job, Americans are taught to value difference and know by now that a positive reaction to diversity is the "culturally acceptable" answer. Thus even those with strong misgivings may ritually observe that diversity can be a strength.
The authors found disagreement and concern about exactly what diversity means. Many people struggle with their own mixed feelings and worry about disunity.
"Black or white, happy multiculturalist or ambivalent realist, Americans of all stripes see it as a problem if there are simply groups with no national culture to unify them," they write.
Using the same survey to conduct in-depth interviews with respondents in Atlanta, Boston, Los Angeles and Minneapolis-St. Paul, Hartmann and colleague Joyce Bell found that people were often tongue-tied when it came to concretely explaining diversity's value.
They also seemed unable to talk about issues of race and inequality. Here diversity-speak emerges as a kind of "happy talk" in which "racial differences can be simultaneously acknowledged and even celebrated at the very same time that race and its problems are downplayed and disavowed."
America has a lot at stake in its capacity to successfully manage diversity. . .
Ultimately, America has no choice but to contend with diversity, and while Putnam wasn't happy with his findings, he says it is important to confront them.
"People like me who are in favor of a more diverse society don't do ourselves any favor by denying that building a diverse society is a difficult task," he said.
To read the entire research report, go to www.sacbee.com/325/v-print/story/260481.html.
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3. International Medicine: A Story Michael Moore Didn't Tell By Paul Howard, Special to washingtonpost.com's Think Tank Town, Tuesday, July 17, 2007
Michael Moore's "Sicko" is now in national release, chock full of anecdotes and scare stories denigrating American health care in favor of the United Kingdom, Canada and even Cuba. But Moore ignores the fact that our greater commitment to market-driven medical innovation makes miracles possible for patients with the most deadly and rare diseases, like cancer.
Here's one story you won't see in Moore's film: During
the recent NBA playoffs, Derek Fisher, a point guard for the Utah Jazz,
discovered that his daughter Tatum, then 10 months old, was diagnosed with a
rare form of cancer called retinoblastoma. (There are only 350 annual cases of
retinoblastoma in the United States.) Left untreated, the cancer grows on the
retina until it causes blindness and death. Luckily for Tatum and her family,
the U.S. is the global leader in cancer treatment and research
. To read more, please go to www.medicaltuesday.net/intlnews.asp .
Tatum's story is a microcosm of how the United States is revolutionizing cancer treatment. After her diagnosis, Fisher and his family flew Tatum to the world-renowned Memorial Sloan-Kettering Cancer Center in New York, where doctors are testing an experimental procedure that didn't exist even a year ago. At Sloan-Kettering, Dr. David Abramson and his colleague Dr. Pierre Gobin enrolled Tatum in a clinical trial where cancer-killing drugs are injected directly into the eye in an attempt to not only kill the tumor, but to save a child's eyesight. After treatment, Tatum's doctors were optimistic that her prognosis is good.
Think Tatum's story is one of a kind? Think again. America's commitment to the treatment of patients with rare diseases is unmatched. The Orphan Drug Act, passed by Congress in 1983, gives companies tax incentives and seven years of market exclusivity in return for developing treatments for rare diseases. (The FDA designates "orphan" drugs as those that treat diseases affecting fewer than 200,000 American patients annually.) According to the FDA, in the decade before the act passed there were fewer than 10 products approved for orphan diseases; today, there are over 300.
Patients with rare diseases aren't the only ones seeing improvements in treatment. U.S. cancer mortality rates have declined every year since 1991, an unmatched achievement in the developed world. Five year survival rates for breast cancer, if detected early, are over 95%. In January 2007, the American Cancer Society reported that total cancer deaths in the U.S. declined for the second straight year, despite an aging population that is at higher risk for cancer.
How about Europe, where health care is "guaranteed"? In their 2006 book "The Business of Health," researchers Robert Ohsfeldt and John Schnieder report five-year adjusted cancer survival rates for the United States, England, Denmark, France, Germany, Italy, Sweden and Switzerland. For breast, thyroid and cervical cancer in women, and for colon, lung and prostate cancer in men, Ohsfeldt and Schneider reported that U.S. patients have better survival rates than European cancer patients.
Why is the U.S. better? Partly because cancer patients here get faster access to new medicines. In many European countries, companies must engage in lengthy negotiations with government health bureaucrats over prices for new cancer drugs. (Even afterwards, patient access to new medicines may be restricted.)
The absence of price controls means that more cancer drugs are launched here first than anywhere else. The Karolinska Institute in Stockholm recently issued a survey of cancer treatment in 25 countries. The report found that "the [U.S.] has been the country of first launch for close to half of the oncology drugs brought to market in the last 11 years." From 1995-2005, the U.S. had 12 "first launches," compared to two in Germany, four in the U.K., three in Switzerland, and one in France. . .
Moore is right that American health care is in need of reform. But any reforms must maintain market incentives for medical innovation, and we shouldn't accept policies that will inevitably result in rationing health care for the sickest and most vulnerable patients.
American health care isn't perfect, but it's always trying to do better. Tatum's story is a tribute to that commitment, one that we must sustain.
To read the entire report, go to www.washingtonpost.com/wp-dyn/content/article/2007/07/16/AR2007071601391_pf.html.
The writer is a senior fellow at the Manhattan Institute's Center for Medical Progress and editor of Medical Progress Today Online.
Government medicine does not give timely access to healthcare, it only gives access to a waiting list.
--Canada's Supreme Court
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4. Medicare: Previously Uninsured Use Medicare More, NY Times, July 12, 2007, By GINA KOLATA
When uninsured adults with common chronic illnesses became eligible for Medicare, they saw doctors and were hospitalized more often and reported greater medical expenses than people who had had insurance. And their increased use of medical services continued at least until at least age 72, researchers are reporting today.
Their study, published in The New England Journal of Medicine, is one of the first to follow a large group of people through that crucial time of transition from being ineligible for Medicare to receiving Medicare benefits.
Its researchers, led by Dr. John Z. Ayanian, an associate professor of medicine and health care policy at Harvard Medical School, used data from the Health and Retirement Study, a federally financed study that included 9,760 adults who were 51 to 61 in 1992. Dr. Ayanian and his colleagues focused on 5,158 of them who survived to age 65 by 2004 and who either had private insurance or no insurance at all before receiving Medicare.
The participants were interviewed and
surveyed about their health and medical care every two years until 2004. That
allowed the Harvard researchers to ask what happened
when people who had not had insurance suddenly could have their health care
paid for by the federal government.
To read more,
please go to www.medicaltuesday.net/medicare.asp .
The effect that emerged - a surge in the use of health care by those who were previously uninsured - was concentrated in people with cardiovascular disease or diabetes. Those are conditions, the investigators noted, in which treatment can prevent serious consequences that can require extra doctor visits, hospitalizations and expense. In the study, 2,951 of the 5,158 participants had one of those conditions.
When such previously uninsured people became eligible for Medicare, they had 13 percent more doctor visits, 20 percent more hospitalizations, and reported 51 percent greater medical expenditures than those with the same diseases who had had insurance all along.
Although the findings made sense, said Jonathan Skinner, an economist at Dartmouth College, they were not a foregone conclusion. . .
But, economists note, it has to cost more to insure everyone than it does to leave some people out.
"The quick interpretation is, ‘Well this saves money,' but it's a partial savings," said Mark Pauly, a health economist at the Wharton School of the University of Pennsylvania. "You get some money back, but it's still going to cost money." . . .
"Health insurance is supposed to not just prevent the complications of chronic diseases but also to keep you healthier," Dr. McClellan said. "And Medicare historically has not done a very good job of that."
Even now, he said, with expanded screening services, only about half of Medicare beneficiaries avail themselves of them.
Dr. Alan Garber, a health economist at Stanford, also raised the question of how best to expand medical services. Reducing costs, he added, should not be the driving factor.
"There are many good reasons to advocate coverage of the uninsured," Dr. Garber said. "At the top of the list, though, is a belief that coverage expansions can improve health. If they also reduce costs, that is icing on the cake."
To read the entire report, go to www.nytimes.com/2007/07/12/us/12medicare.html?ei=5070&en=9d511e999728776f&ex=1185076800&pagewanted=print.
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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Recently, a new patient came into the office to
establish a medical record. He had brought in a rather large, about a
hundred-page record, which was rather complete. After a complete medical
history, examination, pulmonary testing to determine the extent of his asthma,
and an ECG and CXR, I went over the results with him and his wife, completing
an hour evaluation. He then remarked, "What about the lab?" I pointed
out that we had just gone over his lab and his cholesterol, lipids, liver and
kidney function tests were normal. His glycohemoglobin and blood count and
urinalysis were all normal. But he still wasn't satisfied. He asked,
"Can't we just start over and recheck everything? They only checked my
cholesterol every five years"
To read more,
please go to www.medicaltuesday.net/gluttony.asp .
He was unhappy with the short 20-minute appointments he had received at the world's largest HMO which has the world's largest electronic record system. I pointed out that although we had spent a full hour with his initial appointment, the medical world really deals with appointments of 20-minutes length, whether it was his previous HMO, the VA or private offices. Very few physicians still spend a full hour for an initial office visit. In fact, our future appointments would also be20 minutes. And yes, the graph on my wall indicated that the national recommendation for repeat cholesterol was every five years if they were normal. And his had been normal for the past fifteen years.
He left a very unhappy man. His final retort was, "I thought that when I had my personal private physician, he would check my tests as often as I felt I needed them checked."
When a third party, the insurance carrier, pays the bill, the patient is totally floating in a non-real and irresponsible situation, placing him at odds with his medical advisor and counselor. Only with patient (consumer) directed health care, where the patient is always responsible for a percentage of the bill, will there be an equally strong drive to "Medical Frugality." Then health care costs will be controlled and be reduced to the lowest possible number without any government interference.
[We should replace Consumer Directed Health Care (CDHC) with Patient Directed Health Care (PDHC) since patients do not visualize or consider themselves consumers which for many has a bad connotation.]
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A 51-year-old truck driver went to see a new doctor for a routine exam. The doctor ordered some blood tests for his patient, and a few came back abnormal.
The doctor referred the man to a gastroenterologist for a more extensive evaluation. He went to see the specialist, who ordered additional tests, including a colonoscopy to screen for cancer. Just before the colonoscopy, the man canceled the appointment and never rescheduled.
Two years passed. Suddenly, the man noticed some
rectal bleeding. He no longer held the same insurance, so he went to a new
specialist, who found colon cancer.
To read more,
please go to www.medicaltuesday.net/myths.asp .
The man sued the first intestinal expert, arguing that it was the doctor's responsibility to reschedule the test when the patient failed to show up. The doctor argued that the man was given an appointment for the test, and when he canceled, it became the patient's responsibility to reschedule.
While the facts are not in dispute -- the patient and the doctor agree that he was told about the appointment, that he decided to cancel it and that he failed to follow up -- there is debate about responsibility.
Recently, my son completed a homework assignment but forgot to turn it in the next day. He argued that he had lots on his mind and the teacher should have asked him for the completed assignment. Had we asked the teacher, I suspect the teacher would have argued that it was not his responsibility to figure out who didn't turn in their assignment and track them down. This is the student's responsibility.
Admittedly, the man's situation is far more serious. This man will likely have a far poorer outcome as a result of his cancer not being detected sooner. While lawyers can and do argue about who has the ultimate responsibility for lack of follow-up, it seems that in this case the system failed. No doubt this adult man should have rescheduled his appointment. After all, he was the one who might benefit from the procedure and he was in control of his own daily schedule. . .
To read the entire OpEd article and the outcome, go to www.sacbee.com/107/v-print/story/258642.html.
Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Identifying characteristics of patients mentioned in his column are changed to protect their confidentiality. Reach him at firstname.lastname@example.org.
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Dr. Milton: I just don't understand why we don't just go in and win the war. We won against huge superpowers in two world wars in four years or less, and we can't clean up a regional conflict?
Dr. Michelle: Looks to me like it was a mistake to go in, doesn't it to you?
Dr. Rosen: It
was a Nobel Prize Winning idea to introduce Freedom and Liberty into the
Mideast where they can't handle freedom.
To read more,
please go to www.medicaltuesday.net/lounge.asp .
Dr. Yancy: They've been fighting for 500 years and they will continue fighting in the Mideast for another 500 years and there is nothing we can do about it.
Dr. Rosen: But you have to admit that at the beginning of the last century there were only about 25 countries out of the 190 countries that had freedom and democracy. We're up to about 50 now. Certainly it was grandiose to think we could introduce freedom into the Arab world.
Dr. Yancy: Dream on. They only understand Guns and Killing. They don't just kill their enemies. They even kill their own brothers and sisters. They are not adverse to seeing people kill and be killed.
Dr. Rosen: Are you really saying that it's entirely hopeless to civilize the Mideast?
Dr. Yancy: I visit there every year with my family in Israel. Let them kill each other.
Dr. Michelle: So you're really agreeing with me. I don't understand Milton? Let's just go in and win?
Dr. Milton: We know where the columns of suicide missions come from. When another column comes down and we lose a bunch of troops, our Ambassador in Syria should notify them that we will not tolerate their involvement and, if it happens again, we will level the city from which they came.
Dr. Michelle: Then you will increase the regional nature of the war.
Dr. Milton: I don't think so. When the next suicide mission strikes, we just strike the source and level that city in Syria. Then our Ambassador notifies the Syrian government that we don't like their involvement and they should decease or we will again eliminate the source.
Dr. Michelle: You don't think that they really would, do you?
Dr. Milton: Certainly. After the third city is leveled, Syria will make sure that no suicide missions come from their country.
Dr. Michelle: But maybe they can't stop them?
Dr. Milton: I believe they will make sure that they do so. They don't want to see Damascus leveled. Remember when one Mafia Don tells another Don, if one of your men does that again, we will strike you personally. The Mafia Don never said, "I didn't do it." He'll find who did it and make sure it doesn't happen again to save his own skin.
Dr. Yancy: Now you're talking sense. The only type of sense understood in that part of the world. I agree the war would be over after the third or fourth strike. In less than a week.
Dr. Rosen: Remember this same argument during the Korean War when our president would not allow our generals to eliminate the buildup across the Yalu River for fear of enlarging the war? If we would have eliminated the columns coming from China, Korea would still be unified. Isn't that why we have the problem with North Korea now? There wouldn't have been a country called North Korea if we would have handled the problem expeditiously.
Dr. Yancy: Yes, let the General's finish the war and keep the civilian president from making military decisions that will haunt us for the next 50 or 100 years, assuming the Korean problem resolves by the year 2050.
Dr. Rosen: But the Mideast problem won't resolve in the next 50 years. I think Mark Steyn summed it up very well in his book, America Alone.
Uncle Sam: Y'Know, Vladimir, I'm feeling a bit nostalgic for the times when mutually assured destruction was in more responsible hands.
Vladimir: Yes, then it was called the balance of terror. -Pat Oliphant
* * * * *
Why Health Care Reform is Failing - Again, By David J. Gibson, MD
DESPITE ALL THE CARBON DIOXIDE generated by the tyronic bloviators under the Capitol dome, health care reform is failing once again. At its inception, this round of high-minded reform had many political fathers. There was the Arnold Schwarzenegger Plan, which had no sponsor in the Legislature. Then Speaker Fabian Núñez's plan appeared at trumpeted news conferences. Not to be outdone, Senate President pro Tem Don Perata trotted out his own plan.
Each used apocalyptic arguments and attempted to foment an atmosphere of hysteria to support their proposals. A couple of proposals are still technically alive, but appear to be in a persistent vegetative state. Reform had many fathers, but just as in the past, it will be buried an orphan.
Perhaps this time we can learn some important lessons.
There are nine major contributors to the failure of reform.
To read more,
please go to www.medicaltuesday.net/voicesofmedicine.asp .
The focus was on reforming financing rather than the flawed health care system.
Changing the financing system is not reforming health care. America's health care system is a World War II era construct. Then, surgery in hospitals represented the leading edge of medical technology. Our health care system still performs relatively well when addressing acute episodes of care. But it is ill equipped to address chronic conditions, which now dominate as the baby boomers age.
The result is unsustainable costs related to preventable complications. Redesigning the underwriting system without first redesigning the delivery system is a waste of time and resources. Treating chronic disease on an acuity basis has generated increasing per capita health care spending over the past half century at a rate two to three times faster than per capita gross domestic product (GDP). At its current growth rate, health care spending will consume almost 80 percent of GDP by 2075. As a result, Medicare now has an unfunded liability six times the size of Social Security.1
Furthermore, we are trying to develop financing for yesterday's health care system.
All of the financing reforms sought to preferentially fund yesterday's acuity/invasive/custodial delivery paradigm. These proposals did not account for the transition now taking place. In the dawning genomic era, diagnostic and therapeutic technology will focus on the cellular level. This technology will prioritize the proactive prevention of disease rather than invasively treating the predictable consequences of the disease process in a custodial environment.
Increased public investing in health care will not reduce the level of the uninsured.
In America, health care spending conforms to the laws of gas in thermodynamics. The system will infinitely expand to accommodate increased funding.
Unfortunately, no measurable outcome improvement has ever been demonstrated. For example, state and local government spending on health care delivery increased from $115.9 billion in 1995 to $170.2 billion in 2005.2 That was a 46.9 percent jump, compared to inflation registering 22.4 percent (as measured by the GDP price deflator) over the same period. Total federal health-related spending - including health services, research, Medicare and veteran's health care - during this same period increased from $291.7 billion in 1995 to $577.9 billion in 2005, a 98 percent increase.
Did the number of uninsured decline with this increase in public spending? No, the raw numbers of uninsured increased - from 40.6 million in 1995 to 46.5 million in 2005. As a share of the population, 15.4 percent were uninsured in 1995 versus 15.9 percent in 2005.
Government at all levels is bankrupt.
At the federal level, a recently released report3 demonstrates that our government has already promised $63.675 trillion more in benefits than it will collect in taxes. That figure exceeds the gross value of all assets within the United States by $20 trillion dollars. Just paying for these already promised benefits would require an immediate 14.4 percent tax on all payrolls. America's voluntary based tax system will not survive such an increase. The economy would be driven underground.
The bad news does not stop there. At the state level, we really do not know the extent of current entitlement liabilities. However, conservative estimates indicate the national total could be $1 trillion. Here in California, State Controller John Chiang has estimated the cost of promised health care benefits to state employees over the next three decades. The tab is $47.9 billion.
Chiang's estimate is unrealistically optimistic.4 Using more accepted standards, the Legislative Analyst's Office last year estimated the liability at $70 billion. This covers only state employees. Cities, school districts and community colleges face an additional estimated $90 billion in unfunded health care obligations.
Liabilities of these magnitudes at all levels of government make a new, publicly funded, health care entitlement an unattainable option. . .
Outside of new taxes, no one is willing to pay for reform.
Californians who have health insurance - and who vote - currently pay the lion's share of taxes. They have not bought the argument that they should pay more taxes for coverage of the uninsured. The increasing dissociation between tax payments and benefits received exacerbates the difficulty in selling more taxes.
A recently published study5 found that America's lowest-earning one-fifth of households received roughly $8.21 in government spending for each dollar of taxes paid in 2004. Households with middle incomes received $1.30 per tax dollar, and America's highest-earning households received $0.41. Government spending targeted at the lowest-earning 60 percent of U.S. households is larger than what they paid in federal, state and local taxes. In 2004, between $1.03 trillion and $1.53 trillion was redistributed downward from the two highest income quintiles to the three lowest income quintiles.
Making the case that an ever-decreasing number of taxpayers should pay for their non-taxed brethren is even more difficult in a steeply progressive tax system state like California
The Schwarzenegger proposal incorporates a dubious end run on Prop 13. Five percent "fees" would have been charged to doctors and hospitals. For the health care system, this was a non-starter at its inception.
The health care system does not want reform.
The health care industry wants more money pumped into the existing financing system by third parties. What stakeholders in the industry do not want is fundamental reform and redesign of the system itself. Without new outside funding, the industry opts for the status quo. . . .
Californians do not trust their government to manage the health care system.
At the national level, the inattention to competent management is a long and growing list. These include border security, hurricane Katrina, Iraq, medical care for returning service members - the list stretches on. On the state level, California has been unable to maintain its infrastructure, manage the prison system (which boasts the highest per inmate cost in the nation), educate our children and balance its budget.
Taxpayers long ago concluded their government does not govern. It has become a massive social redistribution organization that is inadequately managed, outrageously expensive and never held accountable for objective outcomes.
To read the entire article with references, go to www.ssvms.org/articles/0707gibson.asp.
* * * * *
the Phoenix" flies into philosophy, civics, religion, ethics; transporting
Potter to new ethereal realms, By James J.
(James Murtagh spent 20 years as an Intensive Care Unit physician. Dr. Murtagh is a member of Semmelweis Society International, and has hosted several Congressional forums on the Healthcare Integrity Project.)
Spoiler alert- Consider seeing the movie before reading this Op Ed .
A funny thing besets Harry Potter on the way to Hogwarts this year. He not only has to battle evil. He has to battle the banality of evil. More importantly, he introduces his viewers to a whole new realm of ideas.
Orwell is the real unseen ghost of "Harry Potter and the Order of the Phoenix". Hogwarts becomes ruled by, a mindless 1984-like bureaucracy, where Ignorance is Bliss, Slavery is the Freedom, and War is Peace. A cold war descends, graying newly bleak walls with Stalinist-type propaganda. The news media becomes a mouthpiece for the corrupt establishment, creating perfect soil for the real evil, Lord Voldemort, to prepare a blitzkrieg. Sure, all wizards and witches are equal, but some are more equal.
The delusional, self-righteous McCarthyite leader of the Ministry of Magic ignores facts, apparently believing he is divinely inspired. Sound familiar? No doubt, future wizards and witches will write term papers on why England slept as the storm gathered.
Even witches conduct witch trials, it
appears. Harry has to appear before a rigged kangaroo court that gives him less
due process than Salem gave witches. Harry is exonerated at the last minute,
but it is clear the witches and wizards persecute their own much more
effectively than normal humans (muggles).
The hidebound in-fighting Kafkaesque establishment preserves its own petty perks and even if they have to torture and or attempt murder students. They ignore the inconvenient truths their world faces. They are, to paraphrase Al Gore and Winston Churchill, passing from an era of procrastination to a time of consequences.
Take the magic out of learning and magic? Only J.K. Rowling could turn such a fiendish feat. Rowling is the genius who brought children to delight in reading, and to re-envision school as a sanctuary, where well scrubbed kids might delight in their old-school ties and don's gowns. But, in an incredible turn, everything is flipped, nothing can be taken at face value, and the children learn more important lessons, including: freedom isn't fee.
Even allies lie to you, possibly to protect you, possibly for a greater good, or because are being themselves used, or possibly for darker reason. Harry enjoys his first kiss, but moments later the girl betrays him Mata Hari-like to the Gestapo-like headmistress. But the girl had been forced to betray him with truth potion. Was the truth potion given by a man trying to help or hurt Harry?
Harry Potter studies more spycraft that witchcraft. The film has the feel of John le Carré, with double and triple agents aching to come in from the cold, some after decades of apparent deep undercover work. True allegiances are deeply hidden. Where lays the ultimate allegiance of Severus Snape? Is Dumbledore a master strategist who could even outwit George Smiley? Harry-and we- do not know who is the puppet and who is the puppetmaster. The final installment of the series is one of the most anticipated in the history of the written word.
To read the entire OpEd Review, please go to www.healthcarecom.net/JM_HarryPotter.htm.
To read other Cinematic Reviews by Dr. Murtagh, go to www.delmeyer.net/CinematicOpEdReviews.htm.
* * * * *
Christopher Caldwell's column, "Healthcare as Horror Movie" in Financial Times (July 7, 2007), states that most viewers of "SiCKO will leave with less understanding of the US healthcare crises than when they arrived.
But won't they leave SiCKER?
To read more,
please go to www.medicaltuesday.net/hhk.asp .
Clive Cookson, also in Financial Times, (July 7, 2007) reports that all week, commentators in Britain have been expressing outraged surprise that doctors, of all people, should have tried to commit mass murder in the cause of jihad. He also reports that several thousand foreign-trained Muslim doctors are working in the NHS, including many distinguished hospital consultants.
But you haven't seen
anything yet. Just wait until the UK and the US catch up with the Netherlands
and Oregon with physician-assisted suicide, then doctors can commit serial
murder - legally. With
thousand doctors committing murder serially, that should have a chilling effect
on the masses - at least on the bodies turning cold.
Nancy Keates reports that Naturopaths use "Emotional Freedom Techniques" that clears emotions and restores balance. She reports on a case that no longer gets short of breath or has a fast heart rate.
Sounds like the beneficial cardiac and pulmonary effects should really decrease health care costs for two of the most expensive specialties.
* * * * *
John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?," go to www.healthplanusa.net/AE-AreYouReallyInsured.htm.
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.
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 . To read the
rest of this section, please go to www.medicaltuesday.net/org.asp . 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. •
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 . Be sure
to read his OpEd article in the VOM section 8 above. •
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 . •
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 . •
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 Sicko is Wacko.
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 in Perspective. Dr. Hurwitz' 25 year sentence was thrown out. Read the details at www.aapsonline.org/nod/newsofday451.php. 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 Is Consumer-Directed HealthCare Safe. 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. www.jpands.org/. There are a number of important articles that can be accessed from the current Table of Contents. Don't miss the excellent Editorial by Dr. Huntoon on I Think, Therefore I'm Well: the Amazing Brain, or the extensive book review section which covers eight great books this month.
Be sure to put the AAPS 64th Annual Meeting to be held on October 10-13, 2007, in Philadelphia/Cherry Hill, NJ, on your planning calendar.
* * * * *
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Del Meyer, MD, Editor & Founder
6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608
Words of Wisdom
Just because you do not take an interest in politics doesn't mean politics won't take an interest in you. -Pericles (430 BC)
Government is like a baby's alimentary canal - with a happy appetite at one end and no responsibility at the other. -Ronald Reagan
What this country needs are more unemployed politicians. -Edward Langley, Artist 1928-1995
Consumerism is the "shame of marketing." -Peter Drucker, the Daily Drucker
Some Recent Postings
Harry Potter Battles Big Brother, by James Murtagh, MD, www.healthcarecom.net/JM_HarryPotter.htm
America Alone, The End of the World as we Know It, by Mark Steyn, reviewed by Del Meyer, MD www.delmeyer.net/bkrev_AmericaAlone.htm
Claudia Alta (Lady Bird) Johnson, first lady and environmentalist, died on July 11th, aged 94
NOVEMBER 22nd 1963 started in drizzle, but soon turned bright. The sun shone on Dallas, the breeze was light, and Lady Bird Johnson enjoyed the drive in the open limousine, even when the Secret Service man thrust her husband down to the floor, even when the car screeched so violently round the corner by the hospital that she feared they would be flung out of it. Looking towards the first limousine, she saw what looked like "a drift of pink blossom" on the back seat. It was Jackie Kennedy lying across her dying husband.
Mrs Johnson saw beauty
even at that moment, when her life turned upside down. It was instinctive; she could
not help it. Her lonely, motherless childhood had been made bearable by roaming
the pinewoods, fields and bayous round Karnack in east Texas, delighting in
magnolia blooms and the first spring daffodils and the touch of Spanish moss
against her face. She found beauty, too, in a marriage to Lyndon Baines Johnson
that seemed to friends, at least for its first 20 years, to be a sojourn in
To read more, please go to www.medicaltuesday.net/org.asp .
She knew he was a handful at first sight: lanky and good-looking, impossibly full of himself and his political ambitions, bossing her about from the first date onwards, rushing her so precipitately into marriage in November 1934 that they had neither a proper ring nor flowers. But he gave her "a queer sort of moth-and-flame feeling", so she followed. The orders continued: to bring him breakfast in bed, to have a hot meal ready whenever he and his congressional cronies came home, to serve him seconds instantly ("Bird, bring me another piece of pie!"). A snap of his fingers, and she would run across the room. A public dressing down for her dowdiness and shyness ("Bird, why can't you look nice, like Connie here?"), and she would take it on the chin. Her unwavering smile would make the house beautiful. Her steadiness would calm Lyndon down. And it was love and orderliness, rather than subservience, that made her lay out his clothes each morning with his pen, filled up, in one suit pocket and his cigarette lighter, filled up, in another, and the cufflinks in the shirt-cuffs, and the shoes shined.
To read the entire obit, go to www.economist.com/obituary/displaystory.cfm?story_id=9507380.
On This Date in History – July 24
On this date in 1908, the FBI was established by Attorney General Charles J. Bonaparte. It did not acquire its Napoleonic complex until some years later.
On this date in 1947, the Department of Defense was established with the Armed Forces unification Act. It recognized that in an era of the totality of war, there had to be one combined overall military command.
On this date in 1953, Fidel Castro led a futile attack on a Cuban Army barracks at Santiago and was captured and sent to prison. But it gave his movement its name and the next time he struck he was more successful.
After Leonard and Thelma Spinrad