1.
Featured Article:
The Unmedicated Mind, WSJ, By NANCY KEATES
2.
In the News:
Government Diversity Program Is Dividing America For Decades
3.
International Medicine: A Story
Michael Moore Didn't Tell By Paul Howard
4.
Medicare: Uninsured
Use Medicare More
5.
Medical Gluttony:
Can we start over?
6.
Medical Myths: It's
the Doctor's
Responsibility That I Keep My Appointment
7.
Overheard in the
Medical Staff Lounge: America Alone
8.
Voices of Medicine:
Why Health Care Reform is Failing - Again by David Gibson,
MD
9.
The Cinema and
Bookshelf: Harry Potter Battles Big Brother, by James Murtagh,
MD
10.
Hippocrates &
His Kin: Just a Notch above SiCKO
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' 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 logan@freestarmovie.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 storiesbut 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.
* * * * *
1. Featured Article: The Unmedicated Mind
[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. . .
Safety Concerns
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.
|
TREATMENT |
WHAT IT IS |
REPORT CARD |
|
Acupuncture |
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. |
|
Craniosacral Therapy |
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. |
|
Valerian |
An herb |
Several studies have reported benefits in reducing
non-specific anxiety symptoms. However, most studies have been small and
poorly designed, and are considered inconclusive. |
|
SAM-e |
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. |
|
5-Hydroxytryptophan |
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.
* * * * *
2.
In the News:
Government Diversity Program Is Dividing America For Decades
Are Americans divided
over diversity? New research suggests diversity weakens civic ties and fosters mutual
distrust, By Jonathan Tilove - Sunday, July 8, 2007, NEWHOUSE NEWS SERVICE
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.
* * * * *
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
* * * * *
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
* * * * *
5.
Medical Gluttony:
Can we start over?
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 be 20
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.]
* * * * *
6. Medical Myths: It's the Doctor's Responsibility That I
Keep My Appointment
Inside Medicine:
Slipping through the cracks: Who is responsible? By Dr. Michael Wilkes - Sac Bee, Saturday, July 7, 2007
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 drwilkes@sacbee.com.
* * * * *
7.
Overheard in the
Medical Staff Lounge: America Alone
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
* * * * *
8.
Voices of
Medicine: Review Of Local and Regional Medical Journals
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 Nϊρez'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.
* * * * *
9. Book/Cinematic Review: Harry Potter Battles Big
Brother
"Order of
the Phoenix" flies into philosophy, civics, religion, ethics; transporting
Potter to new ethereal realms, By James J.
Murtagh, M.D.
(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). www.medicaltuesday.net/bookreviews.asp.
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 Carrι, 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.
* * * * *
10. Hippocrates & His Kin: Just a Notch above SiCKO
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 a several
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.
* * * * *
11. Physicians Restoring Accountability in Medical
Practice, Government and Society: